Ch. 47 pt 2

Proper Disposal of Diabetes-Related Supplies

• Insulin syringes and pens, needles, and lancets should be disposed of according to local regulations.

• If community disposal programs are unavailable:

  • Utilize puncture-resistant containers.

  • Contact local trash authorities for disposal instructions regarding filled containers; these should not be mixed with recyclable containers.

• Promoting self-care, home-based, and transitional care is essential.

Importance of Patient Education

• Patients should be educated about self-care practices.

• If poor glucose control or preventable complications arise:

  • The nurse must assess reasons for ineffective management of the treatment regimen.

  • Avoid assumptions that issues are solely due to the patient's decision to neglect self-management.

• Possible reasons for ineffective management include:

  • Forgetting to follow the plan or not having learned it properly.

  • Cultural or religious beliefs may interfere with treatment adherence.

  • Correctable issues may arise from a lack of information or understanding.

• Focus of diabetes education should prioritize patient empowerment.

Addressing Patient Needs and Preparing Education

• Patient education should cover the following aspects:

  • Behavior change

  • Self-efficacy

  • Health beliefs

• If knowledge deficit is not the cause, consider:

  • Physical or emotional barriers impairing self-care skills.

  • Personal and work-related priorities that may need assistance in establishing.

• Assess the patient for:

  • Infection

  • Emotional stress (potential to elevate blood glucose levels)

Strategies for Promoting Self-Care Management Skills

• Address underlying factors affecting diabetes control, including:

  • Knowledge deficits

  • Self-care deficits

  • Illness or cognitive function impairments.

• Simplify treatment regimens that are too complex.

• Adjust treatment regimens based on patient requests:

  • Allow flexibility in meal and insulin scheduling.

• Develop personalized plans or contracts with patients involving:

  • Simple, measurable goals.

• Reinforcement should focus on self-care behaviors performed, not only on neglected actions.

• Help patients identify motivating personal factors related to their treatment, allowing for:

  • Pursuit of life goals.

  • Minimizing undue focus on diabetes management.

• Where necessary, involve family and caregivers in education and care plans.

Transitioning and Ongoing Care

• Degree of interaction with primary healthcare providers varies depending on:

  • Age

  • Socioeconomic factors

  • Existing complications

  • Type of diabetes

  • Comorbid conditions

• Patients may be seen by:

  • Home health, community-based, or transitional care nurses for various diabetes management needs.

• All patients should:

  • Schedule visits to primary providers at least twice a year, regardless of glucose control.

  • Participate in routine health promotion activities including:

  • Annual flu vaccinations

  • Age-appropriate health screening protocols.

Self-Injection of Insulin Instruction

1. Preparation:

   • Use one hand to stabilize the skin (spreading or pinching).

   • Hold the syringe like a pencil with the other hand.

2. Injection Process:

   • Insert the needle straight into the skin at a 90-degree angle or as directed (some patients may insert at a 45-degree angle).

   • Push the plunger all the way to inject insulin.

   • Remove the needle directly after injecting.

   • Hold a cotton ball over the site to stop any bleeding for several seconds.

3. Syringe Disposal:

   • Use disposable syringes only once.

   • Place used syringes in a hard plastic container with a tight-fitting lid, in accordance with state regulations.

4. Best Practices:

   • Avoid reusing syringes, especially for patients with poor hygiene or illness.

   • Consider participation in support groups (in-person or online) to help newly diagnosed patients or those adjusting to diabetes management.

Acute Complications of Diabetes

• Three major acute complications arise due to blood glucose imbalances:

  1. Hypoglycemia

  2. Diabetic Ketoacidosis (DKA)

  3. Hyperglycemic Hyperosmolar Syndrome (HHS)

Hypoglycemia

• Defined as blood glucose below 70 mg/dL (3.9 mmol/L).

• Causes include:

  • Excess insulin/oral hypoglycemics

  • Inadequate food intake

  • Increased physical activity

• Symptoms can occur at any time but are frequent before meals.

Characteristics of Hypoglycemia

• Level 1: Mild hypoglycemia (54 - <70 mg/dL)

  • Symptoms: Sweating, tachycardia, tremors, hunger.

• Level 2: Moderate hypoglycemia (<54 mg/dL)

  • Symptoms: Confusion, drowsiness, slurred speech, poor concentration.

• Level 3: Severe hypoglycemia

  • Need for assistance, disorientation, or unconsciousness.

Management of Hypoglycemia

• Immediate treatment involves administering fast-acting carbohydrates.

  • Recommended dose: 15 grams of fast-acting concentrated sugar (e.g., glucose tablets, juice).

  • After initial treatment, follow with a snack that includes starch and protein.

• Educate on prevention strategies:

  • Avoid meal delays

  • Regular intervals between food intake

  • Always carry fast-acting sugar and wear a medical identification bracelet.

Diabetic Ketoacidosis (DKA)

• Abnormal metabolism that leads to ketoacidosis due to the absence of insulin or insufficient treatment.

• Classic presentation involves:

  • Hyperglycemia

  • Ketosis

  • Metabolic acidosis (pH < 7.3)

DKA Management

• Focus on:

  • Rehydration

  • Correcting electrolyte imbalances

  • Continuous insulin infusion.

• Avoid rapid glucose drops during treatment to prevent hypoglycemia.

• Follow diagnostic guidelines for careful electrolyte monitoring, particularly potassium.

Hyperglycemic Hyperosmolar Syndrome (HHS)

• Occurs mainly in older adults, with significant dehydration and hyperglycemia (>600 mg/dL).

• Symptoms include:

  • Neurologic changes like confusion or seizures.

HHS Management

• Similar to DKA; focus on:

  • Fluid rehydration

  • Electrolyte balance

Nursing Process for Diabetes Management

• Comprehensive nursing process includes:

  • Monitoring for arrhythmias via ECG in DKA patients

  • Assessment of hypoglycemia or DKA signs during monitoring

  • Education on self-care skills, compliance, and self-management plan.

Long-Term Complications of Diabetes

• Divided into macrovascular and microvascular complications, affecting various organ systems related to chronic hyperglycemia.

• Macrovascular: Heart disease, stroke, peripheral vascular disease.

• Microvascular: Retinopathy, nephropathy.

Diabetic Retinopathy

• Leading cause of blindness related to diabetes; regular screenings necessary.

• Stages include mild, moderate non-proliferative, severe non-proliferative, and proliferative.

Diabetic Nephropathy

• Chronic kidney disease linked to diabetes; screening for albuminuria and glomerular filtration rate is essential.

Peripheral Neuropathy

• Affects sensation and changes function in lower extremities.

• Management includes blood glucose control to prevent or mitigate symptoms.

Foot Care for Diabetic Patients

• Routine foot examinations and education are essential to prevent ulcers and complications:

  • Daily inspections for injuries

  • Proper hygiene and skin care practices

  • Protective footwear recommendations.

Patient Education on Foot Care

• Educate on key preventive measures:

  • Inspect feet daily

  • Maintain cleanliness, keeping skin dry

  • Use appropriate footwear that fits well.

Transitioning to Community-Based Care

• Coordination of care as patients transition from hospital to home is essential for continued health management. The nurse should assess and reinforce understanding of diabetes management for successful out-of-hospital management.

• Emphasis on personalized care plans and community resources when needed, ensuring ongoing education and support.