Situation No. 2

Patient K., 56 years old, was admitted to the therapeutic department. At the time of supervision, the patient complained of periodic dry mouth, a feeling of thirst, frequent urination, including at night (up to 4 times), weight loss of 13 kg over several months, sharp deterioration of vision, frequent attacks of dizziness, and genital itching. The patient indicates weakness and fatigue when performing homework, also worried about dizziness and headaches accompanying an increase in blood pressure to 150/90 mm. rt. Art., numbness of the limbs, difficulty moving.

Stage I Nursing examination:

Carrying out the first stage of the nursing process - nursing examination. During the nursing examination, we obtained the following data: Objectively: The general condition of the patient is satisfactory, consciousness is clear. Position – active. Appearance appropriate for age. Constitution type – normosthenic, height – 166 cm, weight – 75 kg. Body mass index – 27.8. The skin is clean, scratching in the abdomen, itching in the abdomen and vulva, visible mucous membranes - no changes. Subcutaneous fat tissue is evenly distributed. Muscle atrophy of the lower extremities was detected, there was no edema, and pulsation was preserved.
When examining the respiratory organs - form chest– normal, it symmetrically participates in the act of breathing. The respiratory rate is 18 per minute. Blood pressure is 150/90 mmHg, heart rate is 75, there is no pulse deficit. The boundaries of the heart are not changed. Heart sounds are rhythmic, muffled. The tongue is dry, the abdomen is symmetrical, there is a postoperative scar from a cesarean section in the lower part of the anterior abdominal wall. Symptoms of peritoneal irritation are negative.

Stage II Nursing diagnosis:

Stage II of the nursing process - disrupted needs are identified, problems are identified - real, potential, priority.

Patient problems:

Priority: thirst, itching of the skin and vulva, decreased vision, increased blood pressure, frequent urination.

Real: weakness, itching of the skin and vulva, weight gain, decreased vision, increased blood pressure, frequent urination, numbness of the limb, stiffness.

Potential: acute myocardial infarction, chronic renal failure, cataracts and diabetic retinopathy, angiopathy of the extremities.

Short-term - eliminate itching, thirst, normalize the amount of urination.

Long-term - normalize vision, blood pressure, nutrition through diet by the time of discharge.

Stage III Planning nursing interventions:

a) Patient preparation and collection biological material for laboratory research;

b) Conducting a conversation about the need to follow a diet;

c) Daily nursing examination, identifying patient problems and solving them through independent nursing interventions;

d) Carrying out medical prescriptions.

Stage IV Implementation of the nursing intervention plan:

a) Psychological support.

b) Provide assistance to the patient in meeting basic life needs.

c) Monitoring blood pressure, pulse, blood sugar levels, body weight.

d) Perform dependent interventions.

Stage V Efficiency assessment: Evaluation of the results of nursing interventions: The patient's condition has improved. The goal has been achieved.

Sister story

inpatient no.20453/683

Name medical institution _MU Central City Hospital of Torez

Date and time of receipt_ _05/06/2017 at 13:25 _Date and time of discharge _ 15.05.2017

Who referred the patient _CPMC family doctor Simushina T.A.

Sent to hospital for emergency indications: Yes, no (underline)

Through __year__ hours after the onset of illness or injury

hospitalized as planned: yes, No (emphasize)

Types of transportation: on a gurney, on a wheelchair, can go (underline)

Branch therapeutic department Ward __ №7__

Transferred to department _________ days 6______

FULL NAME. Khimochka Galina Ivanovna

Floor __ Female __ Age __ 56 years old (full years, for children under 1 year - months, up to 1 month - days)

Place of work, position ____ pensioner____

Occupational hazards: yes, No(underline), indicate which _____________

For disabled people, gender and disability group _____________________________________________

Permanent place of residence (telephone) b. Ilyich house 13 sq. 44__tel: 0666443214

Daughter: Valentina Ivanovna Bedilo, Torez, Moskovskaya str._35__tel:_0506478997

(enter the address, indicating for visitors the region, district, locality, address and telephone number of relatives)

Family/close people Daughter: Bedilo Valentina Ivanovna

Blood type __ I __ Rhesus - accessory ___ ___Rh+_____________

Allergy history:

medications ____No ____

Food allergen- ____ No _______

other _______________________________

Side effects of medications ____ ____________________ _________

name of the drug, nature of the side effect

Epidemiological history__ ______________________

(contact with infectious patients, travel outside the city or state, blood transfusion, injections, surgical interventions for the last 6 months)

Medical diagnosis diabetes mellitus type 2, newly diagnosed, severe form, decompensated.

Complications Diabetic retinal angiopathy. Diabetic peripheral angiopathy of the lower extremities. Distal sensory polyneuropathy of the lower extremities.

Nursing diagnoses: Thirst, polyuria, weakness, weight loss, itching of the skin and vulva, dizziness, blurred vision, numbness of the limb.

SUBJECTIVE EXAMINATION

History of illness:

1. Reason for contact, self-assessment of condition for a long time feels strong thirst and increased urination, dizziness, weight loss, body itching.

2. Attitude to the disease: adequate, denial, underestimation of the severity of the condition, exaggeration of the severity of the condition, retreat into illness __ adequate ______________________

3. Motivation for recovery (yes, weak, no) ____ There is ____________________

4. Expected result ___ the patient's well-being will improve ________________

5. Attitude to procedures: adequate, inadequate __ adequate _____________

6. Sources of information: patient, family, medical documents, friends, medical personnel and other sources ___ medical staff _____

7. Patient’s current complaints Thirst, increased urination, weakness, weight loss, itchy skin, dizziness, blurred vision, numbness of the limb.

8. Date of illness _06.05.2017_ Cause excess weight and poor nutrition.

the sequence of symptoms, their dynamics, intensity, localization of pain.

________________________________________________________________________

In the chronic course: duration of the disease, frequency and duration of exacerbations

9. What causes deterioration continuing to maintain this lifestyle.

10. What alleviates the condition (medicines, physiotherapeutic methods, etc.) sugar-lowering tablets and diet No. 8-9

11. How did the disease affect the patient’s lifestyle? I started eating right.

Anamnesis of life:

1. Conditions in which he grew up and developed grew and developed in normal conditions

2. Environment: proximity to hazardous industries, parking lots, highways, etc.

There is no environmental hazard.

3. Past illnesses, surgeries caesarean section at the age of 26

4. Sexual life (age, contraception, problems ) there is no sex life.

5. Gynecological history not burdened , preventive examinations annually.

last examination by a gynecologist, onset of menstruation, frequency, pain, profuseness, duration, last day,

_______One pregnancy, menopause since 45 years.

Number of pregnancies, abortions, miscarriages; menopause - age)

6. Allergic history (intolerance to food, medications, household chemicals) _ No __

7. Dietary features (what he prefers) prefers sweet foods, spicy foods, fatty foods.

8. Bad habits (smoking, at what age, how many pieces per day, drinking alcohol, drugs) I do not smoke

9. Spiritual status (culture, beliefs, entertainment, recreation, moral values) Orthodox

10. Social status (role in the family, at work, at school, financial situation) in the family mother, grandmother.

11. Heredity: the presence of the following diseases in blood relatives (underline): diabetes,

hypertension, ischemic heart disease, stroke, obesity, tuberculosis, mental illness and etc___________________

OBJECTIVE RESEARCH (underline as appropriate)

date 05.05.2017

1. Consciousness: clear, confused, missing.

2. Position in bed: active, passive , forced.

3. Height_ 166 Weight _ 75 _ Proper weight__ 66kg __ Weight before weight loss __88kg_

4. Body temperature__ _36.7 __

5. Condition of the skin and visible mucous membranes:

color ( pink, hyperemia, pallor, cyanosis, jaundice)

turgor reduced

humidity normal

defects scratching on the stomach.

scratches, diaper rash, bedsores, scars, rashes

scar after caesarean section__

damage, injection marks, scars, varicose veins (specify location)

swelling: yes, no __ No___

skin appendages: nails __fine__ hair __ fine _______ not detected

fragility, fungal infections, pediculosis

6. Lymph nodes are enlarged: yes, no ___No__

localization

7. Musculoskeletal system (specify location):

deformation of the skeleton (joints): yes, no ___No__

pain leg pain

stiffness ___No____

possibility of rotation; Yes, No muscle atrophy: yes, no__ No___

adaptive reactions (during amputation, paralysis)_____ No___

8. Respiratory system:

breath: deep, superficial, rhythmic, arrhythmic, noisy (underline, add) ______________

nature of shortness of breath: expiratory, inspiratory, mixed

chest excursion - symmetry: Yes, No

cough: dry, wet (underline)

Sputum: purulent, hemorrhagic, serous, foamy, with unpleasant smell

Amount of sputum:______________

9. The cardiovascular system:

Pulse (frequency, tension, rhythm, filling, symmetry, deficit) __75 beats Well filled, rhythmic, tense

BP on two arms: left 150/90 right 155/90

Pain in the heart area (underline)

§ character ( pressing, squeezing, stabbing, burning)

§ localization ( behind the sternum, in the area of ​​the apex, left half of the chest)

§ irradiation ( up, left, left collarbone, shoulder, under the shoulder blade)

§ duration ____20-30min___

§ heartbeat (constant , periodic)

§ factors that cause palpitations __from excitement__

§ how pain is relieved __corvalol__

Edema: yes, no (localization) __No__

Fainting conditions ____No____

Dizziness ___ frequent___

Numbness and tingling sensation in the extremities ___ Yes______

10. Gastrointestinal tract:

Appetite: unchanged, reduced, absent, increased __constant hunger__

Swallowing: normal, difficult normal

Removable dentures: yes, no No tongue coated: yes, no No nausea, vomiting: yes, no No

Heartburn No

Belching No

Hypersalivation, thirst Yes

Pain No

Having a stoma No

Chair: issued, constipation, diarrhea, incontinence, presence of impurities: mucus, blood, pus

Abdomen: normal shape, retracted, flat usual form.

Increased in volume: flatulence, ascites not enlarged

Asymmetrical: yes, no No

Palpation of the abdomen: painlessness b, soreness, tension, peritoneal irritation syndrome No

11. Urinary system:

Urination: free, difficult, painful, faster, incontinence, enuresis

Urine color ordinary, modified: hematuria, “beer”, “meat slop”

Transparency: Yes, No; daily amount of urine: normal, anuria, oliguria, polyuria

Pasternatsky's symptom No

Presence of a permanent catheter, stoma No

12. Endocrine system:

Hair type: male, female;

Distribution of subcutaneous fat: male type, female type;

Visible enlargement of the thyroid gland: yes, No.

13. Nervous system:

Sleep: normal, insomnia, restless; duration 6-8 hours

Are sleeping pills required: yes, no No

Tremor: yes, No; gait disturbance; Not really No

Paresis, paralysis yes, no No

14. Genital (reproductive) system: mammary glands: (size, asymmetry: yes , No) fine

DISTURBED NEEDS (UNDERLINE): breathe, eat, drink, excrete, move, maintaining temperature, sleeping and resting, dressing and undressing, being clean, sexual needs, avoiding danger, communicating, respect and self-esteem, self-actualization.

OBSERVATION DIARY

date	06.05.16	08.05.16	10.05.16	12.05.16	13.05.16	15.05.16
Observation days	Saturday	Monday	Wednesday	Friday	Saturday	Saturday
Mode	stationary	stationary	stationary	stationary	stationary	stationary
Diet	Table No. 9	Table No. 9	Table No. 9	Table No. 9	Table No. 9	Table No. 9
Complaints	Thirst, pov. Urination, dry mouth, itching of the skin and vulva, dizziness, numbness in the legs, stiffness.	Thirst, pov. Urination, dry mouth, itching, dizziness, numbness in legs, stiffness.	Thirst, moderate urination, itchy skin, dizziness, numbness in legs.	dry mouth, itchy skin, dizziness.	dry mouth, dizziness.	No complaints.
Dream	5-6 hours	6 hours	6.5 hours	8 ocloc'k	8 ocloc'k	8 ocloc'k
Appetite	Pov. appetite	Pov. appetite	Pov. appetite	good	good	good
Chair	Fine	Fine	Fine	Fine	Fine	Fine
Urination	increased	increased	increased	Not much increased	Fine	Fine
Hygiene (on your own, assistance required)	Help is needed	Help is needed	Help is needed	on one's own	on one's own	on one's own
Consciousness	clear	clear	clear	clear	clear	clear
Mood	bad	satisfactory	satisfactory	satisfactory	satisfactory	good
Range of motion	Passive and limited	Passive and limited	passive	active	active	active
Skin (color, clean, dry, rash, bedsores, etc.)		Pink, combed, moisturized.	Pink, combed, moisturized.	Pink, combed, moisturized.	Pink, clean	Clean, dry, pink.
Pulse
HELL	150/90	155/80	145/95	130/90	130/90	120/70
NPV
Palpation of the abdomen	Soft, painless	Soft, painless	Soft, painless	Soft, painless	Soft, painless	Soft, painless
Body temperature (morning, evening)	Morning 36.9 Evening 36.7	Morning 36.9 Evening 36.7	Morning 36.9 Evening 36.7	Morning 36.9 Evening 36.7	Morning 36.9 Evening 36.7	Morning 36.8 Evening 36.9
Complications during drug administration	none	none	none	none	none	none
Visitors	Daughter	Daughter, grandson	Daughter	Daughter, grandson	Daughter	Daughter

FULL NAME. Khimochka Galina Ivanovna

Branch Therapeutic

Diagnosis Newly diagnosed diabetes mellitus type II, severe form, decompensation stage

NURSE DIAGNOSIS SHEET

No.	Patient problems	Nursing diagnosis
1.	Thirst	Thirst is observed as a result of increased blood sugar in the patient.
2.	Increased urination (polyuria)	Polyuria is observed due to severe thirst in the patient, namely excessive fluid intake.
3.	Dizziness	Dizziness due to vascular damage throughout the body.
4.	Weakness	Weakness due to a violation of the general condition of the body.
5.	Weight loss	Weight loss due to disruption of the process of converting sugar into energy for the body.
6.	Itching of the skin and vulva	Itching of the skin due to impaired metabolism, and the accumulation of toxins in the body, which leads to contamination of the body, against the background of this, itching of the skin appears.
7.	Visual impairment	Visual impairment due to damage to the vessels of the retina, early development of cataracts.
8.	Numbness of the limbs	Numbness of the limbs due to damage to the nerve vessels and blood vessels limbs.

