ارجو المساعدة بلييييييييييييييييييييييييييز - ملتقى طلاب وطالبات جامعة الملك فيصل,جامعة الدمام

بنت النزهه · #1 2009- 5- 15

السلام عليكم ورحمة الله وبركاتة

ارجوا مساعدتكم يا اعضاء ياحلوين

في (( case study for diabetes mellitus ))
:150:
انا قدرت اسوي جزء منه وبقى لي كم جزء يتضمن

clinical manifestations ( ideal and actual in a table *

nutritional status (ideal and actual in table *

medication (med. name , dose , route , frequancy *
nursing care plan *

nurse_mohammad · 2009- 5- 16

عليكم السلام
سوري على التاخر

Clinical manifestations:
Early
1. Polydipsia, polyuria
2. Fatigue, malaise, drowsiness
3. Anorexia, nausea, vomiting
4. Abdominal pains, muscle cramps
Later
1. Kussmaul respiration (deep respirations)
2. Fruity, sweet breath
3. Hypotension, weak pulse
4. Stupor and coma

NCP :
Nursing Assessment
1. Obtain a history of current problems, family history, and general health history.
A) Has the patient experienced polyuria, polydipsia, polyphagia, and any other symptoms?
B) Number of years since diagnosis of diabetes
C) Family members diagnosed with diabetes, their subsequent treatment, and complications
2. Perform a review of systems and physical examination to assess for signs and symptoms of diabetes, general health of patient, and presence of complications.
A) General: recent weight loss or gain, increased fatigue, tiredness, anxiety
B) Skin: skin lesions, infections, dehydration, evidence of poor wound healing
C) Eyes: changes in visionâ€”floaters, halos, blurred vision, dry or burning eyes, cataracts, glaucoma
D) Mouth: gingivitis, periodontal disease
E) Cardiovascular: orthostatic hypotension, cold extremities, weak pedal pulses, leg claudication
F) GI: diarrhea, constipation, early satiety, bloating, increased flatulence, hunger or thirst
G) Genitourinary (GU): increased urination, nocturia, impotence, vaginal discharge
H) Neurologic: numbness and tingling of the extremities, decreased pain and temperature perception, changes in gait and balance

Nursing Diagnoses
1. Imbalanced Nutrition: More than Body Requirements related to intake in excess of activity expenditures
2. Fear related to insulin injection
3. Risk for Injury (hypoglycemia) related to effects of insulin, inability to eat
4. Activity Intolerance related to poor glucose control
5. Deficient Knowledge related to use of oral hypoglycemic agents
6. Risk for Impaired Skin Integrity related to decreased sensation and circulation to lower extremities
7. Ineffective Coping related to chronic disease and complex self-care regimen

Nursing Interventions
Improving Nutrition
1. Assess current timing and **************************** of meals.
2. Advise patient on the importance of an individualized meal plan in meeting weight-loss goals. Reducing intake of carbohydrates may benefit some patients; however, fad diets or diet plans that stress one food group and eliminate another are generally not recommended.
3. Discuss the goals of dietary therapy for the patient. Setting a goal of a 10% (of patient's actual body weight) weight loss over several months is usually achievable and effective in reducing blood sugar and other ****************bolic parameters.
4. Assist patient to identify problems that may have an impact on dietary adherence and possible solutions to these problems. Emphasize that lifestyle changes should be maintainable for life.
5. Explain the importance of exercise in maintaining/reducing body weight.
A) Caloric expenditure for energy in exercise
B) Carryover of enhanced ****************bolic rate and efficient food utilization
6. Assist patient to establish goals for weekly weight loss and incentives to assist in achieving them.
7. Strategize with patient to address the potential social pitfalls of weight reduction.

