N212: Health Differences Across the Life Span 2

Health Differences Across the Lifespan 2 Study Guide • Sensory: cataracts; glaucoma; diabetic retinopathy • Cardiovascular: orthostatic hypertension; accelerated atherosclerosis leading to stroke; myocardial infarction; peripheral vascular disease; increased blood viscosity; platelet disorders • Renal: hypertension; edema; albuminuria; chronic renal failure • Integumentary: atrophic changes; foot ulcers; gangrene • Immune: poor healing; periodontal disease; lung infections; chronic skin infections; urinary tract infections; vaginitis Diagnosis: fasting blood glucose level greater than or equal to 126 mg/dl; glycosylated hemoglobin is increased; Glucose Tolerance Test (GTT) shows hyperglycemia; 2-hour postprandial blood glucose level shows hyperglycemia (greater than 200 mg/dl) Medical management: use of an exchange list for meal planning to design a diet that will distribute caloric need; counting carbohydrate, fat, and protein intake over 24 hours; avoid refined and simple sugars and saturated fats; use of hypoglycemics, with the short-acting (regular, semilente), intermediate-acting (NPH, lente), or long-acting (PZI, Ultralente); HBA1C test provides an average blood sugar for three months, with the normal range between 4-6%; if the number is high it indicates poor control Nursing interventions: Assess acid-base and fluid balance (prone to ketoacidosis/hypokalemia) to see if there is need for emergency potassium replacement to reduce the risk of potentially life- threatening complications; provide meticulous skin and foot care (monitor for infection, skin breakdown, changes in peripheral circulation, poor wound healing, and numbness in extremities); determine patient’s compliance to diet, exercise, and medication regimen; diet consists of CHO in amounts to individual needs, protein at 10-20% of caloric intake, saturated fat of less than 10% of calories with cholesterol intake equal to or less than 300mg/day; sodium intake 2400-3000mg/day, dietary fiber 20-35g/day; encourage an exercise plan, promote safety, and prevent infection; identify appropriate glucose monitoring protocol and medication administration process; promote acceptance and effective coping while living with DM; teach early identification of hypoglycemia; check BG as scheduled; treat hypoglycemia with 15 grams CHO snack, such as 8 oz. skim milk, 5 Lifesaver candies, 3 large marshmallows, or 6 oz. juice; recheck BG after treatment of hypoglycemia; maintain hydration and avoid hyperglycemia; teach sick day protocol and exercise protocol with patient; instruct patient to avoid alcohol while taking insulin because it lowers BG levels and may cause hypoglycemia Sick day management: maintain food and fluid intake; continue to take insulin; BG monitoring up to every 4 hours; report greater than 250mg/dL and monitor urine for ketones Instructions for insulin: Store insulin in the refrigerator and keep it away from direct sunlight. Note the expiration date and replace after four weeks. Discard the vial and use a new one if regular insulin appears cloudy. Do not shake the vial as this may inactivate insulin and form bubbles that lead to dosage errors. Roll non-regular insulin gently between hands to evenly disperse suspended ©2017 Achieve Test Prep Page 102 of 140