A.
Definition
Diabetes mellitus
is a group of symptoms that occur in a person who is caused by the presence of elevated
levels of blood glucose due to insulin deficiency both in absolute and relative
(Noer, 2003).
Diabetes mellitus is a disease in which the sufferer can not control the sugar levels in the body. The body will always lack or excess sugar that interfere with the body's systems work as a whole (School of Medicine, 2001).
Diabetes mellitus is a common disease resulting from a deficiency of insulin or a decreased effectiveness of insulin (Brooker, 2001).
Diabetes mellitus is a disease in which the sufferer can not control the sugar levels in the body. The body will always lack or excess sugar that interfere with the body's systems work as a whole (School of Medicine, 2001).
Diabetes mellitus is a common disease resulting from a deficiency of insulin or a decreased effectiveness of insulin (Brooker, 2001).
B. Classification
Types of Diabetes
• Type 1 diabetes mellitus (Type 1 DM)
Incidence of Type 1 diabetes in Western countries + 10% of type 2 DM. In tropical countries much less again. Clinical picture biasanyatimbul in childhood and peak during puberty. But there are also arising in adulthood.
• Diabates mellitus type 2 (DM type 2)
Type 2 diabetes is the most common type (over 90%). Arise more often after the age of 40 with a note in the seventh decade of diabetes prevalence reaches 3 to 4 times higher than the average adult.
• Other Types of Diabetes Mellitus
There are several other types of diabetes such as genetic defects of beta cell function, genetic defects of insulin action, diseases of the exocrine pancreas, endokrinopati, because of drugs or chemicals, infections, cause a rare immunological and other genetic syndromes associated with DM.
• Gestational Diabetes Mellitus
Gestational diabetes mellitus is diabetes that occurs during pregnancy. This type is very important to know the impact on the fetus are less well when not handled properly.
• Type 1 diabetes mellitus (Type 1 DM)
Incidence of Type 1 diabetes in Western countries + 10% of type 2 DM. In tropical countries much less again. Clinical picture biasanyatimbul in childhood and peak during puberty. But there are also arising in adulthood.
• Diabates mellitus type 2 (DM type 2)
Type 2 diabetes is the most common type (over 90%). Arise more often after the age of 40 with a note in the seventh decade of diabetes prevalence reaches 3 to 4 times higher than the average adult.
• Other Types of Diabetes Mellitus
There are several other types of diabetes such as genetic defects of beta cell function, genetic defects of insulin action, diseases of the exocrine pancreas, endokrinopati, because of drugs or chemicals, infections, cause a rare immunological and other genetic syndromes associated with DM.
• Gestational Diabetes Mellitus
Gestational diabetes mellitus is diabetes that occurs during pregnancy. This type is very important to know the impact on the fetus are less well when not handled properly.
C. Pathophysiology
In the process of metabolism, insulin holds a very important role is assigned to the glucose enter the cells. Insulin is a substance secreted by the beta cells in the pancreas.
1) Pancreatic
The pancreas is a gland located behind the stomach. Inside are a collection of cells called Langerhans islands that contain beta cells. Mngeluarkan beta cell insulin to regulate blood glucose levels. In addition there is also the beta cells that produce glucagon alfa srl that worked contrary to insulin which increases blood glucose levels. Also there are mngeluarkan somastostatin delta cells.
2) Work Insulin
Insulin is described as the key to unlock the entrance of glucose into the cells, and then in the cell, it dimetabolismekan glucose into energy.
3) Pathophysiology of Type 1 DM
Why insulin in Type 1 diabetes mellitus is not there? This is caused by this type arise due to an autoimmune reaction that is caused due to an inflammation in insulitis beta cells. This led to the emergence of antibodies against beta cells called ICA (Islet Cell Antibody). Antigen reaction (beta cells) with antibodies (ICA) it creates causes the destruction of beta cells.
4) Pathophysiology of Type 2 DM
Type 2 diabetes mellitus normal amount of insulin, but instead may be more insulin receptors located on the cell surface is less. Inulin receptor is described as keyhole entrance into the cell. At the state had less number of key holes, until despite her key (insulin) a lot, but because of a lock (receptor) is less, then the glucose enter cells will be small, so that the cell will lack glucose and glucose in the blood will increase. The state is the same as in Type 1 DM. The difference is that Type 2 diabetes in addition to high glucose levels, insulin levels are too high or normal. This condition is called insulin resistance.
