Diabetes Mellitus

Ok friend please copies artkel this is about Askep Diabetes Mellitus (Dm) complete, the student is important Akper essence of nursing, just deh to the point:

A. Definition

Diabetes Mellitus is a state of chronic hyperglycemia with various metabolic disorders due to hormonal disturbances that cause chronic complications of the eyes, kidneys, nerves, and blood vessels, accompanied by lesions in the basal vessels in the examination by electron microscopy. (Arif Mansyoer, 1997: 580)

Diabetes Mellitus is a chronic disease involving abnormalities in the complex metabolism of carbohydrates, protein and fat and the development of macrovascular complications, microvascular and neurological. Diabetes Mellitus is classified as an endocrine or hormonal disease because the picture of the production or use of insulin (Barbara C. Long, 1996:4)

Diabetes Mellitus is a syndrome caused by an imbalance between demand and supply of insulin. This syndrome is characterized by hyperglycemia and associated with abnormalities, metabolism of carbohydrates, fats and proteins. Abmormalitas metabolic leads to the development of specific forms of kidney complications, ocular, and cardiovascular neurogenic (Hotma Rumoharba, Skp, 1997).

Diabetes Mellitus is a disease hereditary (inherited) form of recession genetically caused metabolic disorders KH relative or absolute insulin deficiency that may arise at any age with symptoms of hyperglycemia, glycosuria, polyuria, polidipsi, general weakness and weight loss.

Aetiological classification DM American Diabetes Association (1997) as recommended by Society of Endocrinology Indonesia (PERKENI) are:

1. Diabetes type 1 (beta cell destruction, usually leading to absolute insulin deficiency):

a. Autoimmune

b. Idiopathic

2. Diabetes type 2 (varying from mainly predominant insulin resistance with relative insulin deficiency to a defect in insulin secretion, especially with insulin resistance).

3. Other types of diabetes

a. Genetic defects of beta-cell function:

1) Maturity Onset Diabetes of the Young (MODY) 1,2,3

2) mitochondrial DNA

b. Genetic defects of insulin

c. Exocrine pancreatic disease

1) Pancreatitis

2) Tumor / pankreatektomi

3) Pankreatopati fibrotakalkus

d. Endokrinopati: acromegaly, Cushing's syndrome, pheochromocytoma, and hipertiroidism.

e. Because the drugs / chemicals

1) Vacor, pentamidine, nicotinic acid

2) Glucocorticoids, thyroid hormone

3) thiazides, dilantin, interferona, etc..

f. Infections: Congenital rubella, cytomegalovirus

g. Causes of immunology yanng rare: antibody antiinsullin

h. Other genetic syndromes associated with DM yanng: down syndrome, kllinefelter syndrome, Turner syndrome, etc..

4. Gestational Diabetes Mellitus

B. Etiology

Insulin Dependent Diabetes Mellitus (IDDM) or Diabetes Mellitus Insulin Depends (DMTI) caused by the destruction of islet beta cells lengerhands due to an autoimmune process. While Non Insulin Dependent Diabetes Mellitus (NIDDM) or Not Dependent Diabetes Mellitus Insulin (DMTTI) due to the relative failure of beta cells and insulin resistance.

C. Pathophysiology

Because of the aging process, lifestyle, infection, heredity, obesity and pregnancy can cause insulin deficiency or insulin ineffective so so that permeability disturbances of glucose in the cell.

In addition it can also be caused due to acute excess thyroid hormone, prolactin and growth hormone can lead to increased levels of glucose darah.peningkatan hormone - hoormon in the long run, especially in regard diabetogenic growth hormone (causing diabetes). Hormone - the hormone insulin stimulates excessive spending by the islet beta cells lengerhans paankreas, so eventually decline innsulin cell response and an impaired liver in processing glukoosa into glycogen or glikogenesis process the blood sugar levels will increase.

And when it came glucosuria renal threshold through which menybebkan increased volume of urine, thirst and the simulated patient will drink water in large amounts (polidipsi) because glucose is lost with urine, then there ekhilangan calories and starvasi seeluler, kyak eat and people are often eating ( polifagi).

Hyperglycemia causes increased levels of sugar in the sweat, the sweat evaporates, sugars accumulate in the skin and cause irritation and itching - itching. Hyperglycemia due to a buildup of glucose in the cells that damage the capillaries and cause to be peningkaatan sarbitol menyebabkann endothelial dysfunction. Leakage sclerosis causes the disorder - disorder in the arteries and kepiler.