NURSING CARE PLAN

date	Patient problem	Goal (expected result)	Nursing interventions Actions of the nurse	Periodicity, frequency, frequency of assessment	End date for achieving the goal	Final assessment of the effectiveness of care
06.05	Thirst and increased urination	The condition is returning to normal	Limit the amount of water to 1.5-2 liters; Diuresis control; Blood sugar control; Explain the essence of diet No. 9 to the patient. Inform your doctor about your condition and test results. Dependent: 1. Follow the doctor’s orders: sugar-lowering tablets or insulin.	Daily	15.05	The patient's condition has improved
06.05	Itching of the skin and vulva	The itching will disappear	Carry out hygienic treatment of the skin in areas of scratching using a chamomile solution; Toilet the genitals with a diluted solution of potassium permanganate (1:10000) or chamomile solution. Change the patient's bed linen and underwear. Blood sugar control. Monitoring the patient's condition. Dependent: 1. Follow further doctor’s orders. 2. Apply the prescribed ointment or cream to the scratches. (baby cream)	Daily	15.05	The itching has disappeared
06.05	Dizziness	The condition will improve	Independent: 1. Bed rest; 2. Ventilate the room; Provide fresh air flow; Monitoring blood pressure, pulse, respiratory rate; Provide physical and mental peace;	Of necessity	15.05	Condition has improved
06.05	Numbness of the limbs	The condition will improve	Independent: 1. Reassure the patient; 2. Assess the patient’s condition; 3. Provide physical and mental peace; 4. Examine the limb for changes, palpate to determine sensitivity, determine the temperature of the limb 5. Cover the limbs with heating pads (if cold) 6. Notify the doctor. Dependent: 1. Follow doctor’s orders	Daily	13.05	Condition has improved
06.05	Weight loss by 13 kg.	Weight is normalized	Independent: 1. Reassure the patient; 2. Explain the course of your further actions; Obtain the patient's consent for the procedure. Measure the patient's weight on a scale. And control it every day. Explain the essence of diet No. 9 Tell your doctor about the weighing result. Dependent: 1. Follow doctor’s orders	Daily	15.05	Condition has improved
06.05	Visual impairment	Vision returns to normal	Independent: 1. Reassure the patient; 2. Assess the patient’s condition; Provide physical and mental peace; Monitoring blood pressure, pulse, respiratory rate; Tell your doctor. Dependents: 1. Follow the doctor’s orders: invite an ophthalmologist for a consultation. 2. Carry out further instructions for the patient.	Daily	15.05	Condition has improved

Some patients with diabetes can care for themselves and do not need outside care. But for many older people with various somatic pathologies or complications of diabetes, professional care is required, the task of which is to systematize both taking medications and planning a proper diet, physical activity, and personal hygiene.

Diabetes mellitus type 2 patient care, recommendations:

1. Care staff and the patient themselves should receive information about this disease. Healthy eating and physical activity, maintaining a normal weight and following doctor’s recommendations to control sugar levels are the leading factors for maintaining a quality life for a patient with diabetes.

2. If the patient smokes, then it is necessary to consult a doctor in order to find a way to get rid of this bad habit. Smoking increases the risk of various complications of diabetes, including heart attack, stroke, nerve damage and kidney damage. In fact, smokers with diabetes are three times more likely to die from cardiovascular disease than non-smokers with diabetes.

3. Maintain normal blood pressure and cholesterol levels in the blood. Just like diabetes, high blood pressure can damage blood vessels. High cholesterol levels can also become a problem for any person, and diabetes significantly increases the possibility of developing vascular atherosclerosis. And when there is a combination of these factors, the risk of developing such serious complications as a heart attack or stroke increases many times over. Eating healthy foods and exercising daily, as well as taking the necessary medications, can help you control your sugar and cholesterol levels.

4. Clear schedules for annual medical examinations and regular vision tests. Systematic examinations by doctors make it possible to diagnose complications of diabetes in the early stages and connect necessary treatment during. An eye doctor will check your eyes for signs of retinal damage, cataracts, and glaucoma.

5. Vaccination. High blood sugar can weaken the immune system, making routine immunizations more important than for the average person.

6. Taking care of your teeth and oral cavity. Diabetes may increase the risk of gum infections. You should brush your teeth at least twice a day, floss once a day, and visit your dentist at least twice a year. You should immediately contact your dentist if there is bleeding from the gums or visual swelling or redness.

7. High blood sugar can damage the nerves in the legs and reduce blood flow to the legs. If left untreated, cuts or blisters can lead to serious infections. To prevent foot problems you need to:

§ Wash your feet daily in warm water.

§ Dry your feet, especially between the toes.

§ Moisturize your feet and ankles with lotion.

§ Wear shoes and socks at all times. Never walk barefoot. Wear comfortable shoes that fit your feet well and protect your feet.

§ Protect feet from hot and cold exposure. Wear shoes on the beach or on hot asphalt. Do not put your feet in hot water. Test the water before you put your feet in. Never use hot water bottles, heating pads, or electric blankets. These measures are aimed at ensuring that the patient does not suffer leg damage due to decreased sensitivity due to diabetes.

§ Check your feet every day for blisters, cuts, sores, redness or swelling.

§ You should consult a doctor if you have leg pain or damage that does not go away within a few days.

8. Take aspirin daily. Aspirin reduces the blood's ability to clot. Taking aspirin daily can reduce the risk of heart attack and stroke, major complications in people with diabetes.

9. There are several things you can do to prevent skin problems:

§ Keep skin clean and dry. Use talc in areas where there are skin folds, such as the armpits and groin.

§ Avoid very hot baths and showers. Use moisturizing soaps.

§ Prevent dry skin. Scratching or scratching dry skin (if itchy) can lead to skin infection, so it is necessary to keep the skin moisturized to prevent cracking, especially in cold or windy weather.

§ Contact a dermatologist if problems cannot be resolved.

10.Physical activity. Exercising can help a diabetic patient lose weight and control blood sugar levels. Walking just 30 minutes a day, for example, can help stabilize your glucose levels. The greatest motivator for exercise is the person caring for the patient, who can encourage the patient to exercise. The level of load depends on the patient’s condition and in each individual case the load may be different.

CONCLUSION

In a practical study of the topic “The role of the nurse in organizing care for a patient with type II diabetes mellitus,” we described nursing process for: diabetes mellitus type 2 of moderate severity, stage of decompensation. And the second case of diabetes mellitus, newly diagnosed, severe, stage of decompensation. Caring for a disease in older people such as diabetes mellitus requires increased attention from nurses. The nurse should monitor the patient's condition, blood sugar levels, and report any changes to the patient's attending physician.

The practical part also provides general recommendations that are needed when caring for a patient with type 2 diabetes. For many older people with various complications of diabetes, professional care is required, the task of which is to systematize the intake of medications, plan a proper diet, physical activity, and personal hygiene.

I concluded that when timely treatment and proper patient care can improve the condition and prevent complications.

CONCLUSION

Type 2 diabetes mellitus is a chronic endocrine disease of the pancreas caused by increased blood sugar as a result of a relative lack of insulin (a hormone produced by the pancreas). Type 2 diabetes is called non-insulin-dependent; in this disease, tissue sensitivity to insulin is impaired (insulin resistance). Or insulin resistance is combined with insufficient production of pancreatic hormone.

Modern medicine claims that type 2 diabetes is caused by a combination of genetic and life factors, and the vast majority of cases of this disease are detected in people with increased body weight and obesity.

Since insulin deficiency in type 2 diabetes is not absolute, but relative, a sick person may not be aware of his disease for a long time and attribute some symptoms to poor health. At the initial stage, metabolic disorders are not very pronounced and often an overweight person does not even notice weight loss, since his appetite increases. But over time, the state of health worsens, weakness and other characteristic signs appear: itchy skin, dry mouth, polyuria, increased blood pressure, weakness, weight loss, thirst, blurred vision, numbness of the extremities.

The main complications in the patient may be microangiopathy, microangiopathy, polyneuropathy, arthropathy, and ophthalmopathy. With proper care, these complications can be prevented.

The nurse has a very major role in diagnosis. The type of diagnosis is prescribed by the doctor, and the nurse must tell the patient about the upcoming procedure and properly prepare him for the test: blood test, urine test, and glucose tolerance test.

Comprehensive treatment of the disease includes three main areas: following a low-carbohydrate diet, increasing physical activity, and taking medications that reduce blood glucose concentrations. Great value has a dietary adjustment. Following a diet at the initial stage of diabetes allows you to normalize carbohydrate metabolism, lose excess weight and reduce the production of glucose at the liver level. If you add to this an active lifestyle and giving up bad habits, you can avoid the rapid progression of the disease and live a full life for a long time.

The main prevention is a balanced diet, prevention of obesity, and physical activity.

Caring for such patients involves taking care of the skin, feet, and teeth. Explain to the patient how to properly care and why it needs to be done. It should be explained to such patients that their diagnosis is not a death sentence; if you take care of your health, you can even get rid of this illness. The basic principles for solving the problems of a patient with such a diagnosis were given in the practical part, and basic recommendations for caring for such patients were formulated.

BIBLIOGRAPHY

1 Ametov, A. S. Diabetes mellitus type 2 /: problems and solutions / A. S. Ametov. - M.: GEOTAR-Media, 2016. - 704 p.

2 Ametov, A. S. Modern approaches to the treatment of type 2 diabetes mellitus and its complications [Text] / A. S. Ametov, E. V. Doskina // Problems of endocrinology. - 2015. - No. 3. - P. 61-64. - Bibliography: p. 64 (16 titles).

3 Ametov, A. S. Modern approaches to the treatment of diabetic polyneuropathy [Text] / A. S. Ametov, L. V. Kondratyeva, M. A. Lysenko // Clinical therapy. - 2015. - No. 4. - P. 69-72. - Bibliography: p. 72

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• List of abbreviations
• Introduction
• 1.3 Classification
• 1.4 Etiology of diabetes mellitusIItype
• 1.5 Pathogenesis
• 1.6 Cynic picture
• 1.8 Treatment methods
• 1.9 The role of the nurse in care and rehabilitation for diabetesIItype
• 1.10 Clinical examination
• Chapter 2. Description of the material used and research methods used
• 2.1 Scientific novelty of the research
• 2.2 Dark chocolate in the fight against insulin resistance
• 2.3 History of chocolate
• 2.4 Research part
• 2.5 Basic principles of the diet
• 2.6 Diagnostics
• Chapter 3. Research results and discussion
• 3.1 Research results
• Conclusion
• List of used literature
• Applications

List of abbreviations

DM - diabetes mellitus

BP - blood pressure

NIDDM - non-insulin dependent diabetes mellitus

UAC - general analysis blood

OAM - general urine analysis

BMI - individual body weight

OT - waist circumference

DN - diabetic nephropathy

DNP - diabetic neuropathy

UFO - ultraviolet irradiation

IHD - coronary heart disease

SMT - sinusoidal modulated current

HBOT - hyperbaric oxygenation

UHF - ultra high frequency therapy

CNS - central nervous system

WHO - World Health Organization

Introduction

“Diabetes mellitus is the most dramatic page in modern medicine, since this disease is characterized by high prevalence, early disability and high mortality rates” Ivan Dedov, Director of the Endocrinological Research Center, 2007.

Relevance. Diabetes mellitus is a common disease and ranks third among the causes of death after cardiovascular diseases and cancer. Currently, according to WHO, there are already more than 175 million patients in the world, their number is growing steadily and by 2025 could reach 300 million. In Russia, over the past 15 years alone, the total number of patients with diabetes has doubled. Over the past 30 years, there has been a sharp rise in the incidence of type 2 diabetes mellitus, especially in major cities industrialized countries, where its prevalence is 5-7%, primarily in age groups 45 years and older, and developing countries, where the main age group is susceptible this disease. The rise in the prevalence of type 2 diabetes is associated with lifestyle factors, ongoing socioeconomic changes, population growth, urbanization and population aging. Calculations show that with increasing average duration In the upcoming life up to 80 years, the number of patients with type 2 diabetes will exceed 17% of the population.