That many factors play a role as a cause of insulin resistance:
1. Especially those that are central obesity (apple shape)
2. Diets high in fat and low in carbohydrates
3. Lack of exercise
4. Hereditary factors (hereditary)
D. Etiology
Viruses and Bacteriaš
DM is the virus that causes rubella, mumps, and human coxsackievirus B4. Through the mechanism of infection sitolitik in beta cells, this virus results in the destruction or disruption of cells. Could also, this virus attacks through autoimmunity reaction leading to loss of beta cell autoimmunity in. Diabetes mellitus is caused by the bacteria could still be detected. However, health experts suspect bacterial quite instrumental cause DM.
Toxic or Toxic MaterialsÆ
Toxic materials that can directly damage beta cells is alloxan, pyrinuron (rodenticides), and streptozoctin (products of a type of fungus). Another ingredient is cyanide from cassava.
Genetic or Heredity FactorsÆ
Diabetes mellitus tended to be reduced or diawariskan, not transmitted. Family members of patients with DM (diabetes) have a greater likelihood of developing the disease compared with family members who do not have diabetes. Health experts also said diabetes is a disease which is adrift sex chromosomes or sex. Usually men become real people, whereas women as party carrying the gene for inherited by his children.
E. Clinical
Symptoms of diabetesÆ
Classic symptoms of diabetes are excessive thirst frequent urination, especially at night, lots of eating and weight down quickly. In addition, there are complaints sometimes weak, tingling in fingers and toes, swift hunger, itch, become blurred vision, decreased sex drive, difficult wounds healed and the mothers often give birth to babies over 4 kg.Kadang- Sometimes there are patients who did not feel any complaints, because they are aware of any diabetes health check diemukan when blood glucose levels are high.
In the process of metabolism, insulin holds a very important role is assigned to the glucose enter the cells. Insulin is a substance secreted by the beta cells in the pancreas.
1) Pancreatic
The pancreas is a gland located behind the stomach. Inside are a collection of cells called Langerhans islands that contain beta cells. Mngeluarkan beta cell insulin to regulate blood glucose levels. In addition there is also the beta cells that produce glucagon alfa srl that worked contrary to insulin which increases blood glucose levels. Also there are mngeluarkan somastostatin delta cells.
2) Work Insulin
Insulin is described as the key to unlock the entrance of glucose into the cells, and then in the cell, it dimetabolismekan glucose into energy.
3) Pathophysiology of Type 1 DM
Why insulin in Type 1 diabetes mellitus is not there? This is caused by this type arise due to an autoimmune reaction that is caused due to an inflammation in insulitis beta cells. This led to the emergence of antibodies against beta cells called ICA (Islet Cell Antibody). Antigen reaction (beta cells) with antibodies (ICA) it creates causes the destruction of beta cells.
4) Pathophysiology of Type 2 DM
Type 2 diabetes mellitus normal amount of insulin, but instead may be more insulin receptors located on the cell surface is less. Inulin receptor is described as keyhole entrance into the cell. At the state had less number of key holes, until despite her key (insulin) a lot, but because of a lock (receptor) is less, then the glucose enter cells will be small, so that the cell will lack glucose and glucose in the blood will increase. The state is the same as in Type 1 DM. The difference is that Type 2 diabetes in addition to high glucose levels, insulin levels are too high or normal. This condition is called insulin resistance.
That many factors play a role as a cause of insulin resistance:
1. Especially those that are central obesity (apple shape)
2. Diets high in fat and low in carbohydrates
3. Lack of exercise
4. Hereditary factors (hereditary)
D. Etiology
Viruses and Bacteriaš
DM is the virus that causes rubella, mumps, and human coxsackievirus B4. Through the mechanism of infection sitolitik in beta cells, this virus results in the destruction or disruption of cells. Could also, this virus attacks through autoimmunity reaction leading to loss of beta cell autoimmunity in. Diabetes mellitus is caused by the bacteria could still be detected. However, health experts suspect bacterial quite instrumental cause DM.
Toxic or Toxic MaterialsÆ
Toxic materials that can directly damage beta cells is alloxan, pyrinuron (rodenticides), and streptozoctin (products of a type of fungus). Another ingredient is cyanide from cassava.
Genetic or Heredity FactorsÆ
Diabetes mellitus tended to be reduced or diawariskan, not transmitted. Family members of patients with DM (diabetes) have a greater likelihood of developing the disease compared with family members who do not have diabetes. Health experts also said diabetes is a disease which is adrift sex chromosomes or sex. Usually men become real people, whereas women as party carrying the gene for inherited by his children.
E. Clinical
Symptoms of diabetesÆ
Classic symptoms of diabetes are excessive thirst frequent urination, especially at night, lots of eating and weight down quickly. In addition, there are complaints sometimes weak, tingling in fingers and toes, swift hunger, itch, become blurred vision, decreased sex drive, difficult wounds healed and the mothers often give birth to babies over 4 kg.Kadang- Sometimes there are patients who did not feel any complaints, because they are aware of any diabetes health check diemukan when blood glucose levels are high.