Teaching About Insulin
1. Assist patient to reduce fear of injection by encouraging verbalization of fears regarding insulin injection, conveying a sense of empathy, and identifying supportive coping techniques.
2. Demonstrate and explain thoroughly the procedure for insulin self-injection (see page 914).
3. Help patient to master technique by taking a step-by-step approach.
A) Allow patient time to handle insulin and syringe to become familiar with the equipment.
B) Teach self-injection first to alleviate fear of pain from injection.
C) Instruct patient in filling syringe when he or she expresses confidence in self-injection procedure.
4. Review dosage and time of injections in relation to meals, activity, and bedtime based on patient's individualized insulin regimen.

Preventing Injury Secondary to Hypoglycemia
1. Closely monitor blood glucose levels to detect hypoglycemia.
2. Instruct patient in the importance of accuracy in insulin preparation and meal timing to avoid hypoglycemia.
3. Assess patient for the signs and symptoms of hypoglycemia.
A) Adrenergic (early symptoms)â€”sweating, tremor, pallor, tachycardia, palpitations, nervousness from the release of adrenalin when blood glucose falls rapidly
B) Neurologic (later symptoms)â€”light-headedness, headache, confusion, irritability, slurred speech, lack of coordination, staggering gait from depression of central nervous system as glucose level progressively falls
4. Treat hypoglycemia promptly with 15 to 20 g of fast-acting carbohydrates.
A) Half cup (4 oz) juice, 1 cup skim milk, three glucose tablets, four sugar cubes, five to six pieces of hard candy may be taken orally.
B) Nutrition bar specially designed for diabeticsâ€”supplies glucose from sucrose, starch, and protein sources with some fat to delay gastric emptying and prolong effect; may prevent relapse. Used after hypoglycemia treated with fact-acting carbohydrate.
C) Glucagon 1 mg (subcutaneously or I.M.) is given if the patient cannot ingest a sugar treatment. Family member or staff must administer injection.
D) I.V. bolus of 50 mL of 50% dextrose solution can be given if the patient fails to respond to glucagon within 15 minutes.
5. Encourage patient to carry a portable treatment for hypoglycemia at all times.
6. Assess patient for cognitive or physical impairments that may interfere with ability to accurately administer insulin.
7. Between-meal snacks as well as extra food taken before exercise should be encouraged to prevent hypoglycemia.
8. Encourage patients to wear an identification bracelet or card that may assist in prompt treatment in a hypoglycemic emergency.
A) Identification bracelet can be obtained from MedicAlert Foundation International, http://www.medicalert.org.
B) Identification card may be requested from the American Diabetes Association, http://www.diabetes.org.

Improving Activity Tolerance
1. Advise patient to assess blood glucose level before and after strenuous exercise.
2. Instruct patient to plan exercises on a regular basis each day.
3. Encourage patient to eat a carbohydrate snack before exercising to avoid hypoglycemia.
4. Advise patient that prolonged strenuous exercise may require increased food at bedtime to avoid nocturnal hypoglycemia.
5. Instruct patient to avoid exercise whenever blood glucose levels exceed 250 mg/day and urine ketones are present. Patient should contact health care provider if levels remain elevated.
6. Counsel patient to inject insulin into the abdominal site on days when arms or legs are exercised.