Diabetes mellitus is dangerous due to complications. This disease has been known since ancient times. Even before our era, in Ancient Egypt, doctors described a disease resembling diabetes mellitus. The term “diabetes” (from the Greek “I pass through”) was first used by the ancient physician Aretaeus of Cappadocia. This is what he called copious and frequent urination, when it is as if “all the liquid” taken orally quickly passes through the body." In 1674, attention was first paid to the sweet taste of urine in diabetes. The discovery of insulin in 1921 is associated with the names of Canadian scientists Frederick Banting and Charles Best Insulin treatment was first developed by the English physician Lawrence, who himself suffered from diabetes.

In the 60-70s. In the last century, doctors could only watch helplessly as their patients died from complications of diabetes. However, already in the 70s. Methods for using photocoagulation to prevent the development of blindness and methods for treating chronic renal failure were developed in the 80s. - clinics have been created for the treatment of diabetic foot syndrome, which has allowed the frequency of amputations to be halved. A quarter of a century ago, it was difficult to even imagine how high the effectiveness of diabetes treatment could be achieved today. Thanks to the introduction of non-invasive methods of outpatient determination of glycemic levels into everyday practice, it was possible to achieve its careful control. The development of pen syringes (semi-automatic insulin injectors) and later “insulin pumps” (devices for continuous subcutaneous insulin administration) contributed to a significant improvement in the quality of life of patients.

The relevance of diabetes mellitus (DM) is determined by the extremely rapid increase in incidence. According to WHO in the world:

-every 10 seconds, 1 diabetic patient dies;

- about 4 million patients die annually - this is the same as from HIV infection and viral hepatitis;

-every year more than 1 million amputations of the lower extremities are performed in the world;

-more than 600 thousand patients completely lose their vision;

-approximately 500 thousand patients' kidneys stop working, which requires expensive hemodialysis treatment and inevitable kidney transplantation

diabetes mellitus nursing care

The prevalence of diabetes mellitus in the Russian Federation is 3-6%. In our country, according to 2001 data, more than 2 million patients were registered, of which about 13% were patients with type 1 diabetes mellitus and about 87% - type 2. However, the true incidence, as shown by studies epidemiological studies is 8-10 million people, i.e. 4-4.5 times higher.

According to experts, the number of patients on our planet in 2000 was 175.4 million, and in 2010 it increased to 240 million people.

It is quite obvious that the forecast of experts that the number of people with diabetes will double over every next 12-15 years is justified. Meanwhile, more accurate data from control and epidemiological studies conducted by the team of the Endocrinological Research Center in various regions of Russia over the past 5 years have shown that the true number of diabetic patients in our country is 3-4 times higher than officially registered and amounts to about 8 million people. (5.5% of the total population of Russia).

Chapter 1. Current state problem being studied

1.1 Anatomical and physiological features of the pancreas

The pancreas is an unpaired organ located in abdominal cavity on the left, surrounded by a loop of 12-point intestine on the left, and the spleen. The mass of the gland in adults is 80 g, length - 14-22 cm, in newborns - 2.63 g and 5.8 cm, in children 10-12 years old - 30 cm and 14.2 cm. The pancreas performs 2 functions: exocrine ( enzymatic) and endocrine (hormonal).

Exocrine function consists in the production of enzymes involved in digestion, processing of proteins, fats and carbohydrates. The pancreas synthesizes and secretes about 25 digestive enzymes. They are involved in the breakdown of amylase, proteins, lipids, and nucleic acids.

Endocrine function perform special structures of the pancreas - the islets of Langerhans. Researchers focus on β cells. They produce insulin, a hormone that regulates blood glucose levels and also affects fat metabolism,

d - cells producing somatostatin, b-cells producing glucagon, PP - cells producing polypeptides.

1.2 The role of insulin in the body

I. Maintains blood sugar levels within the range of 3.33-5.55 mmol/l.

II. Promotes the conversion of glucose into glycogen in the liver and muscles; glycogen is a “depot” of glucose.

III. Increases the permeability of the cell wall to glucose.

IV. Inhibits the breakdown of proteins and converts them into glucose.

V. Regulates protein metabolism, stimulating protein synthesis from amino acids and their transport into cells.

VI. Regulates fat metabolism, promoting the formation fatty acids.

The significance of other pancreatic hormones

I. Glucagon, like insulin, regulates carbohydrate metabolism, but the nature of its action is directly opposite to the action of insulin. Under the influence of glucagon, glycogen is broken down into glucose in the liver, resulting in an increase in blood glucose levels.

II. Somastotin regulates insulin secretion (inhibits it).

III. Polypeptides. Some affect the enzymatic function of the gland and the production of insulin, others stimulate appetite, and others prevent fatty liver degeneration.

1.3 Classification

There are:

1. Insulin-dependent diabetes (type 1 diabetes), which develops mainly in children and young people;

2. Non-insulin-dependent diabetes (type 2 diabetes mellitus) - usually develops in people over 40 years of age who have overweight. This is the most common type of disease (occurs in 80-85% of cases);

3. Secondary (or symptomatic) diabetes mellitus;

4. Diabetes in pregnant women.

5. Diabetes due to malnutrition.

1.4 Etiology of diabetes mellitus type II

The main factors that provoke the development of type 2 diabetes mellitus are obesity and hereditary predisposition.

1. Obesity. In the presence of obesity I degree. The risk of developing diabetes mellitus increases by 2 times, with stage II. - 5 times, at stage III. - more than 10 times. The development of the disease is more associated with the abdominal form of obesity - when fat is distributed in the abdominal area.

2. Hereditary predisposition. If your parents or immediate relatives have diabetes, the risk of developing the disease increases 2-6 times.

1.5 Pathogenesis

Diabetes mellitus (lat. diabetesmellotus) is a group of endocrine diseases that develop as a result of insufficiency of the hormone insulin, resulting in the development of hyperglycemia - a persistent increase in blood glucose levels. The disease is characterized chronic course and disorders of all types of metabolism: carbohydrate, fat, protein, mineral and water-salt.

Diabetes mellitus symbol according to UN classification

IN basis pathogenesis NIDSD lie three main mechanism:

· Insulin secretion is impaired in the pancreas;

· Peripheral tissues (primarily muscles) become resistant to insulin, which leads to disruption of glucose transport and metabolism;

· Glucose production increases in the liver.

The main cause of all metabolic disorders and clinical manifestations of diabetes is a deficiency of insulin or its action.

Non-insulin-dependent diabetes mellitus (NIDDM, type II) affects 85% of patients with diabetes mellitus. Previously, this type of diabetes was called adult-onset diabetes or diabetes of the elderly. In this variant of the disease, the pancreas is completely healthy and always releases into the blood an amount of insulin that corresponds to the concentration of glucose in the blood. The “organizer” of the disease is the liver. The blood glucose level in this type of diabetes mellitus is elevated only due to the inability of the liver to accept excess glucose from the blood for temporary storage. Both glucose and insulin levels in the blood are simultaneously elevated. The pancreas is forced to constantly replenish the blood with insulin and maintain its elevated level. Insulin levels will constantly follow glucose levels, rising or falling.

Acidosis, the appearance of an acetone odor from the mouth, a precomatous state, and diabetic coma are fundamentally impossible with NIDDM, because the level of insulin in the blood is always optimal. There is no insulin deficiency in NIDDM. Accordingly, NIDDM is much easier than IDDM.

1.6 Cynic picture

· Hyperglycemia;

· Obesity;

· Hyperinsulinemia (increased insulin levels in the blood);

· Hypertension

· Cardiovascular diseases (CHD, myocardial infarction);

Diabetic retinopathy (decreased vision), neuropathy (decreased sensitivity, dryness and flaking skin, pain and cramps in the limbs);

· Nephropathy (excretion of protein in the urine, increased blood pressure, impaired renal function).

1. When first visiting a doctor, the patient usually has classic symptoms of diabetes mellitus - polyuria, polydipsia, polyphagia, severe general and muscle weakness, dry mouth (due to dehydration and decreased function of the salivary glands), itching (in the genital area in women).

· There is a decrease in visual acuity.

· Patients notice that after drops of urine dry on their underwear and shoes, white spots remain.

2. Many patients consult a doctor about itching, boils, fungal infections, leg pain, and impotence. The examination reveals non-insulin-dependent diabetes mellitus.

3. Sometimes there are no symptoms and the diagnosis is made by random examination of urine (glucosuria) or blood (fasting hyperglycemia).

4. Often, non-insulin-dependent diabetes mellitus is first detected in patients with myocardial infarction or stroke.

5. The first manifestation may be hyperosmolar coma.

Symptoms from the outside various organs and systems:

Leather And muscular system. There is often dry skin, a decrease in its turgor and elasticity, recurrent furunculosis, hydroadenitis, fungal skin lesions are often observed, nails are brittle, dull, with striations and a yellowish color. Sometimes vitelligo appears on the skin.

System organs digestion. The most common changes are: progressive caries, periodontal disease, loosening and hair loss, gingivitis, stomatitis, chronic gastritis, diarrhea, rarely peptic ulcer stomach and duodenum.

Cordially - vascular system. Diabetes mellitus contributes to the early development of atherosclerosis and ischemic heart disease. IHD in diabetes develops earlier, is more severe and causes complications more often. Myocardial infarction is the cause of death in almost 50% of patients.

Respiratory system. Patients are predisposed to pulmonary tuberculosis and frequent pneumonia. They suffer from acute bronchitis and are predisposed to its transition to a chronic form.

excretory system. Cystitis, pyelonephritis are common, and there may be a carbuncle or kidney abscess.

NIDDM develops gradually, unnoticeably and is often diagnosed accidentally during routine examinations.

1.7 Complications of diabetes

Complications sugar diabetes share on spicy And late.

TO number acute include: ketoacidosis, ketoacidotic coma, hypoglycemic states, hypoglycemic coma, hyperosmolar coma.

Late complications: diabetic nephropathy, diabetic neuropathy, diabetic retinopathy, delayed physical and sexual development, infectious complications.

Acute complications of diabetes mellitus.

Ketoacidosis And ketoacidotic coma.

The leading mechanism of origin of the disease is absolute insulin deficiency, leading to a decrease in the processing of glucose by insulin-dependent tissues, hyperglycemia and energy “hunger”, high physical activity, and significant alcohol load.

Clinic: gradual onset, increasing dryness of mucous membranes, skin, thirst, polyuria, weakness, headache, weight loss, the smell of acetone in the exhaled air, repeated vomiting, noisy breathing, muscle hypotension, tachycardia.

The final stage of central nervous system depression is coma. Treatment consists of combating dehydration and hypovolemia, eliminating intoxication by administering fluids (orally in the form of mineral and drinking water, intravenously in the form of saline, 5% glucose solution, rheopolyglucin).

Hypoglycemic state And hypoglycemic coma.

Hypoglycemia is a decrease in blood sugar levels. In 3-4% of cases, hypocoma is the cause fatal outcome diseases. The main reason leading to the development of hypoglycemia is the discrepancy between the amount of glucose in the blood and the amount of insulin in a specific period of time. Typically, such an imbalance occurs due to an overdose of insulin due to intense physical activity, diet disorders, liver pathology, and alcohol intake.

Hypoglycemic conditions develop suddenly: mental functions decrease, drowsiness appears, sometimes excitability, an acute feeling of hunger, dizziness, headache, internal trembling, convulsions.

There are 3 degrees of hypoglycemia: mild, moderate and severe.

Mild hypoglycemia: sweating, a sharp increase in appetite, palpitations, numbness of the lips and tip of the tongue, weakening of attention, memory, weakness in the legs.

With moderate forms of hypoglycemia, additional symptoms appear: trembling, blurred vision, thoughtless actions, loss of orientation.

Severe hypoglycemia is manifested by loss of consciousness and convulsions.

Characteristic signs of hypoglycemia are: sudden weakness, sweating, trembling, restlessness, and feeling hungry.

Consequences of hypoglycemic coma. The immediate ones (a few hours after the coma) are hemiparesis, hemiplegia, myocardial infarction, cerebrovascular accident. Distant - develop over a few days or weeks. They are manifested by encephalopathy (headaches, memory loss, epilepsy, parkinsonism.

Treatment begins immediately upon diagnosis with intravenous bolus injection of 20-80 ml of 40% glucose until consciousness is restored. Intramuscular or subcutaneous administration of 1 ml of glucagon is recommended. Mild hypoglycemia can be relieved by the usual intake of food and carbohydrates (3 pieces of sugar, or 1 tablespoon of granulated sugar, or 1 glass of sweet tea or juice.)

Hyperosmolar coma. The reasons for its development are increased levels of sodium, chlorine, sugar, and urea in the blood. It occurs without ketoacidosis and develops within 5-14 days. Neurological symptoms predominate in the clinic: impaired consciousness, muscle hypertonicity, nystagmus, paresis. Dehydration, oliguria, and tachycardia are pronounced. Emergency care should begin with the administration of a hypotonic (0.45%) sodium chloride solution and 0.1 U/kg insulin.