F.
Investigations
Diagnosis of DM generally will be considered in the presence of typical symptoms of diabetes such as polyuria, polydipsia, weakness, and weight loss. Other symptoms that may be raised by the patient is tingling, itching, blurred eyes and impotensia in male patients, and pruritus vulvae and in female patients. If the complaint and typical symptoms, the examination found that when blood glucose> 200 mg / dl is sufficient to establish the diagnosis of DM. Generally, blood glucose test results while the new one just is not enough to abnormal clinical diagnosis of DM.
If the blood glucose test results dubious, oral glucose tolerance is needed to confirm a diagnosis of DM. For diagnosis of diabetes mellitus and impaired glucose tolerance others examined blood glucose 2 hours after a glucose load. Required at least 2 times the glucose levels had abnormal to confirm the diagnosis of DM, both on 2 different tests or presence of 2 abnormal results during the same examination.
How to oral glucose tolerance
• Three days earlier meal as usual
• Physical activity enough, not too much
• Fasting overnight, for 10-12 hours
• Fasting blood glucose checked
• Awarded 75 grams of glucose dissolved in 250 ml of water, and drink during / in 5 minutes
• Examined blood glucose 1 (one) hour and 2 (two) hours after glucose load
• During the examination, the patients were examined still a break and not
G. Complication
Complications of diabetes mellitus can occur acutely and chronically, which raised a few months or a few years after diabetes mellitus.
• Acute Complications of Diabetes Mellitus
Two of the most important acute complication is hypoglycemia and diabetic coma reaction.
1. Hypoglycemia reactions
Symptomatic hypoglycemia reaction is caused by the body's lack of glucose, with signs of hunger, trembling, sweating, dizziness, and so on. Hypoglycemic coma patient should be immediately taken to the hospital because of need to receive injections of 40% glucose and glucose infusion. Diabetes who experienced hypoglycemic reactions (still conscious), or hypoglycemic coma, usually caused by the anti-diabetic drugs are taken too high a dose, or people with eating late, or it could be due to excessive physical exercise.
2. Diabetic coma
Contrary to hypoglycemic coma, diabetic coma was caused by the body's blood levels are too high, and usually more than 600 mg / dl. Symptoms of diabetic coma that often arises is:
• Decreased appetite (usually people with diabetes have a big appetite)
• Drink a lot, peeing a lot
• Then followed by nausea, vomiting, breathing became rapid and the patient, as well as the smell of acetone
• Often accompanied by body heat because there is usually an infection and diabetic coma patient should be immediately taken to the hospital
• Chronic Complications of Diabetes Mellitus
Chronic complications of diabetes occurs in basically all the blood vessels throughout the body (diabetic angiopathy). For convenience, divided 2 diabetic angiopathy:
• makroangiopati (macrovascular)
• mikroangiopati (microvascular)
Although it does not mean that each other apart and did not happen all at once simultaneously.
H. Management
The form:
a. Antidiabetic medication
1) triggers insulin secretion:
J sulfonylureas
J Glinid
2) Incremental sensitivity to insulin:
J biguanid
J Tiazolidindion
J alpha glucosidase inhibitors
b. Insulin
c. Prevention of complications
M Stop Smoking
M Optimizing cholesterol levels
M Maintaining a stable body weight
M Controlling high blood pressure
M Regular exercise can be beneficial:
• Controlling blood glucose levels
• Lose excess weight (preventing obesity)
• Helps reduce stress
• Strengthen muscles and heart
• Increasing levels of 'good' cholesterol (HDL)
• Helps lower blood pressure
NURSING MANAGEMENT
A. ASSESSMENT
Assessment is the first step in the nursing process and basic overall (Boedihartono, 1994: 10).
Assessment of patients with diabetes mellitus (Doenges, 1999) include:
a. Activity / Rest
Symptoms: weakness, fatigue, difficulty moving / walking, muscle cramps, decreased muscle tone.
Signs: decreased muscle strength.
b. Circulation
Symptoms: foot ulcers, healing time, tingling / numbness in the extremities.
Signs: skin hot, dry and reddish.
c. Ego Integrity
Symptoms: depend on others.
Signs: anxiety, sensitive stimuli.
d. Elimination
Symptoms: changes in the pattern of urination (polyuria), nakturia
Signs: dilute urine, pale dry, poliurine.
e. Food / fluid
Symptoms: loss of appetite, nausea / vomiting, do not follow the diet, weight loss.