Providing Information About Oral Antidiabetic Agents
1. Identify barriers to learning, such as visual or hearing impairments, low literacy, distractive environment.
2. Encourage active participation of the patient and family in the educational process.
3. Teach the action, use, and adverse effects of oral antidiabetic agents.
A) Sulfonylurea compounds promote the increased secretion of insulin by the pancreas and partially normalize both receptor and postreceptor defects. Many drug interactions exist, so patient should alert all health care providers of use. Potential adverse reactions include hypoglycemia, photosensitivity, GI upset, allergic reaction, reaction to alcohol, cholestatic jaundice, and blood dyscrasias.
B) Metformin (Glucophage), a biguanide compound, appears to diminish insulin resistance. It decreases hepatic glucose production and intestinal reabsorption of glucose and increases insulin reception and glucose transport in cells. Many drug interactions exist, so patient should alert all health care providers of its use. Metformin must be used cautiously in renal insufficiency, conditions that may cause dehydration, and hepatic impairment. Potential adverse reactions include GI disturbances, ****************llic taste, and lactic acidosis (rare).
C) Alpha-glucosidase inhibitors (acarbose [Precose] and miglitol [Glyset]) delay the digestion and absorption of complex carbohydrates (including sucrose or table sugar) into simple sugars, such as glucose and fructose, thereby lowering postprandial and fasting glucose levels.
D) Thiazolidinedione derivatives (rosiglitazone [Avandia] and pioglitazone [Actos]) primarily decrease resistance to insulin in skeletal muscle and adipose tissue without increasing insulin secretion. Secondarily, they reduce hepatic glucose production. They should be used cautiously in liver disease and heart failure. Liver function tests should be monitored periodically. Ovulation may occur in anovulatory premenopausal women. Adverse reactions include edema, weight gain, anemia, and elevation in serum transaminases.
E) Meglitinide analogues (repaglinide [Prandin]) and amino acid derivatives (nateglinide [Starlix]) stimulate pancreatic release of insulin in response to a meal. They have a more rapid onset and shorter duration than sulfonylureas. They should not be taken when a meal is skipped or missed. They should be used cautiously in patients with renal and hepatic dysfunction, and may cause hypoglycemia.

Maintaining Skin Integrity
1. Assess feet and legs for skin temperature, sensation, soft tissue injuries, corns, calluses, dryness, hammer toe or bunion deformation, hair distribution, pulses, deep tendon reflexes.
A) Use a monofilament to test sensation of the feet and detect early signs of peripheral neuropathy (see Figure 25-2).
B) Test vibratory sense over interphalangeal joints of the feet using a low-frequency tuning fork. Vibratory sense is typically lost before tactile sensation.
2. Maintain skin integrity by protecting feet from breakdown.
A) Use heel protectors, special mattresses, foot cradles for patients on bed rest.
B) Avoid applying drying agents to skin (eg, alcohol).
C) Apply skin moisturizers to maintain suppleness and prevent *****ing and fissures.
3. Instruct patient in foot care guidelines (see Procedure Guidelines 25-2).
4. Advise the patient who smokes to stop smoking or reduce if possible, to reduce vasoconstriction and enhance peripheral blood flow. Help patient to establish behavior modification techniques to eliminate smoking in the hospital and to continue them at home for smoking-cessation program.

Improving Coping Strategies
1. Discuss with the patient the perceived effect of diabetes on lifestyle, finances, family life, occupation.
2. Explore previous coping strategies and skills that have had positive effects.
3. Encourage patient and family participation in diabetes self-care regimen to foster confidence.
4. Identify available support groups to assist in lifestyle adaptation.
5. Assist family in providing emotional support.

Community and Home Care Considerations
1. A home care or visiting nurse referral can be initiated to follow up on patient education initiated in the hospital or clinic and ensure that the patient has the resources to care for self at home.
2. Patient should be checking fingerstick glucose at home, and glucometer should be checked by home care or clinic nurse periodically to make sure it is properly calibrated and correlates with meter used at clinic or hospital.
3. As long as the home is clean and the patient uses reasonable hygiene, procedures for glucose self-monitoring and insulin injection do not need to be sterile. No alcohol preparation of the skin or insulin vial is needed.
4. Insulin syringes may be reused, so long as the needle is kept clean and no pain or signs of skin irritation develop after multiple use.
5. Although urine glucose testing is no longer recommended to monitor diabetic condition, the patient may benefit from urine ketone testing, especially when ill. Teach the patient how to test urine with ketone test strip and to notify health care provider if ketosis persists.
6. Make sure that all patients have a handy source of glucose for hypoglycemic episodes. A small tube of glossy decorating gel for cakes, easily carried in a pocket or purse, contains about 15 g glucose and can be squirted in the mouth for fast absorption during a hypoglycemic attack.
7. Draw blood work on a fasting basis (no food or fluids other than water for 8 hours) or ensure that patients attend laboratory appointments for drug monitoring.
A) For patients taking thiazolidinediones, serum transaminases (aspartate aminotransferase, alanine aminotransferase) should be monitored every 2 months for a year and then periodically. If levels rise, more frequent monitoring and possibly drug discontinuation will be necessary.
B) Renal function tests (blood urea nitrogen [BUN] and serum creatinine) and urine for microalbumin or microalbumin/creatinine ratio will be monitored periodically.
C) Fasting plasma glucose and glycated hemoglobin are followed regularly.
D) Fasting lipid panel (12 to 14 hours fasting) is done periodically.
8. Address safety issues if patient has hypoglycemic attacksâ€”driving, operating machinery, and exertional activity.