Late complications of diabetes

Diabetic nephropathy (DN) - specific damage to the vessels of the kidneys is the main cause of premature death in patients with diabetes mellitus from uremia and cardiovascular diseases. Leads to the development of chronic renal failure.

Diabetic retinopathy - damage to the retina in the form of microaneurysms, pinpoint and spotty hemorrhages, hard exudates, edema, and the formation of new vessels. It ends with hemorrhages in the fundus and can lead to retinal detachment. Initial stages retinopathy is detected in 25% of patients with newly diagnosed type 2 diabetes mellitus. The incidence of retinopathy increases by 8% per year, so that after 8 years from the onset of the disease, retinopathy is detected in 50% of all patients, and after 20 years in approximately 100% of patients.

Diabetic neuropathy (DPN) is a common complication of diabetes. The clinic consists of the following symptoms: night cramps, weakness, muscle atrophy, tingling, tension, crawling, pain, numbness, decreased tactile and pain sensitivity.

By medical statistics Clinic No. 13, I identified complications and mortality in patients with diabetes, indicating the immediate cause of death for 2014

1.8 Treatment methods

Treatment with oral hypoglycemic drugs (OHDs)

Classification:

I. Alpha-glucosidase inhibitors, which slow down the absorption of carbohydrates into small intestine(glucobay).

II. Sulfonylureas (stimulate the release of insulin from β-cells, enhance its effect). These are Chlorpropamide (Diabetoral), Tolbutamide (Orabet, Orinaza, Butamide), Gliclazide (Diabeton), Glibenclamide (Maninil, Gdyukobene).

III. Biguanides (utilize glucose, reduce glucose production by the liver and its absorption in the gastrointestinal tract, enhance the effect of insulin: Phenformin (Dibotin), Metformin, Buformin.

IV. Thiazolidinedione derivatives - Diaglitazone (change the metabolism of glucose and fats, improve the penetration of glucose into tissues).

V. Insulin therapy

VI. Combination therapy (insulin + oral hypoglycemic drugs - PSP).

IV. Crestor (Reduces elevated cholesterol concentrations. primary prevention major cardiovascular complications.)

VII. Atacand (Used for arterial hypertension.)

Diet therapy in patients with type II diabetes

Diet therapy for type II diabetes mellitus differs little from dietary approaches for type I diabetes mellitus. If possible, you should reduce your caloric intake. It is recommended to prescribe a diet with a calorie content of 20-25 kcal per kg of actual body weight.

Using the table, you can determine your body type and daily energy requirement.

In the presence of obesity, caloric intake decreases according to the percentage of excess body weight to 15-17 kcal per kg (1100-1200 kcal per day). Daily caloric intake: carbohydrates - 50%, proteins - 15-20%, fats - 30-35%.

Dietary fat distribution: 1/3 saturated fat, 1/3 simple unsaturated fatty acids, 1/3 polyunsaturated fatty acids ( vegetable oils, fish)

It is necessary to determine “hidden fats” in foods. They may be found in frozen and canned foods. Avoid products containing 3 g or more fat per 100 g of product.

	main sources
Reducing fat intake	butter, sour cream, milk, hard and soft cheeses
Reducing intake of saturated fatty acids	pork, duck meat, cream, coconuts
3. Increased consumption of foods high in protein and low in saturated fatty acids	fish, chicken, turkey meat, game.
4. Increasing consumption of complex carbohydrates and fiber	all types of fresh and frozen vegetables and fruits, all types of grains, rice
5. slight increase in the content of simple unsaturated and polyunsaturated fatty acids	sunflower, soybean, olive oil
Reduced cholesterol intake	brain, kidneys, tongue, liver

1. Fractional meals

2. Limit your intake of saturated fats

3. Exclusion from the diet of mono- and polysaccharides

4. Reduce cholesterol intake

5. Eating foods high in dietary fiber. Dietary fiber improves the processing of carbohydrates by tissues, reduces the absorption of glucose in the intestine, which helps reduce glycemia and glycosuria.

6. Reduce alcohol intake

Individual weight body determined By formula:

Using BMI, you can assess the risk of developing type II diabetes, as well as atherosclerosis and arterial hypertension.

BMI and associated health risks

		health risk	Events
underweight		absent
		absent
excess body weight		elevated	weight loss
obesity		very tall
severe obesity		extremely high	immediate weight loss

Waist circumference (WC) is a simple indicator by which you can judge how susceptible you are to the above diseases. OT for women should be at least 88 cm, and for men - less than 102 cm.

Physical activity and calorie expenditure

In patients with diabetes, various types of physical activity consume a certain amount of calories, which must be immediately replenished. When resting in a sitting position, 100 kcal are consumed per hour, the same amount of calories contained in 1 apple or 20 g of peanuts. Walking for an hour at a speed of 3-4 km/h burns 200 kcal, the same amount of calories contained in 100 g of ice cream. Riding a bicycle at a speed of 9 km/h consumes 250 kcal/h, the same amount of kcal contained in 1 meat pie.

Reducing body weight to an optimal level is beneficial for everyone fat people, but especially for patients with type II diabetes mellitus. Physical exercise plays a huge role in losing weight and improving health. Exercise has been shown to reduce resistance (in other words, increase sensitivity) to insulin, which can improve glycemic control even regardless of the degree of weight loss. In addition, the influence of risk factors for the development of cardiovascular diseases is reduced (for example, high blood pressure is reduced). For type II diabetes, moderate-intensity exercise (walking, aerobics, resistance exercise) for 30 minutes daily is recommended. However, they must be systematic and strictly individual, since in response to physical activity several types of reactions are possible: hypoglycemic states, hyperglycemic states (in no case should you start physical exercise when your blood sugar is more than mol/l), metabolic changes up to ketoacidosis, fiber detachment.

Surgical methods for treating diabetes mellitus

This year marks 120 years since the first attempt to transplant a pancreas into a diabetic patient. But to date, transplantation has not been widely introduced into the clinic due to its high cost and frequent rejection. Pancreas and b-cell transplants are currently being attempted. In most cases, rejection and death of the graft occur, which complicates and limits the use of this treatment method.

Insulin dispensers

Insulin dispensers - "insulin pump" - are small devices with an insulin reservoir, fixed on the belt. They are designed in such a way that insulin is administered subcutaneously through a tube at the end of which there is a needle, continuously for 24 hours a day.

Positive aspects: they allow you to achieve good compensation for diabetes, eliminating the use of syringes and repeated injections.

Negative aspects: dependence on the device, high cost.

Physiotherapeutic prophylactic agents

Physiotherapy indicated for mild diabetes, the presence of angiopathy, neuropathies. Contraindicated in severe diabetes, ketoacidosis. Physical factors in patients are applied to the pancreas area to stimulate it for a general effect on the body and prevent complications. SMT (sinusoidal modulated currents) help lower blood sugar levels and normalize fat metabolism. A course of 12-15 procedures. Electrophoresis of SMT with a medicinal substance. for example with adebit, manilin. They use nicotinic acid, magnesium preparations (reduce blood pressure), potassium preparations (necessary for the prevention of seizures)

Ultrasound prevents the occurrence of lipodystrophy. Course of 10 procedures.

UHF- procedures improve the function of the pancreas and liver. A course of 12-15 procedures.

Ural Federal District stimulates general metabolism, increases the barrier properties of the skin.

HBO ( hyperbaric oxygenation) - treatment and prevention with oxygen under high blood pressure. This type of exposure is necessary for people with diabetes, as they have oxygen deficiency.

Balneo- and spa-therapeutic prophylactic agents

Balneotherapy is the use of mineral waters for therapeutic and preventive purposes. For diabetes, it is recommended to use mineral waters, which have a beneficial effect on blood sugar levels and the removal of acetone from the body.

Carbon dioxide, oxygen, and radon baths are useful. Temperature 35-38 C, 12-15 minutes, course 12-15 baths.

Resorts with drinking mineral waters: Essentuki, Borjomi, Mirgorod, Tatarstan, Zvenigorod

Herbal medicine for diabetes

Chokeberry (Rowan) chokeberry reduces the permeability and fragility of blood vessels, use drinks made from berries.

Hawthorn improves metabolism

Cowberry - has a general strengthening, tonic, uroseptic effect

Cranberry- quenches thirst, improves well-being.

Tea mushroom- for hypertension and nephropathy

1.9 The role of the nurse in care and rehabilitation for type II diabetes

Nursing care for diabetes

In everyday life, nursing (compare - to look after, take care) is usually understood as providing assistance to a patient in meeting his various needs. These include eating, drinking, washing, moving, and emptying the bowels and bladder. Care also implies creating optimal conditions for the patient to stay in a hospital or at home - peace and quiet, a comfortable and clean bed, fresh underwear and bed linen, etc. The importance of nursing cannot be overstated. Often, the success of treatment and the prognosis of the disease are entirely determined by the quality of care. Thus, it is possible to perform a complex operation flawlessly, but then lose the patient due to the progression of congestive inflammatory phenomena of the pancreas that arose as a result of his long-term forced immobility in bed. It is possible to achieve a significant restoration of damaged motor functions of the limbs after a cerebrovascular accident or complete fusion of bone fragments after a severe fracture, but the patient will die due to bedsores formed during this time as a result of poor care.

Thus, nursing is a must integral part the entire treatment process, which greatly influences its effectiveness.

Caring for patients with organ diseases endocrine systems s usually includes a number of general measures carried out for many diseases of other organs and systems of the body. Thus, in case of diabetes mellitus, it is necessary to strictly adhere to all the rules and requirements for caring for patients experiencing weakness (regular measurement of blood glucose levels and keeping records on sick leave, monitoring the state of the cardiovascular and central nervous systems, oral care, feeding and urinal, timely change of underwear, etc.) When the patient stays in bed for a long time, special attention is paid to careful skin care and the prevention of bedsores. At the same time, caring for patients with diseases of the endocrine system also involves performing a number of additional measures associated with increased thirst and appetite, skin itching, frequent urination and other symptoms.

1. The patient must be positioned with maximum comfort, since any inconvenience and anxiety increase the body’s need for oxygen. The patient should lie on the bed with the head end elevated. It is necessary to frequently change the patient's position in bed. Clothing should be loose, comfortable, and not restrict breathing and movement. The room where the patient is located requires regular ventilation (4-5 times a day) and wet cleaning. The air temperature should be maintained at 18-20°C. Sleeping in the fresh air is recommended.

2. It is necessary to monitor the cleanliness of the patient’s skin: regularly wipe the body with a warm, damp towel (water temperature - 37-38°C), then with a dry towel. Particular attention should be paid to natural folds. First, wipe the back, chest, stomach, arms, then dress and wrap the patient, then wipe and wrap the legs.

3. Nutrition must be complete, properly selected, specialized. Food should be liquid or semi-liquid. It is recommended to feed the patient in small portions, often, easily absorbed carbohydrates (sugar, jam, honey, etc.) are excluded from the diet. After eating and drinking, be sure to rinse your mouth.

4. Monitor the mucous membranes of the oral cavity for timely detection of stomatitis.

5. Physiological functions and compliance of diuresis with the liquid consumed should be monitored. Avoid constipation and flatulence.

6. Regularly follow the doctor’s orders, trying to ensure that all procedures and manipulations do not cause significant anxiety to the patient.

7. In case of a severe attack, it is necessary to raise the head of the bed, provide access to fresh air, warm the patient’s feet with warm heating pads (50-60°C), and give hypoglycemic and insulin medications. When the attack disappears, they begin to give food in combination with sweeteners. From the 3-4th day of illness at normal body temperature, you need to carry out distraction and unloading procedures: a series of light exercises. In the 2nd week, you should begin to perform physical therapy exercises, massage of the chest and limbs (light rubbing, in which only the part of the body being massaged is exposed).

8. If the body temperature is high, it is necessary to uncover the patient; in case of chills, rub the skin of the torso and limbs with light movements with a 40% solution of ethyl alcohol using a rough towel; if the patient has a fever, the same procedure is carried out using a solution table vinegar in water (vinegar and water - in a ratio of 1: 10). Apply an ice pack or a cold compress to the patient’s head for 10-20 minutes, the procedure must be repeated after 30 minutes. Cold compresses can be applied to large vessels in the neck, armpit, on the elbow and popliteal fossae. Do a cleansing enema with cool water (14-18°C), then a therapeutic enema with a 50% analgin solution (mix 1 ml of solution with 2-3 teaspoons of water) or insert a suppository with analgin.

9. Carefully monitor the patient, regularly measure body temperature, blood glucose level, pulse, respiratory rate, blood pressure.

10. Throughout his life, the patient is under dispensary observation (examinations once a year).

Nursing examination of patients

The nurse establishes a trusting relationship with the patient and clarifies complaints: increased thirst, frequent urination. The circumstances of the occurrence of the disease are clarified (heredity burdened by diabetes, viral infections, causing damage to the islets of Langerhans of the pancreas), what day of illness, what is the level of glucose in the blood at the moment, what medications were used. During the examination, the nurse pays attention to the patient’s appearance (the skin has a pink tint due to the expansion of the peripheral vascular network; boils and other pustular skin diseases often appear on the skin). Measures body temperature (elevated or normal), palpably determines respiratory rate (25-35 per minute), pulse (fast, weak filling), measures blood pressure.