Symptoms: dry skin / scaly, ugly turgor.
f. Pain / comfort
Symptoms: pain in the ulcer wound
Signs: face grimacing with palpitations, looks very carefully.
g. Security
Symptoms: dry skin, itching, skin ulcers.
Symptoms: fever, diaphoresis, damaged skin, lesion / ulceration
h. Counseling / learning
Symptoms: family risk factors diabetes, heart disease, stroke, hypertension, healing Lamba. Obatseperti use steroids, diuretics (thiazides): diantin and phenobarbital (may increase blood glucose levels).
B. Nursing Diagnosis
Nursing diagnosis is a unification of the problem of real or potential patients based on the data that has been collected (Boedihartono, 1994).
Nursing diagnoses in patients with diabetes mellitus (Doenges, 1999) are:
1) Lack of fluid volume associated with osmotic diuresis, gastric loss, excessive diarrhea, nausea, vomiting, limited input, mental mess.
2) Changes in nutrition less than body requirements related to inadequate insulin, decreased oral input: anorexia, nausea, a full stomach, abdominal pain, change in consciousness: hipermetabolisme status, the release of stress hormones.
3) High risk of infection related to inadequate peripheral defense, changes in circulation, high blood sugar levels, invasive procedures and skin damage.
4) Fatigue associated with decreased metabolic energy production, changes in blood chemistry, insulin insufficiency, increased energy needs, status hipermetabolisme / infection.
5) Lack of knowledge about the condition, prognosis and treatment needs related to misinterpretation of information / do not know the source of information.
C. INTERVENTION AND IMPLEMENTATION
Intervention is planning nursing actions that will be implemented to address the problem in accordance with the nursing diagnoses (Boedihartono, 1994)
Implementation is the realization of management and nursing plans that had been developed at the planning stage (Effendi, 1995).
And implementation of nursing intervention in patients with diabetes mellitus (Doenges, 1999) include:
a) Lack of fluid volume associated with osmotic diuresis, gastric loss, excessive (diarrhea, vomiting) input is limited (nausea, mental chaotic).
Objective: body condition is stable, vital signs, skin turgor, normal.
Results Criteria: - patients showed an improvement in fluid balance, with criteria; spending adequate urine (normal range), vital signs stable, clear peripheral pulse pressure, good skin turgor, capillary refill well and mucous membranes moist or wet.
Intervention / Implementation:
1) Monitor vital signs, note the change in blood pressure ortestastik.
R: Hypovolemia can be manifested by hypotension and tachycardia.
2) Assess the pattern of breathing and smelly breath.
R: The lungs secrete carbonic acid is produced through the respiratory compensation against the state alkosis respiratoris ketoacidosis.
3) Assess temperature, color and moisture.
R: Fever, chills, and diaferesis is common in the infection process. Fever with skin redness, dry, maybe a picture of dehydration.
4) Assess peripheral pulses, capillary refill, skin turgor and mucous membranes.
R: Is an indicator of the level of dehydration or adequate circulating volume.
5) Monitor intake and output. Record the urine specific gravity.
R: memeberikan estimate the need for fluid replacement, renal function and the effectiveness of a given therapy.
6) Measure body weight every day.
R: gives the best results of the assessment of the status of ongoing fluid and further in giving replacement fluids.
7) Collaboration fluid therapy as indicated
R: the type and amount of fluid depends on the degree of dehydration and individual patient response.
b) Changes in nutrition less than body requirements related to insufficient insulin, decreased oral input: anorexia, nausea, a full stomach, abdominal pain, change in consciousness: hipermetabolisme status, the release of stress hormones.
Goals: weight can be increased with normal laboratory values and no signs of malnutrition.
Results Criteria: - patient is able to express an understanding of substance abuse, decrease the amount of intake (diet on nutritional status).
- Demonstrate behaviors, lifestyle changes to improve and maintain a proper weight.
Intervention / Implementation:
1) Weigh weight every day as indicated
R: Knowing eating adequate income.
2) Determine the diet and eating patterns of patients compared with foods that can be spent on the patient.
R: Identify deviations from the requirements.
3) Auscultation of bowel sounds, note the presence of abdominal pain / abdominal bloating, nausea, vomiting, keep fasting as indicated.
R: influence of intervention options.
4) Observation of signs of hypoglycemia, such as changes in level of consciousness, cold / humid, rapid pulse, hunger and dizziness.
R: is potentially life threatening, which must be multiplied and handled appropriately.
5) Collaboration in the delivery of insulin, blood sugar tests and diet.
R: It is useful to control blood sugar levels.
c) High risk of infection related to inadequate peripheral defense, changes in circulation, high blood sugar levels, invasive procedures and skin damage.