Patient Education and Health Maintenance
1. Ongoing education of patient to include advanced skills and rationales for treatment, prevention, and management of complications.
2. Educational focusâ€”lifestyle management issues, to include sick-day management (see Patient Education Guidelines), exercise adjustments, travel preparations, foot care guidelines, intensive insulin management, and dietary considerations for dining out.
3. For additional information and support, refer to drug manufacturers' Web sites for special programs for diabetics and to agencies, such as American Diabetes Association, Inc., http://www.diabetes.org; and American Dietetic Association, http://www.eatright.org.

Evaluation: Expected Outcomes
1. Maintains ideal body weight with body mass index less than 25
2. Demonstrates self-injection of insulin with minimal fear
3. Hypoglycemia identified and treated appropriately
4. Exercises daily
5. Verbalizes appropriate use and action of oral hypoglycemic agents
6. No skin breakdown
7. Verbalizes initial strategies for coping with diabetes

سوري الدايت و الميديكاشن راح انزله لك بعد ما ارجع من شغلي :)
يعني 1 و نص الليل راح ينزل باذن الله

طخطوخه · 2009- 5- 16

مشكور نيرس محمد

أنت المثل الاعلى في المنتدى

nurse_mohammad · 2009- 5- 17

Diet

nurse_mohammad · 2009- 5- 17

medications :

Oral antidiabetic agents for patients with type 2 diabetes who do not achieve glucose control with diet and exercise only (see Table 25-2).

A) Act by a variety of mechanisms, including stimulation of insulin secretion from functioning beta cells, reduction of hepatic glucose production, enhancement of peripheral sensitivity to insulin, and reduced absorption of carbohydrates from the intestine.
B) Sulfonylureas and meglitinide analogues may cause hypoglycemic reactions.
C) Biguanides, alpha-glucosidase inhibitors, and meglitinide analogues may cause significant flatus and GI adverse effects.

Insulin therapy for patients with type 1 diabetes who require replacement (see Table 25-3, page 920).

A) May also be used for type 2 diabetes when unresponsive to diet, exercise, and oral antidiabetic therapy.
B) Hypoglycemia may result as well as rebound hyperglycemia (Somogyi effect).
C) Commonly results in increased appetite and weight gain.