Hyperglycemia due to accumulation and thickening of the basement membrane glycoprotein that impaired capillary perfusion that will menyebebkan disorder that affects the tissue down the kidneys, eyes, lower legs, nerves. (Elizabeth J. Corwin, 2001)

D. Clinical Manifestations

1. Polyuria

2. Polydipsia

3. Polyphagia

4. Weight loss

5. vulvular pruritus, fatigue, visual disturbances, sensitive excitatory and muscle cramps (electrolyte disturbances and the occurrence of complications of atherosclerosis).

Other symptoms complained yangmungkin in patients are tingling, itching, blurred eyes and impotaansi in men. (Mansjoer, 1999)

E. Chronic Symptoms

Chronic Symptoms of Diabetes Mellitus

Sometimes-kadng patients suffering from Diabetes Mellitus showed no symptoms of acute (sudden), but these patients showed gajala after a few months or a few months mengiap DM disease. This phenomenon is called chronic or chronic symptoms, while chronic symptoms that often arises is:

- Tingling

- Skin feels hot (medangen) or as terusuk needle

- Pain in the skin so thick that seeehingga berrjalan as on a pillow or mattress

- Cramps

- Easy mengntuk

- Accomplished

- Eyes blurred, replace the glass usually seeing eye

- Itching around the genitals, female pda terrutama

- Dental mudaah off shaky daaan mudaah

- Kemempuan decreased sexual or even impotent

- Terjaddi barriers to growth in children

(Tjokro Prawito, 1997)

The high-risk groups that facilitate the disease diabetes mellitus are:

- A group at high risk for diabetes mellitus

- Older adult age group (over 40 years)

- Obesity

- High blood pressure

- A family history of DM

- A history of diabetes in pregnancy

- History of pregnancy with weight 4 kg baby born

- A history of viral infectious diseases, such as viral morbili

- A long history of taking drugs or injections of corticosteroid group.

(Tjokro Prawito, 1997)

F. Examination Support

•  Blood Glucose: increased by 200 - 100 mg / dl, or more
•  plasma Acetone (ketone): a strikingly positive
•  Free fatty acids: increased levels of lipid and cholesterol
•  serum osmolality: menngkat but usually less than 330 m Osm / l
•  Sodium: may be normal, increased or decreased

Potassium: normal or elevated false (cell migration), will further decrease

Phosphorus: more often decreased.

•  glycosylated hemoglobin: menngkat levels 2-4 fold
•  Arterial blood gas: usually indicates a low pH and a decrease in HCO3 (metabolic acidosis) with compensated respiratory alkalosis.
•  Blood Platelets: Ht may increase (dehydration), leukocytosis, hemokonsentraasi a response to stress or infection.
•  U + / creatinine: may be elevated or normal (dehydration / renal impairment)
•  blood amylase: possible increased which indicates acute pancreatitis as the cause of Diaabetes mellitus (diabetic ketoacidosis)
•  ttiroid function tests: increased activity of thyroid hormones can menongkatkan blood glucose and insulin will need
• Urine: sugar and asetan positive, specific gravity and osmolality may increase.
•  Culture and sensitivity: the possibility saaluran urinary infections, respiratory infections, and wound infections.

G. Medical Management

The main purpose to regulate blood glucose and prevent acute and chronic complications. If the patient has successfully overcome the diabetes, he will avoid hyperglycemia and hypoglycemia.

Medical management in patients with diabetes mellitus depends on the accuracy of the interaction of three factors:

 Physical Activity

 diit

 pharmacological intervention with oral hypoglycemic agents or insulin preparations.

Planned interventions for diabetes should be individualized, must be based on objective, age, lifestyle, nutritional needs, maturation, activity level, occupation, type of diabetes patients and the ability to independently perform the skills required by the management plan.

The initial goal for patients newly diagnosed with diabetes or patients with poor control of diabetes should be focused on the following:

 Elminasi ketosis, if there

 Achieving the desired body weight

 Prevention manifestation of hyperglycemia

 Maintenance of psychosocial well-being

 Maintenance of exercise tolerance

 Prevention of hypoglycemia

Management of Hypoglycemia:

a. Stadium beginning (realized):

 Provide pure sugar 30 grams (2 tablespoons) or syrup / candy gulamurni (not a sweetener instead of sugar or sugar diet / sugar diabetes) and carbohydrate foods bearer

 Stop hypoglycemic drugs while, check blood glucose during

b. Advanced (hypoglycemia commas):

 Handling should be fast

 Provide 40% dextrose solution as much as 2 flakon through every vein blood glucose within normal values ​​or above normal with blood glucose monitoring

 If hypoglycemia is not resolved, give anatagonis insulin such as adrenaline, high doses of cortisone, or glucagon 1 mg intravenous / intramuscular

 Monitoring of blood glucose levels.