Objective: Infection does not occur.
Results Criteria: - identify individual risk factors and potential interventions to reduce infection.
- Maintain a safe aseptic environment.
Intervention / Implementation
1) Observation for signs of infection and inflammation such as fever, redness, pus in the wound, purulent sputum, urine color cloudy and foggy.
R: incoming patients with infections that normally might have been able to trigger a state ketosidosis or nosocomial infections.
2) Increase prevention efforts by performing good hand washing, each contact on all items related to the patient, including his or her own patients.
R: prevention of nosocomial infections.
3) Maintain aseptic technique in invasive procedures (such as infusion, catheter folley, etc.).
R: Glucose levels in the blood will be the best medium for the growth of germs.
4) Insert the catheter / perineal care do well.
R: Reduce the risk of urinary tract infection.
5) Provide skin care with regular and earnest. Massage depressed bone area, keep skin dry, dry linen dantetap toned (not wrinkled).
R: peripheral circulation can be impaired penigkatan that put patients at risk of damage to the skin / eye irritation and infection.
6) Position the patient in semi-Fowler position.
R: makes it easy for the lung to expand, lowering the risk of hypoventilation.
7) Collaboration antibiotics as indicated.
R: penenganan early can help prevent the onset of sepsis.
d) Fatigue associated with decreased metabolic energy production, changes in blood chemistry, insulin insufficiency, increased energy needs, status hipermetabolisme / infection.
Purpose: Fatigue is reduced / decrease fatigue
Results Criteria: - declare mapu to rest and increased power.
- Be able to demonstrate the factors that influence fatigue.
- Shows the increase in capabilities and participate in activities.
Intervention / Implementation:
1) Discuss with the patient the need activity. Create a schedule planning with patients and identification of activities that cause fatigue.
R: education can provide motivation to improve the activity even though the patient may be very weak.
2) Provide an alternative activity denagn adequate rest periods / without being distracted.
R: preventing excessive fatigue.
3) Monitor vital signs before or after the activity.
R: identifying activity level is tolerated physiologically.
4) Discuss how to conserve calories during a shower, change places and so on.
R: with energy saving patients can do more activities.
5) Increase the participation of patients in their daily activities according to ability / tolerance of the patient.
R: increased confidence / self-esteem is positive according to the activity level of patients tolerated.
e) Lack of knowledge about the condition, prognosis and treatment needs related to misinterpretation of information / do not know the source of information.
Purpose: The patient expressed understanding of the conditions, procedures and effects of the treatment process.
Results Criteria: - perform the necessary procedures and explain the rationale of an action.
- Initiate the necessary lifestyle changes and participate in treatment regimen.
Intervention / Implementation:
1) Assess the level of knowledge of the client and family about the disease.
R: megetahui how much experience and knowledge of the client and family about the disease.
2) Provide a description of the client about his illness and his condition now.
R: by knowing the disease and its present state, the client and his family will feel calm and reduce anxiety.
3) Encourage clients and families to pay attention to her diet.
R: diet and proper diet helps the healing process.
4) Ask the client and reiterated family of materials that have been given.
R: knowing how far the client and family understanding and assessing the success of the action taken.
D. EVALUATION
Evaluation is the stage at which the level of success of the nursing process in achieving the goals of nursing assessed and the need to modify or nursing intervention defined purpose (Brooker, 2001).
Evaluation expected in patients with diabetes mellitus are:
1) the body condition is stable, vital signs, skin turgor, normal.
2) Weight loss may increase with normal laboratory values and no signs of malnutrition.
3) Infection does not occur
4) reduced fatigue / tiredness decrease
5) The patient expressed understanding of the conditions, procedures and effects of the treatment process.
REFERENCES
Brooker, Christine. , 2001. Pocket Dictionary of Nursing. EGC: Jakarta.Carpenito, L.J. , 1999. Nursing care plans and documentation of nursing, Nursing Diagnosis and Collaborative Problems, ed. 2. EGC: Jakarta.
Doenges, Marilynn E. , 1999. Nursing care plan guidelines for planning and documenting patient, ed.3. EGC: Jakarta.
Effendy, Nasrul. , 1995. Introduction to Nursing Process. EGC: Jakarta.FKUI. , 2001. Textbook of Medicine Jilid.II ed.3. FKUI: Jakarta.
Haznam. , 1991. Endocrinology. Space Offset: BandungNoer, Sjaifoellah HM, et al. , 2003. Textbook of Medicine, sixth printing. Hall FKUI Publisher: Jakarta
Soegondo S, et al. 2007. Integrated Management of Diabetes Mellitus, sixth printing. Hall FKUI Publisher: Jakarta.