Definition problems patient

Possible nursing diagnoses:

· violation of the need to walk and move in space - chilliness, weakness in the legs, pain at rest, ulcers of the legs and feet, dry and wet gangrene;

· pain in the lower back when lying down - the cause may be the occurrence of nephroangiosclerosis and chronic renal failure;

· attacks and loss of consciousness are intermittent;

increased thirst - the result of increased glucose levels;

· frequent urination - a means of removing excess glucose from the body.

Nursing intervention plan

Patient problems:

A. Existing (present):

- thirst;

- polyuria;

drynessskin;

- cutaneousitching;

- elevatedappetite;

increasedweightbodies,obesity;

- weakness,fatigue;

decreased visual acuity;

- heartache;

pain in the lower extremities;

- the need to constantly follow a diet;

- the need for constant administration of insulin or taking antidiabetic drugs (Maninil, Diabeton, Amaryl, etc.);

Lack of knowledge about:

- the essence of the disease and its causes;

- diet therapy;

- self-help for hypoglycemia;

- foot care;

- calculating bread units and creating menus;

- using a glucometer;

- complications of diabetes mellitus (comas and diabetic angiopathy) and self-help for comas.

B. Potential:

- precomatose and comatose states:

- gangrene of the lower extremities;

- IHD, angina pectoris, acute myocardial infarction;

- chronic renal failure;

- cataracts, diabetic retinopathy;

pustular skin diseases;

- secondary infections;

- complications due to insulin therapy;

- slow healing of wounds, including postoperative wounds.

Short-term goals: reducing the intensity of the patient's listed complaints.

Long-term goals: achieve diabetes compensation.

Independent actions of the nurse

Actions	Motivation
Measure temperature, blood pressure, blood glucose level;	Collection of nursing information;
Define qualities pulse, respiratory rate, blood glucose level;	Monitoring the patient's condition;
Provide clean, dry, warm bed	Create favorable conditions for improving the patient's condition,
ventilate the room, but do not overcool the patient;	oxygenation with fresh air;
Wet cleaning of the room with disinfectant solutions quartz chamber;	Prevention of nosocomial infections;
Washing with antiseptic solutions;	Skin hygiene;
Ensure turning and sitting up in bed;	Avoiding violation of the integrity of the skin - the appearance of bedsores; Prevention of congestion in the lungs - prevention of congestive pneumonia
Conduct conversations with the patient about chronic pancreatitis, diabetes mellitus;	Convince the patient that chronic pancreatitis, diabetes mellitus is a chronic disease, but with permanent treatment it is possible for the patient to achieve improvement;
Provide popular science new literature on diabetes mellitus.	Expand information about the disease sick.

Dependent actions of the nurse

Rp: Sol. Glucosi 5% - 200 ml D. S. For intravenous drip infusion.	Artificial nutrition during hypoglycemic coma;
Rp: Insulini 5ml (1ml-40 ED) D.S. for subcutaneous administration, 15 units 3 times a day 15-20 minutes before meals.	Replacement therapy
Rp: Tab. Glucobai0 .0 5 D. S. insideafterfood	Enhances the hypoglycemic effect, slows down the absorption of carbohydrates in the small intestine;
Rp: Tab. Maninili 0.005 No. 50 D. S Orally, morning and evening, before meals, without chewing	Hypoglycemic drug, Reduces the risk of developing all complications of non-insulin-dependent diabetes mellitus;
Rp: Tab. Metformini 0.5 No. 10 D.S After meals	Utilize glucose, reduce glucose production by the liver and its absorption in the gastrointestinal tract;
Rp: Tab. Diaglitazoni 0.045 No. 30 D.S after eating	Reduces the release of glucose from the liver, changes the metabolism of glucose and fats, improves the penetration of glucose into tissues;
Rp: Tab. Crestori 0.01 No. 28 D.S after eating	Reduces elevated cholesterol concentrations. primary prevention of major cardiovascular complications;
Rp: Tab. Atacandi 0.016 No. 28 D.S after eating	For arterial hypertension.

Interdependent actions of the nurse:

Ensure strict adherence to diet No. 9;	Moderate restriction of fats and carbohydrates;
	Improving blood circulation and trophism of the lower extremities;
Physiotherapy: Electrophoresis: a nicotinic acid magnesium preparations potassium preparations copper preparations Ultrasound	Helps reduce blood sugar levels, normalizes fat metabolism; Improves pancreatic function, dilates blood vessels; reduce blood pressure; prevention of seizures; prevention of seizures, lowering blood sugar levels; preventing the progression of retinopathy; Improves pancreas and liver function; Prevents the occurrence of lipodystrophy; Stimulates general metabolism, calcium and phosphorus metabolism; prevention of diabetic neuropathy, development of foot lesions and gangrene;

Evaluation of effectiveness: the patient's appetite decreased, body weight decreased, thirst decreased, pollakiuria disappeared, the amount of urine decreased, dry skin decreased, itching disappeared, but general weakness remained when performing normal physical activity.

Emergency conditions for diabetes mellitus:

A. Hypoglycemic state. Hypoglycemic coma.

Overdose of insulin or antidiabetic tablets.

Lack of carbohydrates in the diet.

Not eating enough or skipping meals after taking insulin.

Hypoglycemic conditions are manifested by a feeling of severe hunger, sweating, trembling of the limbs, and severe weakness. If this condition is not stopped, then the symptoms of hypoglycemia will increase: trembling will intensify, confusion in thoughts, headache, dizziness, double vision, general anxiety, fear, aggressive behavior will appear, and the patient will fall into a coma with loss of consciousness and convulsions.

Symptoms of hypoglycemic coma: the patient is unconscious, pale, and there is no smell of acetone from the mouth. the skin is moist, profuse cold sweat, muscle tone is increased, breathing is free. Blood pressure and pulse are not changed, the tone of the eyeballs is not changed. In the blood test, the sugar level is below 3.3 mmol/l. there is no sugar in urine.

Self-help for hypoglycemic conditions:

It is recommended that at the first symptoms of hypoglycemia, eat 4-5 pieces of sugar, or drink warm sweet tea, or take 10 glucose tablets of 0.1 g, or drink from 2-3 ampoules of 40% glucose, or eat a few candies (preferably caramel ).

First aid for hypoglycemic conditions:

Call a doctor.

Call a laboratory assistant.

Place the patient in a stable lateral position.

Place 2 pieces of sugar behind the cheek on which the patient is lying.

Prepare medications:

40 and 5% glucose solution. 0.9% sodium chloride solution, prednisolone (amp.), hydrocortisone (amp.), glucagon (amp.).

B. Hyperglycemic (diabetic, ketoacidotic) coma.

Insufficient dose of insulin.

Diet violation (increased carbohydrate content in food).

Infectious diseases.

Stress.

Pregnancy.

Surgical intervention.

Precursors: increased thirst, polyuria, possible vomiting, decreased appetite, blurred vision, unusually strong drowsiness, irritability.

Symptoms of coma: lack of consciousness, smell of acetone from the mouth, hyperemia and dry skin, noisy deep breathing, decreased muscle tone- "soft" eyeballs. The pulse is threadlike, blood pressure is reduced. In the blood test - hyperglycemia, in the urine test - glucosuria, ketone bodies and acetone.

If warning signs of coma appear, immediately contact an endocrinologist or call him at home. If there are signs of hyperglycemic coma, urgently call the emergency room.

First aid:

Call a doctor.

Place the patient in a stable lateral position (prevention of tongue retraction, aspiration, asphyxia).

Take urine with a catheter for express diagnostics of sugar and acetone.

Provide intravenous access.

Prepare medications:

Insulin short acting- actropid (fl.);

0.9% sodium chloride solution (vial); 5% glucose solution (vial);

Cardiac glycosides, vascular agents.

1.10 Clinical examination

Patients are under the supervision of an endocrinologist for life; glucose levels are determined monthly in the laboratory. At diabetes school, they learn how to self-monitor their condition and adjust their insulin dose.

Dispensary observation of endocrinological patients at health care facilities MBUZ No. 13 outpatient department №2

The nurse teaches patients how to keep a diary on self-monitoring of their condition and reaction to insulin administration. Self-control is the key to managing diabetes. Each patient must be able to live with their illness and, knowing the symptoms of complications and insulin overdoses, cope with this or that condition at the right time. Self-control allows you to lead a long and active life.

The nurse teaches the patient to independently measure blood sugar levels using test strips for visual determination; use a device to determine blood sugar levels, and also use test strips to visually determine sugar in the urine.

Under the supervision of a nurse, patients learn to inject themselves with insulin using a syringe - pens or insulin syringes.

Where need to keep insulin ?

Opened vials (or refilled syringe pens) can be stored at room temperature, but not in light at a temperature not exceeding 25° C. The insulin supply should be stored in the refrigerator (but not in the freezer compartment).

Places introduction insulin

Hips - outer third of thigh

Abdomen - anterior abdominal wall

Buttocks - upper outer square

How Right conduct injections

To ensure complete absorption of insulin, injections should be made into the subcutaneous fat and not into the skin or muscle. If insulin is administered intramuscularly, the process of insulin absorption is accelerated, which provokes the development of hypoglycemia. When administered intradermally, insulin is poorly absorbed

“Diabetes schools,” which teach all this knowledge and skills, are organized at endocrinology departments and clinics.

Historical development of diabetes mellitus. The main causes of diabetes mellitus, its clinical features. Diabetes mellitus in old age. Diet for type II diabetes mellitus, pharmacotherapy. Nursing process for diabetes mellitus in the elderly.

course work, added 12/17/2014

The influence of the pancreas on physiological processes in the body. Clinical manifestations and types of diabetes mellitus. Symptoms of diabetic autonomic neuropathy. Methods of perioperative insulin therapy for concomitant diabetes mellitus.

abstract, added 01/03/2010

Risk of developing diabetes mellitus, signs of the disease. Predisposing factors for diabetes mellitus in children. Principles of providing primary nursing care for hyperglycemic and hypoglycemic coma. Organization of therapeutic nutrition for diabetes mellitus.

course work, added 05/11/2014

Types of diabetes. Development of primary and secondary disorders. Deviations in diabetes mellitus. Frequent symptoms of hyperglycemia. Acute complications of the disease. Causes of ketoacidosis. Blood insulin level. Secretion by beta cells of the islets of Langerhans.

abstract, added 11/25/2013

Severity of diabetes mellitus. Organization of the nursing process when caring for patients. Reception medicines. Using insulin to lower blood glucose levels. Monitoring compliance with the medical and protective regime.

presentation, added 04/28/2014

Typical complaints in diabetes mellitus. Features of the manifestation of diabetic microangiopathy and diabetic angiopathy of the lower extremities. Dietary recommendations for diabetes. Patient examination plan. Features of the treatment of diabetes mellitus.

medical history, added 03/11/2014

The concept of diabetes mellitus as a disease based on a lack of the hormone insulin. Diabetes mortality rates. Diabetes mellitus types I and II. Acute and chronic complications in type I diabetes. Emergency conditions in type II diabetes.

abstract, added 12/25/2013

Diabetes concept. The role of therapeutic physical training in diabetes mellitus. The use of physical exercises to restore normal motor-visceral reflexes that regulate metabolism. Features of therapeutic exercises.

abstract, added 10/07/2009

The concept of diabetes mellitus as an endocrine disease associated with relative or absolute insulin deficiency. Types of diabetes mellitus, its main clinical symptoms. Possible complications of the disease, complex treatment sick.

presentation, added 01/20/2016

Epidemiology of diabetes mellitus, glucose metabolism in the human body. Etiology and pathogenesis, pancreatic and extrapancreatic insufficiency, pathogenesis of complications. Clinical signs of diabetes mellitus, its diagnosis, complications and treatment.

Ministry of Health and social development RF

Ministry of Health of the Orenburg Region

State Autonomous Educational Institution of Secondary Professional Education "Orenburg Regional Medical College"

COURSE WORK

in the discipline Nursing care for impaired health of a pediatric patient

Topic: Nursing care for diabetes mellitus in children type I

Completed by a student from group 304

Nursing specialty

Nesterova N.S.

Supervisor:

Vanchinova O.V.

Orenburg 2014

Introduction

Chapter I. Clinical features of diabetes mellitus

1 Risk of developing diabetes

2 Clinical manifestations of diabetes mellitus

3 Signs of the disease and primary manifestations

4 Complications of diabetes

Chapter II. Nursing care for diabetes

1 Nursing care for hyperglycemic and hypoglycemic coma

2 The role of m/s in the organization of schools “School of Diabetes Mellitus”

Conclusion

Bibliography

Introduction

In recent decades, the incidence of diabetes mellitus has been steadily increasing, the number of patients in developed countries amounts to up to 5% of the general population; in fact, the prevalence of diabetes mellitus is higher, since its latent forms are not taken into account (another 5% of the general population). Children and adolescents under 16 years of age make up 5-10% of all patients with diabetes. Diabetes manifests itself at any age (there is even congenital diabetes), but most often during periods of intensive growth (4-6 years, 8-12 years, puberty). Infants are affected in 0.5% of cases. DM is most often detected between the ages of 4 and 10 years, in the autumn-winter period.