I. Complication

a. Acute

 Comma hypoglycemia

 Ketoacidosis

 hyperosmolar coma nonketotik

b. Chronicle

 makroangiopati, menegnai large blood vessels, blood pembukluh heart, peripheral blood vessels, cerebral vascular

 microangiopathic, tiny blood mengenaipembuluh, retino diabetic, diabetic nephropathy

 Diabetic Neuropathy

 Vulnerable infections, such as pulmonary tuberculosis, gingivitas, and urinary tract infections

 Diabetic Foot.

CHAPTER II

NURSING CONCEPTS

A. Assessment

1. History

 General Information:

 Age

 Sex

 BB before and after illness

 TB

 If the client has been diagnosed

 The specific symptoms

 When gejalan appears

 diabetes medications: name, how long, how the injection of RX. Drug

 Type stressors: work, home or family, other penyaakit

 Type of monitoring: blood, urine

 Training Program: type

 health history and past

 Family history: diabetes, heart disease, stroke, obesity, history of lahhir death, birth, babies 9 months

 current health history:

 view double escape

 "Cramp" feet on the street and at rest when uncomfortable

 At the extremities feel: numbness, discoloration, cold, tingling, pain.

 If there is diarrhea: fekol incontinence, when the

 Is there a revenue problem

 Is there a revenue problem: urine left in vesicaurinaria cause a feeling of fullness that aba

 Concern clients and families: the hope and the need special

2. Physical examination

•  Level of consciousness → client orientation in response to stimulation
• Vital Signs: N, S, TD, P, breath odor of acetone
•  manifestations of complications: retinopathy signs → ophtamoncopic
•  skin temperature, weak pulse (posterior tibial and dorsalis pedia)
•  Sensation: blunt and sharp
•  Reflex

c. Psikososia

1.  description of her clients before the diagnosis and current perceptions.
2.  When the client's ability to perform the duties and functions
3.  Interaction with the client's other family members and people in work and school
4.  When Kien feel more stress
5.  Suport and service people around
6.  Depression feels loss of function, independence and control.

d. Laboratory

•  Serum electrolytes (K and Na)
•  Blood Glucose
•  BUN and serum cretinin
•  microalbuminuria
•  Glycosylated hemoglobin (HbA1c)
•  PH value and PCO2

B. Nursing Diagnosis

1. Lack of fluid volume

Can relate to: osmotic diuresis (from hyperglycemia), excessive loss of gastric, diarrhea, vomiting, limited input, nausea, mental mess.

Possible evidenced by: increasing the output of urine, urine dilute. Weakness, thirst, sudden weight loss, skin / dry mucous membranes, poor skin turgor, hypotension, tachycardia, slowed capillary refill.

Expected results /

Criteria for evaluation of patients will: Demonstrate adequate hydration evidenced by stable vital signs, peripheral pulses can be palpated, skin turgor and capillary refill is good, proper urine output individually, and electrolyte levels within normal limits.

Collaboration

•  Provide treatment in accordance with the indications:
•  Normal saline or half normal saline with or without dextrasa
•  Albumin, plasma or dextran.

R / - The type and amount of liquids depends on the degree of lack of fluids and individual patient response.

- Plasma Expanders (substitute sometimes needed if shortages threaten the life or blood pressure).

 Install or maintain urinary catheter left in place

R / Provide precise or accurate measurement to measurement of urine output, especially if the cause autonomic neuropathy bladder (urinary retention or incontinence).

 Provide potassium or other electrolytes intravenously or through appropriate indications.

R / Potassium should be added to the intravenous (soon to inadequate flow) to prevent hypokalemia.

Actions / Interventions

•  Monitor TTV, note any changes in orthostatic blood pressure.
• R / Hypovolemia can be manifested by hypotension and tachycardia.
•  Temperature, skin color, or humidity.
• R / Although fever, chills, and diaphoresis are common in the infection process, fever with skin redness, dry perhaps as a reflection of dehydration.
• Assess the changes in mental / sensory
• R / mental changes may be associated with high glucose or low (hyperglycemia), electrolyte abnormalities, acidosis, decreased cerebral perfusion and the development of hypoxia.

2. Nutrition, changes: less than body requirements.

Can relate to: Insufficient insulin (decrease glucose uptake and utilization by the tissues resulting in increased metabolism of protein or fat).

Peenurunan oral input: anorexia, nausea, stomach full, abdominal pain, change in consciousness.

Hipermetabolisme Status: release of stress hormones (eg epinfrin, cortisol and growth hormone), infectious processes.

Possible evidenced by: Report input is inadequate, lack of interest in food. Weight loss, weakness, fatigue, poor muscle tone, diarrhea.

Expected results / criteria

Evaluation of patients will: Digesting the amount of calories or nutrients right shows the energy levels.