Diagnosis of DM generally will be considered in the presence of typical symptoms of diabetes such as polyuria, polydipsia, weakness, and weight loss. Other symptoms that may be raised by the patient is tingling, itching, blurred eyes and impotensia in male patients, and pruritus vulvae and in female patients. If the complaint and typical symptoms, the examination found that when blood glucose> 200 mg / dl is sufficient to establish the diagnosis of DM. Generally, blood glucose test results while the new one just is not enough to abnormal clinical diagnosis of DM.
If the blood glucose test results dubious, oral glucose tolerance is needed to confirm a diagnosis of DM. For diagnosis of diabetes mellitus and impaired glucose tolerance others examined blood glucose 2 hours after a glucose load. Required at least 2 times the glucose levels had abnormal to confirm the diagnosis of DM, both on 2 different tests or presence of 2 abnormal results during the same examination.
How to oral glucose tolerance
• Three days earlier meal as usual
• Physical activity enough, not too much
• Fasting overnight, for 10-12 hours
• Fasting blood glucose checked
• Awarded 75 grams of glucose dissolved in 250 ml of water, and drink during / in 5 minutes
• Examined blood glucose 1 (one) hour and 2 (two) hours after glucose load
• During the examination, the patients were examined still a break and not
G. Complication
Complications of diabetes mellitus can occur acutely and chronically, which raised a few months or a few years after diabetes mellitus.
• Acute Complications of Diabetes Mellitus
Two of the most important acute complication is hypoglycemia and diabetic coma reaction.
1. Hypoglycemia reactions
Symptomatic hypoglycemia reaction is caused by the body's lack of glucose, with signs of hunger, trembling, sweating, dizziness, and so on. Hypoglycemic coma patient should be immediately taken to the hospital because of need to receive injections of 40% glucose and glucose infusion. Diabetes who experienced hypoglycemic reactions (still conscious), or hypoglycemic coma, usually caused by the anti-diabetic drugs are taken too high a dose, or people with eating late, or it could be due to excessive physical exercise.
2. Diabetic coma
Contrary to hypoglycemic coma, diabetic coma was caused by the body's blood levels are too high, and usually more than 600 mg / dl. Symptoms of diabetic coma that often arises is:
• Decreased appetite (usually people with diabetes have a big appetite)
• Drink a lot, peeing a lot
• Then followed by nausea, vomiting, breathing became rapid and the patient, as well as the smell of acetone
• Often accompanied by body heat because there is usually an infection and diabetic coma patient should be immediately taken to the hospital
• Chronic Complications of Diabetes Mellitus
Chronic complications of diabetes occurs in basically all the blood vessels throughout the body (diabetic angiopathy). For convenience, divided 2 diabetic angiopathy:
• makroangiopati (macrovascular)
• mikroangiopati (microvascular)
Although it does not mean that each other apart and did not happen all at once simultaneously.
H. Management
The form:
a. Antidiabetic medication
1) triggers insulin secretion:
J sulfonylureas
J Glinid
2) Incremental sensitivity to insulin:
J biguanid
J Tiazolidindion
J alpha glucosidase inhibitors
b. Insulin
c. Prevention of complications
M Stop Smoking
M Optimizing cholesterol levels
M Maintaining a stable body weight
M Controlling high blood pressure
M Regular exercise can be beneficial:
• Controlling blood glucose levels
• Lose excess weight (preventing obesity)
• Helps reduce stress
• Strengthen muscles and heart
• Increasing levels of 'good' cholesterol (HDL)
• Helps lower blood pressure
NURSING MANAGEMENT
A. ASSESSMENT
Assessment is the first step in the nursing process and basic overall (Boedihartono, 1994: 10).
Assessment of patients with diabetes mellitus (Doenges, 1999) include:
a. Activity / Rest
Symptoms: weakness, fatigue, difficulty moving / walking, muscle cramps, decreased muscle tone.
Signs: decreased muscle strength.
b. Circulation
Symptoms: foot ulcers, healing time, tingling / numbness in the extremities.
Signs: skin hot, dry and reddish.
c. Ego Integrity
Symptoms: depend on others.
Signs: anxiety, sensitive stimuli.
d. Elimination
Symptoms: changes in the pattern of urination (polyuria), nakturia
Signs: dilute urine, pale dry, poliurine.
e. Food / fluid
Symptoms: loss of appetite, nausea / vomiting, do not follow the diet, weight loss.
Symptoms: dry skin / scaly, ugly turgor.
f. Pain / comfort
Symptoms: pain in the ulcer wound
Signs: face grimacing with palpitations, looks very carefully.
g. Security
Symptoms: dry skin, itching, skin ulcers.