In this regard, the prevention of early diagnosis and control of the course of diabetes in children and adults has become an acute medical and social problem, which in most countries of the world is designated among the priority areas in healthcare. According to statistics provided by the World Health Organization, there are currently 346 million people with diabetes in the world. The increasing incidence of diabetes mellitus among children is of particular concern. In this regard, it is becoming more and more actual problem providing children and their parents with the knowledge and skills necessary for its independent “management”, crises and lifestyle changes, which is the basis for successful treatment of the disease. Currently, in many regions of Russia there are schools for patients with diabetes mellitus, which are created as part of treatment and preventive institutions (Health Centers) on a functional basis.

Subject of study:

Nursing assistance in caring for children with type I diabetes mellitus

Object of study:

Nursing care for diabetes mellitus in children type I

To improve the quality of nursing care when caring for children with diabetes.

To achieve this research goal it is necessary to study:

etiology and predisposing factors of diabetes mellitus in children

clinical picture and features of diagnosing diabetes mellitus in children

principles of primary nursing care for hyperglycemic and hypoglycemic coma

organization of therapeutic nutrition for diabetes mellitus

Chapter I. Clinical features of diabetes mellitus

1 Risk of developing diabetes

Children born to diabetic mothers have a high risk of developing diabetes. The risk of developing diabetes is even higher in a child whose both parents are diabetic. In children born to sick mothers, pancreatic cells that produce insulin retained genetic sensitivity to the effects of certain viruses - rubella, measles, herpes, mumps. Therefore, the impetus for the development of diabetes mellitus in children is acute viral diseases.

Thus, hereditary predisposition is only one side of the problem, a prerequisite on which others are superimposed, no less important factors, putting this genetic program into action, causing the development of the disease. The problem is that a woman suffering from any type of diabetes (even gestational) often has a large baby with significant fat deposits. Obesity is one of the most important factors influencing the development of diabetes and realizing the hereditary predisposition of the body. Therefore, it is very important not to overfeed the child, carefully monitor his diet, excluding easily digestible carbohydrates from it. From the first days of life and for at least a year, such a child should receive mother's milk, and not artificial formula. The fact is that the mixtures contain cow's milk protein, which can cause allergic reactions. Even mild allergization of the body disrupts the immune system and contributes to the disruption of carbohydrate and other metabolisms. Therefore, the prevention of diabetes in children is breastfeeding and the baby’s diet, as well as careful monitoring of his weight.

Preventive measures for diabetes include:

natural breastfeeding;

diet and weight control of the child;

hardening and increasing general immunity, protecting against viral infections;

lack of overwork and stress.

1.2 Clinical manifestations of diabetes mellitus

Diabetes mellitus is a disease caused by an absolute or relative deficiency of insulin, leading to metabolic disorders, primarily carbohydrate metabolism, manifested by chronic hyperglycemia.

Children have only type 1 diabetes, that is, insulin-dependent. The disease proceeds in the same way as in adults, and the mechanism of development of the disease is the same. But there are still significant differences, because the child’s body is growing, developing and still very weak. The pancreas of a newborn is very small - only 6 cm, but by the age of 10 it almost doubles in size, reaching a size of 10-12 cm. The pancreas of a child is very close to other organs, they are all closely connected and any violation of one organ leads to the pathology of another . If the child’s pancreas does not produce insulin well, that is, it has a certain pathology, then there is a real danger of the stomach, liver, and gall bladder being involved in the disease process.

The production of insulin by the pancreas is one of its intrasecretory functions, which is finally formed by the fifth year of the baby’s life. It is from this age until about 11 years of age that children are especially susceptible to diabetes. Although a child at any age can acquire this disease. Diabetes mellitus ranks first among all endocrine diseases in children. However, temporary changes in a child's blood sugar level do not indicate the presence of diabetes mellitus. Since a child constantly and rapidly grows and develops, all his organs develop along with him. As a result, all metabolic processes in the body in children proceed much faster than in adults. Carbohydrate metabolism is also accelerated, so a child needs to consume 10 to 15 g of carbohydrates per 1 kg of weight per day. That's why all children love sweets very much - it's a need for their body. But kids, unfortunately, cannot stop their addictions and sometimes consume sweets in much larger quantities than they need. Therefore, mothers should not deprive their children of sweets, but control their moderate consumption.

Carbohydrate metabolism in a child's body occurs under the control of insulin, as well as a number of hormones - glucagon, adrenaline, adrenal hormones. Diabetes mellitus occurs precisely because of pathologies in these processes. But carbohydrate metabolism is also regulated by the child’s nervous system, which is still very immature, so it can malfunction and also affect blood sugar levels. Not just immaturity nervous system child, but also his endocrine system sometimes leads to the child’s metabolic processes being disrupted, resulting in changes in blood sugar levels and periods of hypoglycemia. But this is not at all a sign of diabetes. Although the child’s blood sugar level should be constant and can fluctuate only within small limits: from 3.3 to 6.6 mmol/l, even more significant fluctuations not associated with pancreatic pathology are not dangerous and disappear with age. After all, they are the result of imperfections in the nervous and endocrine systems. child's body. Typically, premature, underdeveloped children or adolescents during puberty and those who have significant physical exertion are susceptible to such conditions. As soon as the functions of the nervous and endocrine systems are stabilized, the mechanisms for regulating carbohydrate metabolism will become more advanced and blood sugar levels will normalize. Along with this, attacks of hypoglycemia will pass. However, despite the seeming harmlessness of these conditions, they are very painful for the baby and can affect his future health. Therefore, it is imperative to monitor the state of the child’s nervous system: no stress or increased physical activity.

Diabetes mellitus has two stages of development, the same in adults and children. The first stage is impaired glucose tolerance, which is not a disease in itself, but indicates a serious risk of developing diabetes. Therefore, if glucose tolerance is impaired, the child should be carefully examined and taken under long-term medical supervision. With the help of diet and other methods of therapeutic prevention, diabetes may not develop. The most important task is to prevent its manifestation. Therefore, it is necessary to donate blood for sugar once a year.

The second stage of diabetes is its development. Now this process cannot be stopped, but it is necessary to keep it under control from the very first days. There are certain difficulties associated with this. The fact is that diabetes mellitus in children develops very quickly and has a progressive nature, which is associated with the general development and growth of the child. This is how it differs from adult diabetes. The progression of diabetes mellitus is that there is a high probability of developing labile diabetes with sharp fluctuations in blood sugar and difficult to respond to insulin therapy. In addition, labile diabetes provokes the development of ketoacidosis and attacks of hypoglycemia. The course of diabetes mellitus is further complicated by the fact that children often suffer from infectious diseases that contribute to the decompensation of diabetes. The younger the child with diabetes, the more severe the disease and the greater the risk of various complications.

Diseases that worsen the course of diabetes mellitus in children and contribute to its decompensation

Infectious and inflammatory diseases.

Endocrine diseases.

3 Signs of the disease and primary manifestations of diabetes mellitus

In childhood, the clinical symptoms of diabetes usually develop rapidly, and parents can often indicate the exact date of onset of the disease. Less commonly, diabetes develops gradually. The most characteristic signs of diabetes are rapid weight loss in the child, uncontrollable thirst and excessive urination. This is what parents need to pay attention to. The child loses weight so quickly that he “melts” right before our eyes. But objectively, he can lose 10 kg in just a few weeks. It is impossible not to notice this. Urine output also exceeds all norms - more than 5 liters per day. And of course, the child constantly asks for a drink and cannot get drunk. This seems strange even to him, and children usually do not pay attention to such nuances. With all these signs, you need to immediately go to a doctor, who will not only give a referral for a blood and urine test for sugar, but also examine the child visually. Indirect signs of diabetes are the following: dry skin and mucous membranes, crimson tongue, low skin elasticity. Laboratory tests usually confirm the doctor's assumption based on the classic signs of diabetes. The diagnosis of diabetes mellitus is made if the fasting blood sugar level exceeds 5.5 mmol/l, which is a sign of hyperglycemia, sugar is found in the urine (glucosuria), and due to the glucose content in the urine, the urine itself has an increased density.

Diabetes mellitus in children can also begin with other signs: general weakness, sweating, increased fatigue, headaches and dizziness, as well as constant thrust for sweets. The child's hands begin to tremble, he becomes pale and sometimes faints. This is a state of hypoglycemia - a sharp decrease in blood sugar. Accurate diagnosis will be determined by a doctor based on laboratory tests.

Another option for the onset of childhood diabetes is the latent course of the disease. That is, insulin is no longer produced well by the pancreas, blood sugar gradually rises, and the child does not yet feel any changes. However, the manifestation of diabetes mellitus can still be noticed by the condition of the skin. It becomes covered with small pustules, boils or fungal lesions; the same lesions appear on the mucous membrane of the mouth or genitals in girls. If a child has persistent pimples and pustules, as well as prolonged stomatitis, it is necessary to urgently test the blood for sugar. With such symptoms, there is a certain risk of diabetes mellitus having already begun, which occurs in a latent form.

4 Forms of complications of diabetes mellitus

Late diagnosis or improper treatment lead to complications that develop either in a short time or over the years. The first type includes diabetic ketoacidosis (DKA), the second includes lesions of various organs and systems, which do not always manifest themselves in childhood and adolescence. Most great danger represents the first group of complications. The reasons for the development of diabetic ketoacidosis (DKA) are unrecognized diabetes mellitus, gross errors in treatment (refusal to administer insulin, major errors in diet), and the addition of a severe concomitant disease. Patients with diabetes often develop hypoglycemic conditions. First, the baby's blood sugar levels rise and must be controlled with carefully adjusted doses of insulin. If there is more insulin than is required to feed the cells with glucose, or the child has experienced stress or physical strain that day, then the blood sugar level drops. A sharp decline Blood sugar is caused not only by an overdose of insulin, but also by insufficient carbohydrate content in the child’s food, non-compliance with the diet, delay in eating and, finally, a labile course of diabetes mellitus. As a result, the child experiences a state of hypoglycemia, which is manifested by lethargy and weakness, headache and a feeling of severe hunger. This condition may be the beginning of a hypoglycemic coma.

Hypoglycemic coma.

Already at the first signs of hypoglycemia - lethargy, weakness and sweating - you need to sound the alarm and strive to increase blood sugar. If this is not done, a hypoglycemic coma can quickly develop: the child will have trembling limbs, convulsions will begin, he will be in a very excited state for some time, and then loss of consciousness will occur. At the same time, breathing and blood pressure remain normal, body temperature is also usually normal, there is no smell of acetone from the mouth, the skin is moist, and the blood sugar level drops below 3 mmol/l.

After correcting the blood sugar level, the child’s health is restored. However, if such conditions are repeated, then diabetes may enter a labile stage, when the selection of insulin dosage becomes problematic, and the child faces more serious complications.

If diabetes cannot be compensated for, that is, for some reason the child’s blood glucose level does not normalize (eats a lot of sweets, fails to pick up the dose of insulin, skips insulin injections, lacks regulation of physical activity, etc.), then this is fraught with serious consequences. serious consequences, including ketoacidosis and diabetic coma.

This is an acute condition that occurs against the background of decompensated diabetes mellitus in children, that is, when the blood sugar level changes uncontrollably and rapidly. Its main characteristics are as follows. The child looks very weak and lethargic, he loses his appetite and appears irritable. This is accompanied by double vision, pain in the heart, lower back, stomach, nausea and vomiting, which does not bring relief. The child suffers from insomnia and complains of poor memory. The smell of acetone is felt from the mouth. This is a clinical picture of ketoacidosis, which can develop into an even more serious complication if urgent therapeutic measures are not taken. This complication is called ketoacidotic coma.

Ketoacidotic coma.

This complication develops after ketoacidosis for several days - usually one to three. Signs of complications change and worsen during this period. Coma is defined as complete loss of consciousness and absence of normal reflexes.

Signs of ketoacidotic coma.

Coma begins with general weakness, increased fatigue, and frequent urination.

Then comes abdominal pain, nausea, and repeated vomiting.

Consciousness is inhibited and then completely lost.

There is a strong smell of acetone from the mouth.

Breathing becomes uneven, and pulse becomes rapid and weak.

Blood pressure drops significantly.

Then the frequency of urination decreases, and they stop altogether. Anuria develops.

If left unchecked, liver and kidney damage begins. These clinical manifestations are confirmed by laboratory diagnostics. In a state of ketoacidotic coma, laboratory tests show the following results:

high blood sugar (more than 20 mmol/l); ^ presence of sugar in urine;

a decrease in blood acidity to 7.1 or lower, which is called acidosis (this is very dangerous condition, since an acidity level of 6.8 is considered fatal);

the presence of acetone in the urine;

increase in ketone bodies in the blood;

due to damage to the liver and kidneys, the amount of hemoglobin, leukocytes and red blood cells in the blood increases;

protein appears in the urine.

Causes of ketoacidotic coma include long-term and difficult to treat diabetes mellitus, stressful situations, heavy physical activity, hormonal changes in the body of adolescents, severe long-term violations of the carbohydrate diet, acute infectious diseases. This type of diabetic coma is very dangerous because it affects all organs and systems so that the diseases can become irreversible. You cannot start a complication; it must be stopped at the very beginning. For this you need therapeutic effects, which will be discussed in the chapter “Treatment of diabetes and its complications,” as well as diet and regimen.