2009- 5- 16	#2
nurse_mohammad :: مشرف سابق:: منتدى كلية العلوم الصحية بالأحساء الملف الشخصي: رقم العضوية : 16648 تاريخ التسجيل: Sun Dec 2008 العمر: 36 المشاركات: 619 الـجنــس : ذكــر عدد الـنقـاط : 3247 مؤشر المستوى: 72 بيانات الطالب: الكلية: خريج كلية العلوم الصحية بالأحساء التخصص: تمريض المستوى: خريج جامعي	رد: ارجو المساعدة بلييييييييييييييييييييييييييز عليكم السلام سوري على التاخر Clinical manifestations: Early 1. Polydipsia, polyuria 2. Fatigue, malaise, drowsiness 3. Anorexia, nausea, vomiting 4. Abdominal pains, muscle cramps Later 1. Kussmaul respiration (deep respirations) 2. Fruity, sweet breath 3. Hypotension, weak pulse 4. Stupor and coma NCP : Nursing Assessment 1. Obtain a history of current problems, family history, and general health history. A) Has the patient experienced polyuria, polydipsia, polyphagia, and any other symptoms? B) Number of years since diagnosis of diabetes C) Family members diagnosed with diabetes, their subsequent treatment, and complications 2. Perform a review of systems and physical examination to assess for signs and symptoms of diabetes, general health of patient, and presence of complications. A) General: recent weight loss or gain, increased fatigue, tiredness, anxiety B) Skin: skin lesions, infections, dehydration, evidence of poor wound healing C) Eyes: changes in visionâ€”floaters, halos, blurred vision, dry or burning eyes, cataracts, glaucoma D) Mouth: gingivitis, periodontal disease E) Cardiovascular: orthostatic hypotension, cold extremities, weak pedal pulses, leg claudication F) GI: diarrhea, constipation, early satiety, bloating, increased flatulence, hunger or thirst G) Genitourinary (GU): increased urination, nocturia, impotence, vaginal discharge H) Neurologic: numbness and tingling of the extremities, decreased pain and temperature perception, changes in gait and balance Nursing Diagnoses 1. Imbalanced Nutrition: More than Body Requirements related to intake in excess of activity expenditures 2. Fear related to insulin injection 3. Risk for Injury (hypoglycemia) related to effects of insulin, inability to eat 4. Activity Intolerance related to poor glucose control 5. Deficient Knowledge related to use of oral hypoglycemic agents 6. Risk for Impaired Skin Integrity related to decreased sensation and circulation to lower extremities 7. Ineffective Coping related to chronic disease and complex self-care regimen Nursing Interventions Improving Nutrition 1. Assess current timing and ************************** of meals. 2. Advise patient on the importance of an individualized meal plan in meeting weight-loss goals. Reducing intake of carbohydrates may benefit some patients; however, fad diets or diet plans that stress one food group and eliminate another are generally not recommended. 3. Discuss the goals of dietary therapy for the patient. Setting a goal of a 10% (of patient's actual body weight) weight loss over several months is usually achievable and effective in reducing blood sugar and other ************bolic parameters. 4. Assist patient to identify problems that may have an impact on dietary adherence and possible solutions to these problems. Emphasize that lifestyle changes should be maintainable for life. 5. Explain the importance of exercise in maintaining/reducing body weight. A) Caloric expenditure for energy in exercise B) Carryover of enhanced ************bolic rate and efficient food utilization 6. Assist patient to establish goals for weekly weight loss and incentives to assist in achieving them. 7. Strategize with patient to address the potential social pitfalls of weight reduction. Teaching About Insulin 1. Assist patient to reduce fear of injection by encouraging verbalization of fears regarding insulin injection, conveying a sense of empathy, and identifying supportive coping techniques. 2. Demonstrate and explain thoroughly the procedure for insulin self-injection (see page 914). 3. Help patient to master technique by taking a step-by-step approach. A) Allow patient time to handle insulin and syringe to become familiar with the equipment. B) Teach self-injection first to alleviate fear of pain from injection. C) Instruct patient in filling syringe when he or she expresses confidence in self-injection procedure. 4. Review dosage and time of injections in relation to meals, activity, and bedtime based on patient's individualized insulin regimen. Preventing Injury Secondary to Hypoglycemia 1. Closely monitor blood glucose levels to detect hypoglycemia. 2. Instruct patient in the importance of accuracy in insulin preparation and meal timing to avoid hypoglycemia. 