Symptoms: fever, diaphoresis, damaged skin, lesion / ulceration
h. Counseling / learning
Symptoms: family risk factors diabetes, heart disease, stroke, hypertension, healing Lamba. Obatseperti use steroids, diuretics (thiazides): diantin and phenobarbital (may increase blood glucose levels).
B. Nursing Diagnosis
Nursing diagnosis is a unification of the problem of real or potential patients based on the data that has been collected (Boedihartono, 1994).
Nursing diagnoses in patients with diabetes mellitus (Doenges, 1999) are:
1) Lack of fluid volume associated with osmotic diuresis, gastric loss, excessive diarrhea, nausea, vomiting, limited input, mental mess.
2) Changes in nutrition less than body requirements related to inadequate insulin, decreased oral input: anorexia, nausea, a full stomach, abdominal pain, change in consciousness: hipermetabolisme status, the release of stress hormones.
3) High risk of infection related to inadequate peripheral defense, changes in circulation, high blood sugar levels, invasive procedures and skin damage.
4) Fatigue associated with decreased metabolic energy production, changes in blood chemistry, insulin insufficiency, increased energy needs, status hipermetabolisme / infection.
5) Lack of knowledge about the condition, prognosis and treatment needs related to misinterpretation of information / do not know the source of information.
C. INTERVENTION AND IMPLEMENTATION
Intervention is planning nursing actions that will be implemented to address the problem in accordance with the nursing diagnoses (Boedihartono, 1994)
Implementation is the realization of management and nursing plans that had been developed at the planning stage (Effendi, 1995).
And implementation of nursing intervention in patients with diabetes mellitus (Doenges, 1999) include:
a) Lack of fluid volume associated with osmotic diuresis, gastric loss, excessive (diarrhea, vomiting) input is limited (nausea, mental chaotic).
Objective: body condition is stable, vital signs, skin turgor, normal.
Results Criteria: - patients showed an improvement in fluid balance, with criteria; spending adequate urine (normal range), vital signs stable, clear peripheral pulse pressure, good skin turgor, capillary refill well and mucous membranes moist or wet.
Intervention / Implementation:
1) Monitor vital signs, note the change in blood pressure ortestastik.
R: Hypovolemia can be manifested by hypotension and tachycardia.
2) Assess the pattern of breathing and smelly breath.
R: The lungs secrete carbonic acid is produced through the respiratory compensation against the state alkosis respiratoris ketoacidosis.
3) Assess temperature, color and moisture.
R: Fever, chills, and diaferesis is common in the infection process. Fever with skin redness, dry, maybe a picture of dehydration.
4) Assess peripheral pulses, capillary refill, skin turgor and mucous membranes.
R: Is an indicator of the level of dehydration or adequate circulating volume.
5) Monitor intake and output. Record the urine specific gravity.
R: memeberikan estimate the need for fluid replacement, renal function and the effectiveness of a given therapy.
6) Measure body weight every day.
R: gives the best results of the assessment of the status of ongoing fluid and further in giving replacement fluids.
7) Collaboration fluid therapy as indicated
R: the type and amount of fluid depends on the degree of dehydration and individual patient response.
b) Changes in nutrition less than body requirements related to insufficient insulin, decreased oral input: anorexia, nausea, a full stomach, abdominal pain, change in consciousness: hipermetabolisme status, the release of stress hormones.
Goals: weight can be increased with normal laboratory values and no signs of malnutrition.
Results Criteria: - patient is able to express an understanding of substance abuse, decrease the amount of intake (diet on nutritional status).
- Demonstrate behaviors, lifestyle changes to improve and maintain a proper weight.
Intervention / Implementation:
1) Weigh weight every day as indicated
R: Knowing eating adequate income.
2) Determine the diet and eating patterns of patients compared with foods that can be spent on the patient.
R: Identify deviations from the requirements.
3) Auscultation of bowel sounds, note the presence of abdominal pain / abdominal bloating, nausea, vomiting, keep fasting as indicated.
R: influence of intervention options.
4) Observation of signs of hypoglycemia, such as changes in level of consciousness, cold / humid, rapid pulse, hunger and dizziness.
R: is potentially life threatening, which must be multiplied and handled appropriately.
5) Collaboration in the delivery of insulin, blood sugar tests and diet.
R: It is useful to control blood sugar levels.
c) High risk of infection related to inadequate peripheral defense, changes in circulation, high blood sugar levels, invasive procedures and skin damage.
Objective: Infection does not occur.
Results Criteria: - identify individual risk factors and potential interventions to reduce infection.
- Maintain a safe aseptic environment.