BB demonstrating stable or addition to the usual range / desired with normal laboratory values.

Collaboration

 Make checks blood sugar using a "finger stiek"

R / Analysis circumstances in bed for more accurate blood sugar (indicating the current state examination) than watching the sugar in the urine (reduced urine were not accurate enough to detect fluctuations in blood sugar levels.

 Provide glucose solution, such as dextrose and half normal saline.

R / glucose solution was added after insulin and blood sugar liquids carrying approximately 250 mg / dl.

 Perform diit expert consultation.

R / Very useful in the calculation and adjustment nitrisi diit to meet the needs of patients.

Actions / Interventions

 Determine the diet and diet program patients and compare it with foods that can be spent on patients.

R / Identify deficiencies and deviations from therapeutic needs.

 Auscultation bowel sounds, note the presence of abdominal pain / abdominal bloating, nausea, vomit food that has not had time to digest, maintain a state of fasting according to indications.

R / hyperglycemia and disorders of fluid and electrolyte balance may decrease mobility or function of the stomach (or Ilius paralytic distension) that will influence the choice of interventions.

 Identify the preferred or desired foods including ethnic or cultural needs.

R / If the food that the patient can be included in the digestion of food, this cooperation can be sought after home.

BB  Weigh every day or according to indications.

R / Assessing adequate food intake (including absorption and utilization).

3. Infection, High risk (Sepsis)

Risk factors include: high blood sugar, decreased leukocyte function, perrubahan in circulation, existing respiratory infections or UTI seebelumnya.

Possible proved by: (can not be applied: the tendaa-signs and symptoms - symptoms make actual diaknosa)

It is expected that / criteria

Evaluation of patients will: mengidentivikasi menceegah or interventions to reduce the risk of infection. Demonstrating techniques, lifestyle changes to prevent infeeksi.

Collaboration

 Perform tests in accordance with the culture and ssensitifitas indication

R / to identify organisms that can select / provide the best anti-biotic therapy.

 Provide appropriate antibiotics

R / initial treatment can help prevent the onset of sepsis.

4. Fatigue

Can be attributed to: a decrease in metabolic energy production, changes in blood chemistry: insulin insufficiency, increased energy demand: status hieper metabolic / infection.

Possible proved by: excessive lack of energy, inability to retain its usual routine, penutunan performance, a tendency to crash.

Results are expected to / criteria

Evaluation of patients will: reveal peeningkatan energy levels, indicating improved ability to participate in the desired activity.

Actions / Interventions

 Discuss with the patient the need for activity

R / education apat provide motivation for passien meninkatkan although activity levels may be very tired.

 Provide an alternative activity with periods of adequate rest / without bother.

R / prevent excessive fatigue.

 Monitor pulse, blood pressure and respiratory frequency before Atua after doing the activity.

R / indicates aktivitass level that can be tolerated physiologically.

 Increase the participation of patients in performing activities of daily living according to Degnan in tolerance

R / increased confidence / self-esteem in a positive corresponding to the level of activity in the patient's tolerance.

5. Less Knowledge (Needs Beljar) Know Your Disease, Proknosis and Treatment Needs.

Can be attributed to: lack of exposure / recall misinterpretation of information.

Possible proved by: a question or request information, express masalah.ketidakakuratan follow the instructions of complications that can be prevented.

Results are expected to / criteria

Evaluation of patients will: express understanding of the disease. Identify relationships signs or symptoms of the disease process dn Degnan linking symptoms with causes. Correctly perform necessary procedures and explain the rationale for the action. Make lifestyle changes and treatment programs in carrying beraprtisipassi.

Actions / Interventions

 Create an environment of mutual trust by listening attentively and always there for the patients.

R / notice and respond to needs to be created before the patient is willing to take part in the learning process.

 Working with patients in managing the expected learning goals

R / participation in carrying improve enthusiastic planning and working with patients with the principles learned.

 Discuss diit plans, as well as the use of high food and how to do meals outside the home.

R / awareness of the importance of kontrrol diit will assist patients in eating or obey emrancanakan program.

 Review the effect of smoking on insulin use, instruct the patient to stop smoking.

R / nicotine constricts small blood vessels in the slow passage and absorption of insulin for blood vessel constriction is experiencing.

 Identify sources - sources that exist in the community, if any.

R / support continuous ride biassanya important lifestyle changes and increased acceptance of yourself.

REFERENCES

1. Practical Management of Type 2 Diabetes Mellsitus. PB Perkeni, 2002.

2. Diabetes Mellitus classification, diagnosis, and therapy. Askandar Tjokroprawito. PT Scholastic Press, 1989.

3. Medical Surgical Nursing Care Plans. Barbara engram. EGC Medical Book Publishers, 1994.