Hyperosmolar coma.

This is another type of diabetic coma that can occur in a child with an advanced, long-term or untreatable disease. Or rather, with diabetes, which was poorly handled by the parents, because the child cannot yet take his illness seriously, carefully control diet, physical activity and insulin administration. All this should be done by the mother, who needs to understand that missed or poorly timed insulin injections are the first step towards the development of decompensation of diabetes and, as a consequence, to its complications.

Hyperosmolar coma develops more slowly than DKA and is manifested by severe dehydration of the child's body. In addition, the child’s nervous system is affected. Lab tests show very high blood sugar (more than 50 mmol/l) and increased hemoglobin and hematocrit, which make the blood too thick.

The diagnosis of hyperosmolar coma is made after laboratory tests confirm another very important and characteristic indicator: an increase in the osmolarity of the blood plasma, that is, a very high content of sodium ions and nitrogenous substances.

Signs of hyperosmolar coma in a child

Weakness, fatigue.

Intense thirst.

Seizures and other nervous system disorders.

Gradual loss of consciousness.

Breathing is frequent and shallow, the smell of acetone is felt from the mouth.

Increased body temperature.

The amount of urine excreted is initially increased and then decreases.

Dry skin and mucous membranes.

Although hyperosmolar coma occurs in children much less frequently than other complications, it poses a serious danger due to severe dehydration and disorders of the nervous system. In addition, the rapid development of this type of coma does not allow delaying medical help. A doctor must be called immediately, and the parents themselves must provide emergency assistance to the child.

However, the banal truth suggests that it is better to prevent such complications and carefully monitor the condition of a child who has diabetes.

Lactic acid coma

This type of coma develops quite quickly, within a few hours, but has other characteristic signs - pain in the muscles and lower back, shortness of breath and heaviness in the heart. Sometimes they are accompanied by nausea and vomiting, which does not bring relief. With a rapid pulse and uneven breathing, blood pressure is reduced. Coma begins with the child's inexplicable excitement - he is choking, nervous, but soon drowsiness sets in, which can turn into loss of consciousness. At the same time, all the usual tests for diabetes are normal - the sugar level is normal or slightly elevated, there is no sugar or acetone in the urine. And the amount of urine excreted is also within normal limits.

Lactic acid coma is determined by other laboratory signs: an increased content of calcium ions, lactic and grape acids is found in the blood.

diabetes mellitus children coma

Chapter II.Nursing care for diabetes mellitus

1 Nursing care for hypoglycemic and hyperglycemic coma

Emergency care for hypoglycemic coma.

Depends on the severity of the condition: if the patient is conscious, it is necessary to give food rich in carbohydrates (sweet tea, white bread, compote). If the patient is unconscious, intravenous injection of 20-50 ml of 20-40% glucose solution. In the absence of consciousness for 10 -15 minutes - intravenous drip administration of 5-10% glucose solution until the patient regains consciousness.

Emergency care for hyperglycemic coma

Immediate hospitalization. Warm the patient. Gastric lavage 5%

sodium bicarbonate solution or isotonic sodium chloride solution (part of the solution is left in the stomach). Cleansing enema with a warm 4% sodium bicarbonate solution. Oxygen therapy. Intravenous drip administration of isotonic sodium chloride solution at the rate of 20 ml/kg body weight (cocarboxylase, ascorbic acid, heparin are added to the dropper). Administration of insulin at a dose of 0.1 U/kg/h in 150-300 ml of isotonic sodium chloride solution (in the first 6 hours, 50% of the total amount of liquid is administered)

2 The role of m/s in the organization of schools “School of Diabetes Mellitus”

The goal and objectives of the school are to teach patients with diabetes mellitus methods of self-control, adaptation of treatment to specific living conditions, prevention of acute and chronic complications diseases.

As for children, training at the “School of Diabetes Mellitus” must be adapted to the age and degree of puberty of the patient. The formation of age groups of students is based on this principle.

) The first group includes parents of newborns and children of the first years of life with diabetes. Young patients are completely dependent on parents and medical staff (food intake, injections, monitoring), and therefore need to form close relationships with the caregiver medical care employee. It is important to create psychological contact with the mother of a sick child, since against the background of increasing stress, her connection with the child decreases and depression is noted. Problems that need to be addressed by the training “team” of medical workers in in this case, are: mood swings in a newborn child with diabetes; the association of injections and monitoring blood glucose levels with pain that arises as a result medical manipulations and are associated in the child with a doctor’s white coat. These barriers make it necessary to establish trusting relationships with the family of the sick child and learn to monitor diabetes, since hypoglycemia in newborns is common and can lead to severe complications.

) There has been widespread debate in many countries around the world about the appropriateness of education for preschoolers with diabetes and whether diabetes outcomes depend on education in this age group. However, parents report the need and importance of training and support.

) The third education group includes school-age children. Classes for these patients include topics:

ü assistance and regulation of the transition to the student’s lifestyle, development of self-esteem (feelings self-esteem) and relationships with peers;

ü training in injection skills and glycemic monitoring;

ü recognizing and understanding symptoms of hypoglycemia;

ü improving understanding of self-management of the disease;

ü adaptation of diabetes mellitus to school learning, eating at school, physical activity and sports;

ü incorporating blood glucose monitoring and injections into school routines;

ü Advice to parents on gradually developing the child's independence while transferring appropriate responsibilities.

There is dissatisfaction among school-aged children that doctors talk to parents rather than to them. Educational programs, which focus on the patient's age, are effective in children and their families.

Sick children can also be included in the third, school group. adolescence. Adolescence is a transitional phase of development between childhood and adulthood and has a number of biological and psychological characteristics, which cause some problems in the management of diabetes mellitus in such patients. Deterioration in control of diabetes mellitus in this age group is often associated with irregular diet, insufficient physical activity, poor adherence to doctor's orders, endocrine changes associated with puberty and other factors. Features of the areas of work at the “School of Diabetes Mellitus” for adolescents include:

ü development of trusting relationships between a teenager, a group of students and a “team” of specialists;

ü helping the teenager determine priorities and set small achievable goals, especially if there are contradictions between social needs a teenager and restrictions associated with the presence of diabetes;

ü providing an understanding of physiological changes during puberty, their impact on insulin doses, solving emerging problems with body weight control, and regulating diet;

ü explaining the importance of screening for early symptoms of diabetes complications and improving metabolic control;

ü confidential conversations with a teenager about the process of puberty, strengthening his sense of self-confidence, but at the same time maintaining trust and support from his parents;

ü Helping adolescents and parents form relationships with new levels of parental involvement in diabetes care.

Nursing care for diabetes:

Action Plan Rationale 1. Inform the patient and his relatives that “diabetes mellitus is not a disease, but a way of life” ü The patient's right to information is ensured ü The child and his relatives understand the advisability of carrying out all care activities 2. Organize the child’s nutrition with a limit of easily digestible carbohydrates (honey, jam, sugar, confectionery, grapes, figs, bananas, etc.) ü Easily digestible carbohydrates give a “salvo” increase in blood glucose3. Organize meals 6 times a day (3 main meals and 3 “snacks”) ü Stable blood glucose levels are achieved 4. Teach the patient or his relatives the rules and techniques for administering insulin, monitor the regular intake of antidiabetic drugs and insulin ü Prevention of the development of ketoacidotic (hyperglycemic) coma 5. Strictly monitor food intake after administering insulin drugs ü Prevention of the development of insulin (hypoglycemic) coma6. Dose the physical and emotional stress of the sick child. ü Prevention of the development of comatose states 7. Strictly monitor the hygiene of the skin and mucous membranes ü Pustular skin diseases are indirect signs diabetes mellitus8. Protect the child from concomitant infections, coldsü In diabetes mellitus, immunity is reduced - FBD (frequently ill children)

3 Organization of therapeutic nutrition for diabetes mellitus

Diet therapy. Mandatory for all clinical forms of diabetes. Its main principles: individual selection of daily calorie content: balanced and physiological in terms of protein, carbohydrates, minerals, fats, vitamins diet (table No. 9); split six meals a day with uniform distribution calories and carbohydrates (breakfast - 25%, second breakfast - 10%, lunch - 25%, afternoon snack - 10%, dinner - 25%, second dinner - 15% of daily calories). Easily digestible carbohydrates are excluded from the diet. It is recommended to replace them with carbohydrates containing a large amount of fiber (it slows down the absorption of glucose). Sugar is replaced with sorbitol or xylitol. Moderate restriction of animal fats.

Drug treatment. The main treatment for diabetes mellitus is the use of insulin. The dose depends on the severity of the disease and the loss of glucose in the urine during the day. For every 5 grams of glucose excreted in the urine, 1 unit of nsulin is prescribed. The drug is administered subcutaneously, intramuscularly and intravenously. There are short-acting insulins (peak action 2-4 hours after administration, duration of pharmacological action 6-8 hours) - akrapid, insulinrap, humulin R, homorap; medium duration of action (peak after 5-10 hours, action 12-18 hours) - B-insulin, lente, long, insulong, monotardNM, homophan; long-acting (peak after 10-18 hours, action 20-30 hours) - ultralong, ultralente, ultratard NM.

In case of a stable course of the disease, combinations of short- and long-acting insulin preparations are used.

In addition, sulfonamide drugs (I and II generations) are prescribed - diabinez, bucarban (oranil), diabeton, and also use biguanides - phenformin, dibiton, adebit, sibin, glucophage, diformin, metaphormin.

Conclusion

Currently, diabetes mellitus is one of the leading medical and social problems. This is due, first of all, to its high prevalence, the continuing trend towards a further increase in the number of patients and the damage that diabetes mellitus, which developed in childhood, causes to society. An analysis of extensive clinical material and a study of the dynamics of referral rates convince us that in addition to an increase in morbidity, there is a change in the age structure, a “rejuvenation” of diabetes mellitus. If a few years ago diabetes mellitus in children of the first years of life was a casuistry, now it is not uncommon. It is traditionally believed that insulin-dependent forms of the disease predominate in children. The prevalence of non-insulin-dependent diabetes in the pediatric population is still unclear and requires study.

The most important achievement in diabetology over the past thirty years has been the increasing role of nurses and the organization of their specialization in diabetology; such nurses provide high-quality care for patients with diabetes; organize interaction between hospitals and doctors general practice and outpatients observed; conduct a large amount of research and patient education. The progress of clinical medicine in the second half of the 20th century made it possible to significantly better understand the causes of diabetes mellitus and its complications, as well as to significantly alleviate the suffering of patients, which was unimaginable even a quarter of a century ago.

Bibliography

1. L.V. Arzamastseva, M.I. Martynova - Socio-demographic characteristics of families of children with diabetes. - Pediatrics, 2012.

V.G. Baranov, A.S. Stroikova - Diabetes mellitus in children. - M., Medicine, 2011

3. Dispensary observation of children in the clinic (edited by K.F. Shiryaeva). L., Medicine, 2011

M.A. Zhukovsky Pediatric endocrinology.-M., Medicine, 2012

Yu.A. Knyazev - Epidemiology of diabetes mellitus in children. - Pediatrics, 2012

V.L. Liss - Diabetes mellitus. In the book: Childhood diseases (edited by A. F. Shabalov). - St. Petersburg, SOTIS, 2013.

V.A. Mikhelson, I.G. Almazova, E.V. Neudakhin - Comatose states in children. - L., Medicine, 2011

8. Guidelines for the cycle of pediatric endocrinology (for students taking the LPMI course). - L., 2012

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Similar works to - Nursing care for diabetes mellitus in children type I

1. Insulin-dependent type - type 1.

2. Insulin-independent type - type 2.

Type 1 diabetes mellitus is more common in people young, type 2 diabetes mellitus - in middle-aged and elderly people. One of the main risk factors is hereditary predisposition (type 2 diabetes mellitus is hereditarily more unfavorable); obesity, unbalanced nutrition, stress, pancreatic diseases, and toxic substances also play an important role. in particular alcohol, diseases of other endocrine organs.

Stages of diabetes:

Stage 1 - prediabetes - a state of predisposition to diabetes mellitus.

Risk group:

Persons with a family history.

Women who gave birth to a live or stillborn child weighing more than 4.5 kg.

Persons suffering from obesity and atherosclerosis.

Stage 2 - latent diabetes - is asymptomatic, the fasting glucose level is normal - 3.3-5.5 mmol/l (according to some authors - up to 6.6 mmol/l). Latent diabetes can be detected by a glucose tolerance test, when the patient, after taking 50 g of glucose dissolved in 200 ml of water, experiences an increase in blood sugar levels: after 1 hour it is above 9.99 mmol/l. and after 2 hours - more than 7.15 mmol/l.
Stage 3 - overt diabetes - the following symptoms are characteristic: thirst, polyuria, increased appetite, weight loss, itching (especially in the perineal area), weakness, fatigue. The blood test shows an increased glucose level, and glucose may also be excreted in the urine.