Intervention / Implementation
1) Observation for signs of infection and inflammation such as fever, redness, pus in the wound, purulent sputum, urine color cloudy and foggy.
R: incoming patients with infections that normally might have been able to trigger a state ketosidosis or nosocomial infections.
2) Increase prevention efforts by performing good hand washing, each contact on all items related to the patient, including his or her own patients.
R: prevention of nosocomial infections.
3) Maintain aseptic technique in invasive procedures (such as infusion, catheter folley, etc.).
R: Glucose levels in the blood will be the best medium for the growth of germs.
4) Insert the catheter / perineal care do well.
R: Reduce the risk of urinary tract infection.
5) Provide skin care with regular and earnest. Massage depressed bone area, keep skin dry, dry linen dantetap toned (not wrinkled).
R: peripheral circulation can be impaired penigkatan that put patients at risk of damage to the skin / eye irritation and infection.
6) Position the patient in semi-Fowler position.
R: makes it easy for the lung to expand, lowering the risk of hypoventilation.
7) Collaboration antibiotics as indicated.
R: penenganan early can help prevent the onset of sepsis.
d) Fatigue associated with decreased metabolic energy production, changes in blood chemistry, insulin insufficiency, increased energy needs, status hipermetabolisme / infection.
Purpose: Fatigue is reduced / decrease fatigue
Results Criteria: - declare mapu to rest and increased power.
- Be able to demonstrate the factors that influence fatigue.
- Shows the increase in capabilities and participate in activities.
Intervention / Implementation:
1) Discuss with the patient the need activity. Create a schedule planning with patients and identification of activities that cause fatigue.
R: education can provide motivation to improve the activity even though the patient may be very weak.
2) Provide an alternative activity denagn adequate rest periods / without being distracted.
R: preventing excessive fatigue.
3) Monitor vital signs before or after the activity.
R: identifying activity level is tolerated physiologically.
4) Discuss how to conserve calories during a shower, change places and so on.
R: with energy saving patients can do more activities.
5) Increase the participation of patients in their daily activities according to ability / tolerance of the patient.
R: increased confidence / self-esteem is positive according to the activity level of patients tolerated.
e) Lack of knowledge about the condition, prognosis and treatment needs related to misinterpretation of information / do not know the source of information.
Purpose: The patient expressed understanding of the conditions, procedures and effects of the treatment process.
Results Criteria: - perform the necessary procedures and explain the rationale of an action.
- Initiate the necessary lifestyle changes and participate in treatment regimen.
Intervention / Implementation:
1) Assess the level of knowledge of the client and family about the disease.
R: megetahui how much experience and knowledge of the client and family about the disease.
2) Provide a description of the client about his illness and his condition now.
R: by knowing the disease and its present state, the client and his family will feel calm and reduce anxiety.
3) Encourage clients and families to pay attention to her diet.
R: diet and proper diet helps the healing process.
4) Ask the client and reiterated family of materials that have been given.
R: knowing how far the client and family understanding and assessing the success of the action taken.
D. EVALUATION
Evaluation is the stage at which the level of success of the nursing process in achieving the goals of nursing assessed and the need to modify or nursing intervention defined purpose (Brooker, 2001).
Evaluation expected in patients with diabetes mellitus are:
1) the body condition is stable, vital signs, skin turgor, normal.
2) Weight loss may increase with normal laboratory values and no signs of malnutrition.
3) Infection does not occur
4) reduced fatigue / tiredness decrease
5) The patient expressed understanding of the conditions, procedures and effects of the treatment process.
REFERENCES
Brooker, Christine. , 2001. Pocket Dictionary of Nursing. EGC: Jakarta.Carpenito, L.J. , 1999. Nursing care plans and documentation of nursing, Nursing Diagnosis and Collaborative Problems, ed. 2. EGC: Jakarta.
Doenges, Marilynn E. , 1999. Nursing care plan guidelines for planning and documenting patient, ed.3. EGC: Jakarta.
Effendy, Nasrul. , 1995. Introduction to Nursing Process. EGC: Jakarta.FKUI. , 2001. Textbook of Medicine Jilid.II ed.3. FKUI: Jakarta.
Haznam. , 1991. Endocrinology. Space Offset: BandungNoer, Sjaifoellah HM, et al. , 2003. Textbook of Medicine, sixth printing. Hall FKUI Publisher: Jakarta
Soegondo S, et al. 2007. Integrated Management of Diabetes Mellitus, sixth printing. Hall FKUI Publisher: Jakarta.
Rabu, April 24, 2013
|
Label:
askep,
Diabetes Mellitus,
perawat,
tugas
|
Langganan:
Posting Komentar (Atom)
0 komentar:
Posting Komentar