3. Assess patient for the signs and symptoms of hypoglycemia. A) Adrenergic (early symptoms)â€”sweating, tremor, pallor, tachycardia, palpitations, nervousness from the release of adrenalin when blood glucose falls rapidly B) Neurologic (later symptoms)â€”light-headedness, headache, confusion, irritability, slurred speech, lack of coordination, staggering gait from depression of central nervous system as glucose level progressively falls 4. Treat hypoglycemia promptly with 15 to 20 g of fast-acting carbohydrates. A) Half cup (4 oz) juice, 1 cup skim milk, three glucose tablets, four sugar cubes, five to six pieces of hard candy may be taken orally. B) Nutrition bar specially designed for diabeticsâ€”supplies glucose from sucrose, starch, and protein sources with some fat to delay gastric emptying and prolong effect; may prevent relapse. Used after hypoglycemia treated with fact-acting carbohydrate. C) Glucagon 1 mg (subcutaneously or I.M.) is given if the patient cannot ingest a sugar treatment. Family member or staff must administer injection. D) I.V. bolus of 50 mL of 50% dextrose solution can be given if the patient fails to respond to glucagon within 15 minutes. 5. Encourage patient to carry a portable treatment for hypoglycemia at all times. 6. Assess patient for cognitive or physical impairments that may interfere with ability to accurately administer insulin. 7. Between-meal snacks as well as extra food taken before exercise should be encouraged to prevent hypoglycemia. 8. Encourage patients to wear an identification bracelet or card that may assist in prompt treatment in a hypoglycemic emergency. A) Identification bracelet can be obtained from MedicAlert Foundation International, http://www.medicalert.org. B) Identification card may be requested from the American Diabetes Association, http://www.diabetes.org. Improving Activity Tolerance 1. Advise patient to assess blood glucose level before and after strenuous exercise. 2. Instruct patient to plan exercises on a regular basis each day. 3. Encourage patient to eat a carbohydrate snack before exercising to avoid hypoglycemia. 4. Advise patient that prolonged strenuous exercise may require increased food at bedtime to avoid nocturnal hypoglycemia. 5. Instruct patient to avoid exercise whenever blood glucose levels exceed 250 mg/day and urine ketones are present. Patient should contact health care provider if levels remain elevated. 6. Counsel patient to inject insulin into the abdominal site on days when arms or legs are exercised. Providing Information About Oral Antidiabetic Agents 1. Identify barriers to learning, such as visual or hearing impairments, low literacy, distractive environment. 2. Encourage active participation of the patient and family in the educational process. 3. Teach the action, use, and adverse effects of oral antidiabetic agents. A) Sulfonylurea compounds promote the increased secretion of insulin by the pancreas and partially normalize both receptor and postreceptor defects. Many drug interactions exist, so patient should alert all health care providers of use. Potential adverse reactions include hypoglycemia, photosensitivity, GI upset, allergic reaction, reaction to alcohol, cholestatic jaundice, and blood dyscrasias. B) Metformin (Glucophage), a biguanide compound, appears to diminish insulin resistance. It decreases hepatic glucose production and intestinal reabsorption of glucose and increases insulin reception and glucose transport in cells. Many drug interactions exist, so patient should alert all health care providers of its use. Metformin must be used cautiously in renal insufficiency, conditions that may cause dehydration, and hepatic impairment. Potential adverse reactions include GI disturbances, ************llic taste, and lactic acidosis (rare). C) Alpha-glucosidase inhibitors (acarbose [Precose] and miglitol [Glyset]) delay the digestion and absorption of complex carbohydrates (including sucrose or table sugar) into simple sugars, such as glucose and fructose, thereby lowering postprandial and fasting glucose levels. D) Thiazolidinedione derivatives (rosiglitazone [Avandia] and pioglitazone [Actos]) primarily decrease resistance to insulin in skeletal muscle and adipose tissue without increasing insulin secretion. Secondarily, they reduce hepatic glucose production. They should be used cautiously in liver disease and heart failure. Liver function tests should be monitored periodically. Ovulation may occur in anovulatory premenopausal women. Adverse reactions include edema, weight gain, anemia, and elevation in serum transaminases. E) Meglitinide analogues (repaglinide [Prandin]) and amino acid derivatives (nateglinide [Starlix]) stimulate pancreatic release of insulin in response to a meal. They have a more rapid onset and shorter duration than sulfonylureas. They should not be taken when a meal is skipped or missed. They should be used cautiously in patients with renal and hepatic dysfunction, and may cause hypoglycemia. Maintaining Skin Integrity 1. Assess feet and legs for skin temperature, sensation, soft tissue injuries, corns, calluses, dryness, hammer toe or bunion deformation, hair distribution, pulses, deep tendon reflexes. A) Use a monofilament to test sensation of the feet and detect early signs of peripheral neuropathy (see Figure 25-2). B) Test vibratory sense over interphalangeal joints of the feet using a low-frequency tuning fork. Vibratory sense is typically lost before tactile sensation. 