Nursing process in diabetes mellitus:

Patient problems:

A. Existing (present):

B. Potential:

Risk of development:

Precomatose and comatose states:

Gangrene of the lower extremities;

Chronic renal failure;

Cataracts and diabetic retinopathy with blurred vision;

Secondary infections, pustular skin diseases;

Complications due to insulin therapy;

Slow healing of wounds, including postoperative wounds.

Collection of information during the initial examination:

Asking the patient about:

Compliance with a diet (physiological or diet No. 9), about diet;

Treatment provided:

Insulin therapy (name of insulin, dose, duration of action, treatment regimen);

Antidiabetic tablet drugs (name, dose, features of their administration, tolerability);

Recent studies of blood and urine tests for glucose levels and examinations by an endocrinologist;

The patient has a glucometer and knows how to use it;

Ability to use a table of bread units and create a menu based on bread units;

Ability to use insulin syringe and a syringe pen;

Knowledge of places and techniques for insulin administration, prevention of complications (hypoglycemia and lipodystrophy at injection sites);

Keeping a diary of observations of a patient with diabetes:

Past and present visits to the “Diabetes School”;

Development in the past of hypoglycemic and hyperglycemic coma, their causes and symptoms;

Ability to provide self-help;

Does the patient have a “Diabetes Passport” or “ Business card diabetic";

Hereditary predisposition to diabetes mellitus);

Concomitant diseases (obstruction of the pancreas, other endocrine organs, obesity);

Complaints of the patient at the time of examination.

Patient examination:

Color, moisture of the skin, presence of scratching:

Determination of body weight:

Determination of the pulse on the radial artery and on the artery of the dorsum of the foot.

Nursing interventions, including working with the patient's family:

1. Conduct a conversation with the patient and his relatives about dietary habits depending on the type of diabetes mellitus and diet. For a patient with type 2 diabetes, give several sample menus for the day.

2. Convince the patient of the need to strictly follow the diet prescribed by the doctor.

3. Convince the patient of the need for physical activity recommended by the doctor.

4. Conduct a conversation about the causes, essence of the disease and its complications.

5. Inform the patient about insulin therapy (types of insulin, the beginning and duration of its action, connection with food intake, storage features, side effects, types of insulin syringes and syringe pens).

6. Ensure timely administration of insulin and taking antidiabetic drugs.

7. Control:

Condition of the skin;

Body weight:

Pulse and blood pressure;

Pulse on the artery of the dorsum of the foot;

Compliance with diet and nutrition;

Transfers to the patient from his relatives;

8. Convince the patient of the need for constant monitoring by an endocrinologist, keeping an observation diary, which indicates the levels of glucose in the blood, urine, blood pressure levels, foods eaten per day, therapy received, changes in well-being.

11. Inform the patient about the causes and symptoms of hypoglycemia and coma.

12. Convince the patient of the need to immediately contact an endocrinologist if there is a slight deterioration in health and blood counts.

13. Teach the patient and his relatives:

Calculation of grain units;

Drawing up a menu based on the number of bread units per day;

Collection and subcutaneous administration of insulin with an insulin syringe;

Foot care rules;

Provide self-help for hypoglycemia;

Measuring blood pressure.

Emergency conditions for diabetes mellitus:

A. Hypoglycemic state. Hypoglycemic coma.

Causes:

Overdose of insulin or antidiabetic tablets.

Lack of carbohydrates in the diet.

Not eating enough or skipping meals after taking insulin.

Hypoglycemic conditions are manifested by a feeling of severe hunger, sweating, trembling of the limbs, and severe weakness. If this condition is not stopped, then the symptoms of hypoglycemia will increase: trembling will intensify, confusion in thoughts, headache, dizziness, double vision, general anxiety, fear, aggressive behavior will appear and the patient falls into a coma with loss of consciousness and convulsions.

Symptoms of hypoglycemic coma: the patient is unconscious, pale, there is no smell of acetone from the mouth. The skin is moist, profuse cold sweat, muscle tone is increased, breathing is free. blood pressure and pulse are not changed, the tone of the eyeballs is not changed. In the blood test, the sugar level is below 3.3 mmol/l. there is no sugar in urine.

Self-help for hypoglycemic conditions:

It is recommended that at the first symptoms of hypoglycemia, eat 4-5 pieces of sugar, or drink warm sweet tea, or take 10 glucose tablets of 0.1 g, or drink from 2-3 ampoules of 40% glucose, or eat a few candies (preferably caramel ).

First aid for hypoglycemic conditions:

Call a doctor.

Call a laboratory assistant.

Place the patient in a stable lateral position.

Place 2 pieces of sugar behind the cheek on which the patient is lying.

Prepare medications:

40 and 5% glucose solution. 0.9% sodium chloride solution, prednisolone (amp.), hydrocortisone (amp.), glucagon (amp.).

B. Hyperglycemic (diabetic, ketoacidotic) coma.

Causes:

Insufficient dose of insulin.

Diet violation (high carbohydrate content in food)

Infectious diseases.

Stress.

Pregnancy.

Operational vm-in.

Precursors: increased thirst, polyuria. Possible vomiting, decreased appetite, blurred vision, unusually strong drowsiness, irritability.

Symptoms of coma: absence of consciousness, smell of acetone from the breath, hyperemia and dry skin, noisy deep breathing, decreased muscle tone - “soft” eyeballs. The pulse is threadlike, blood pressure is reduced. In the blood test - hyperglycemia, in the urine test - glucosuria, ketone bodies and acetone.
If there are signs of hyperglycemic coma, urgently call the emergency room.

First aid:

Call a doctor.

Place the patient in a stable lateral position (prevention of tongue retraction, aspiration, asphyxia).

Take urine with a catheter for rapid diagnostics of sugar and acetone.

Provide intravenous access.

Prepare medications:

Short-acting insulin - actropid (fl.);

0.9% sodium chloride solution (vial); 5% glucose solution (vial);

Cardiac glycosides, vascular agents.

Many patients who have just learned of their diagnosis or that their child is diabetic become frightened and panic. However, although modern medicine does not yet know how to restore pancreatic cells, with properly selected treatment and diet, the lifestyle of a diabetic patient is almost no different from normal!

Of course, the disease imposes some restrictions on him. But once you understand what happens to the body during diabetes, it is not difficult to learn to coexist with your disease, and over time, to completely control it.

And the first person who is next to the patient after a medical diagnosis is made is a nurse. She will give the sick person the first knowledge about his illness (most of us imagine diabetes only as a condition when “you can’t eat sweets and you need to inject insulin”) and will begin to teach the sick person to “live in harmony” with his body.

Nursing examination

The nursing process for diabetes mellitus begins when the doctor, having prescribed treatment, entrusts the patient to the nurse. She will examine the patient, study the medical history, and question him to find out:

• whether he has concomitant endocrine or other diseases;
• did the patient use insulin before the current examination, and if so, what kind, in what doses, according to what schedule; what other antidiabetic and other medications he is taking;
• does he follow a diet, does he know how to use a table of bread units;
• does the patient have a glucometer and know how to use it; whether he injects insulin with a regular insulin syringe or a pen, how correctly he does it and whether he knows about possible complications;
• how long he has been sick, whether he has had hyper- or hypoglycemic comas or other complications, and if so, what caused them; Does he know how to provide self-help?

The nurse will ask questions about the patient’s daily routine, physical activity, and habits. If the patient is a child or an elderly person, she will also talk to his parents or relatives. This method of examination is called subjective, because the completeness of the information obtained largely depends on the experience of the nurse, her ability to ask questions and find a common language with people.

Patient's problems	What should the nurse do?
Psychological discomfort, neurosis, insomnia, unsociability	Provide the patient with physical and psychological peace (for example, if possible, transfer him to a room where there are no “noisy” neighbors); make sure that he does not violate the daily routine; provide care for those who find it difficult to care for themselves
Increased appetite, severe thirst	If the patient has not followed a diet before, help him create a menu or at least adjust his diet; strictly monitor your blood sugar levels
Constant dry skin, severe itching	Carefully monitor foot hygiene, identify inflammation and foot injuries in a timely manner; prevent infection of microtraumas and wounds on the skin

The second part is an objective examination, that is, physical. It includes:

• general external examination. For example, “bags under the eyes” or other swelling indicate problems with the kidneys or heart;
• examination of the skin, with special care - the skin of the feet; examination of the mucous membranes - their pallor indicates dehydration;
• measurement of body temperature, pulse rate and respiratory movements, measurement of height, weight, blood pressure.

After the examination, the nursing process for diabetes mellitus continues with the creation of a special, nursing medical history. It is different from a doctor's office. Based on examinations and tests, the doctor describes “what is happening in the body,” and the nurse, based on observations, records what health problems the patient has in connection with these disorders. Additional information is also recorded in her medical history: is the patient able to take care of himself, does he suffer from neurosis, is he easy to communicate, is he prone to violating his diet or regimen, does he carefully follow the doctor’s instructions, etc.

Help from a nurse in a hospital

Having compiled “her” medical history, the nurse sees the main problems of a particular patient: both those that already exist and those that may arise. Some of them are dangerous, others are easy to prevent, and others are unlikely, but you need to be prepared for them. She also identifies factors that can cause complications: a tendency to violate the diet, neurosis and others, and takes them into account when caring for the patient.

Competent nursing process for diabetes mellitus is impossible without a clear plan. Therefore, the nurse writes a special care guide into her version of the medical history, which details existing and possible problems and plans responses. It might look like this:

The nurse carries out the doctor's instructions under his control or supervision. This includes insulin therapy and the dispensing of medications, including for the prevention of complications (vitamins, drugs to normalize metabolism, etc.); preparation for therapeutic and diagnostic procedures and/or their implementation, and so on. For outpatient treatment, tests and regular follow-up examinations are carried out. There are three types of nursing interventions. This is the implementation of medical prescriptions, nursing care itself, and actions that are carried out together with a doctor or after consultation with him.

1. Nursing care (independent nursing intervention) are actions that the nurse carries out at his own discretion, based on his experience and on the basis of the “nursing” medical history. These include training in self-control skills, basic nutrition and monitoring how the patient complies with the daily routine, diet and doctor’s orders. When caring for children, she will definitely talk to both the baby and his parents. The child will not be so scared in the hospital, and parents will learn about the features of childhood diabetes, correct drafting menu and skills for living with illness.
2. Interdependent is a nursing intervention in which the nurse shares observations of a particular patient with the doctor, and he makes a decision about changes or additions. therapeutic tactics. The nurse will not prescribe sleeping pills to the diabetic herself, but she will tell the doctor about his sleep problems, and the doctor will select the right drug.

One of the features of diabetes mellitus is that the quality of life of a diabetic equally depends on medical care and treatment, and from his self-discipline. The nurse will not visit the patient at home every day and monitor whether he follows doctor’s orders! Therefore, the nursing process in diabetes mellitus is impossible without training in self-control.

Self-control training

Self-management training is especially important for newly diagnosed people. The nurse will explain to them why diabetes occurs, what problems it causes in the body, how medicine, diet and proper hygienic care can compensate for it, and what the consequences of neglecting them are.

The first special knowledge that diabetics receive is training in self-monitoring of blood sugar and urine sugar levels (using glucometers and test strips), rules for calculating bread units and methods for administering insulin. In addition to the ability to use a syringe or pen, a diabetic must:

• understand how insulin works;
• know possible complications when using it - both generally and at injection sites on the skin;
• if necessary, be able to independently adjust the dose (for example, he is invited to a restaurant or, conversely, is forced to skip a meal). The need for insulin may vary with normal acute respiratory infections and even depending on the time of year;
• understand how and why they arise emergency conditions with diabetes (hyper- and hypoglycemic coma), know how to prevent them and what to do if it becomes bad.

However, not only people who have recently learned about their disease, but also experienced diabetics should replenish and update their knowledge from time to time. Medicine does not stand still! Every year it offers more and more convenient means of controlling diabetes, such as insulin pumps or insulin patches.

“I follow all the rules! Why do I need a nurse?

• observe the rules of hygiene;
• Follow a daily routine and go to bed on time. Everyone knows that people suffering from “lack of sleep” get sick more often, but in diabetes, lack of sleep or insomnia weakens the effectiveness of treatment;
• move more, or better yet, exercise daily, even a little;
• follow a diet, understanding exactly which foods are harmful to him and why, and which are beneficial. A diabetic must be able to independently compose his own menu, taking into account the volume and calorie content of food and using a table of bread units;
• Monitor your weight (diabetes is more severe if you are obese).

But if a healthy person prone to obesity can be advised not to eat later than two hours before bedtime, then this advice is not suitable for a diabetic who uses long-acting insulin. He needs to drink a glass of kefir or eat fruit half an hour before bedtime.

It is also very important to remember that practicing good hygiene for diabetics is not just “healthy” as healthy people, but vital! They develop diseases of the gums and teeth more often and more severely, and the danger of damage to the skin of the feet is so great that there is a special term - “diabetic foot syndrome”.

Sensitivity and blood supply to the feet are reduced, so tight shoes lead to deformation of the feet unnoticed by the patient, and over time, ulcers and even gangrene may occur.

>An experienced nurse will definitely tell the patient about these features and notice the danger in time. Therefore, after leaving the hospital, you should not forget the way to the clinic for a long time or ignore the Diabetes School. Even if you have been given the right regimen, your diabetes is well controlled and you do not need specific medical care.