2. Maintain skin integrity by protecting feet from breakdown. A) Use heel protectors, special mattresses, foot cradles for patients on bed rest. B) Avoid applying drying agents to skin (eg, alcohol). C) Apply skin moisturizers to maintain suppleness and prevent ***ing and fissures. 3. Instruct patient in foot care guidelines (see Procedure Guidelines 25-2). 4. Advise the patient who smokes to stop smoking or reduce if possible, to reduce vasoconstriction and enhance peripheral blood flow. Help patient to establish behavior modification techniques to eliminate smoking in the hospital and to continue them at home for smoking-cessation program. Improving Coping Strategies 1. Discuss with the patient the perceived effect of diabetes on lifestyle, finances, family life, occupation. 2. Explore previous coping strategies and skills that have had positive effects. 3. Encourage patient and family participation in diabetes self-care regimen to foster confidence. 4. Identify available support groups to assist in lifestyle adaptation. 5. Assist family in providing emotional support. Community and Home Care Considerations 1. A home care or visiting nurse referral can be initiated to follow up on patient education initiated in the hospital or clinic and ensure that the patient has the resources to care for self at home. 2. Patient should be checking fingerstick glucose at home, and glucometer should be checked by home care or clinic nurse periodically to make sure it is properly calibrated and correlates with meter used at clinic or hospital. 3. As long as the home is clean and the patient uses reasonable hygiene, procedures for glucose self-monitoring and insulin injection do not need to be sterile. No alcohol preparation of the skin or insulin vial is needed. 4. Insulin syringes may be reused, so long as the needle is kept clean and no pain or signs of skin irritation develop after multiple use. 5. Although urine glucose testing is no longer recommended to monitor diabetic condition, the patient may benefit from urine ketone testing, especially when ill. Teach the patient how to test urine with ketone test strip and to notify health care provider if ketosis persists. 6. Make sure that all patients have a handy source of glucose for hypoglycemic episodes. A small tube of glossy decorating gel for cakes, easily carried in a pocket or purse, contains about 15 g glucose and can be squirted in the mouth for fast absorption during a hypoglycemic attack. 7. Draw blood work on a fasting basis (no food or fluids other than water for 8 hours) or ensure that patients attend laboratory appointments for drug monitoring. A) For patients taking thiazolidinediones, serum transaminases (aspartate aminotransferase, alanine aminotransferase) should be monitored every 2 months for a year and then periodically. If levels rise, more frequent monitoring and possibly drug discontinuation will be necessary. B) Renal function tests (blood urea nitrogen [BUN] and serum creatinine) and urine for microalbumin or microalbumin/creatinine ratio will be monitored periodically. C) Fasting plasma glucose and glycated hemoglobin are followed regularly. D) Fasting lipid panel (12 to 14 hours fasting) is done periodically. 8. Address safety issues if patient has hypoglycemic attacksâ€”driving, operating machinery, and exertional activity. Patient Education and Health Maintenance 1. Ongoing education of patient to include advanced skills and rationales for treatment, prevention, and management of complications. 2. Educational focusâ€”lifestyle management issues, to include sick-day management (see Patient Education Guidelines), exercise adjustments, travel preparations, foot care guidelines, intensive insulin management, and dietary considerations for dining out. 3. For additional information and support, refer to drug manufacturers' Web sites for special programs for diabetics and to agencies, such as American Diabetes Association, Inc., http://www.diabetes.org; and American Dietetic Association, http://www.eatright.org. Evaluation: Expected Outcomes 1. Maintains ideal body weight with body mass index less than 25 2. Demonstrates self-injection of insulin with minimal fear 3. Hypoglycemia identified and treated appropriately 4. Exercises daily 5. Verbalizes appropriate use and action of oral hypoglycemic agents 6. No skin breakdown 7. Verbalizes initial strategies for coping with diabetes سوري الدايت و الميديكاشن راح انزله لك بعد ما ارجع من شغلي :) يعني 1 و نص الليل راح ينزل باذن الله

2009- 5- 16	#3
طخطوخه أكـاديـمـي نــشـط الملف الشخصي: رقم العضوية : 18913 تاريخ التسجيل: Tue Jan 2009 المشاركات: 146 الـجنــس : أنـثـى عدد الـنقـاط : 100 مؤشر المستوى: 63 بيانات الطالب: الكلية: كلية العلوم الصحيه بالاحساء	رد: ارجو المساعدة بلييييييييييييييييييييييييييز مشكور نيرس محمد أنت المثل الاعلى في المنتدى
	التعديل الأخير تم بواسطة طخطوخه ; 2009- 5- 16 الساعة 06:45 PM

2009- 5- 17	#4
nurse_mohammad :: مشرف سابق:: منتدى كلية العلوم الصحية بالأحساء الملف الشخصي: رقم العضوية : 16648 تاريخ التسجيل: Sun Dec 2008 العمر: 36 المشاركات: 619 الـجنــس : ذكــر عدد الـنقـاط : 3247 مؤشر المستوى: 72 بيانات الطالب: الكلية: خريج كلية العلوم الصحية بالأحساء التخصص: تمريض المستوى: خريج جامعي	رد: ارجو المساعدة بلييييييييييييييييييييييييييز Diet

2009- 5- 17	#5
nurse_mohammad :: مشرف سابق:: منتدى كلية العلوم الصحية بالأحساء الملف الشخصي: رقم العضوية : 16648 تاريخ التسجيل: Sun Dec 2008 العمر: 36 المشاركات: 619 الـجنــس : ذكــر عدد الـنقـاط : 3247 مؤشر المستوى: 72 بيانات الطالب: الكلية: خريج كلية العلوم الصحية بالأحساء التخصص: تمريض المستوى: خريج جامعي	رد: ارجو المساعدة بلييييييييييييييييييييييييييز medications : Oral antidiabetic agents for patients with type 2 diabetes who do not achieve glucose control with diet and exercise only (see Table 25-2). A) Act by a variety of mechanisms, including stimulation of insulin secretion from functioning beta cells, reduction of hepatic glucose production, enhancement of peripheral sensitivity to insulin, and reduced absorption of carbohydrates from the intestine. B) Sulfonylureas and meglitinide analogues may cause hypoglycemic reactions. C) Biguanides, alpha-glucosidase inhibitors, and meglitinide analogues may cause significant flatus and GI adverse effects. Insulin therapy for patients with type 1 diabetes who require replacement (see Table 25-3, page 920). A) May also be used for type 2 diabetes when unresponsive to diet, exercise, and oral antidiabetic therapy. B) Hypoglycemia may result as well as rebound hyperglycemia (Somogyi effect). C) Commonly results in increased appetite and weight gain.

المواضيع المتشابهه
الموضوع	كاتب الموضوع	المنتدى	مشاركات	آخر مشاركة
تخصصات كلية الاداب ارجو المساعدة	ماتيلدا	منتدى كلية الآداب بالدمام	9	2009- 5- 17 10:47 AM
ارجو المساعدة	ام نور	منتدى معاهد شركة هجر للتعليم و التدريب التقني	1	2009- 4- 12 03:56 AM
الجدول للسنة التحضيرية ( ارجو المساعدة )	دانيال احمد	منتدى كلية الجبيل الصناعية	9	2009- 2- 19 05:46 PM
اختبار تحديد المستوى كلية الجبيل ( ارجو المساعدة)	دانيال احمد	منتدى كلية الجبيل الصناعية	2	2009- 2- 6 06:33 PM

الذين يشاهدون محتوى الموضوع الآن : 1 ( الأعضاء 0 والزوار 1)