Sick diabetes need qualified assistance and nursing care. A medical sister who passes with the patient of the clinic has all the steps of surveys, treatment, the rehabilitation process, can act as an assistant in the hospital and at home. Read more about the nursing process in diabetes, let's talk in our article.
What is needed a nursing process with diabetes
The priority goal of the nursing process is to ensure control over the state of health and help with diabetes mellitus. Thanks to the care of the medical staff, a person feels comfortable, safely.
The nurse is assigned to the group of patients, thoroughly studies their features, together with the attending doctor develops a diagnostic plan, study pathogenesis, possible problems, etc. It is important to take into account their cultural and national habits, traditions, the process of adaptation, age.
Simultaneously with the provision of medical services, the nursing process carries out scientific knowledge about diabetes. Clinical manifestations, etiology, anatomy and physiology of each patient are not aspectable separately. The data collected is used for scientific purposes, to compile abstracts and lectures, in the process of writing dissertations, when developing new drugs from diabetes. The information obtained is the main way to deeply study the disease from the inside, learn to care for diabetics quickly and efficiently.
Important! As a medical staff of the nursing process, students of universities are often used from the last courses. They pass the diploma and course practices. It is not necessary to fear inexperienced such brothers and sisters. Their actions, solutions are controlled by experts with experience and education.
Features and stages of nursing care during diabetes
The main tasks of nursing care for patients with diabetes are:
- Collect information about the patient, his family, lifestyle, habits, primary disease process.
- Create a clinical picture of the disease.
- Denote a brief action plan for nursing care for patients with diabetes.
- Help diabetics in the process of diagnosis, treatment, prevention of sugar disease.
- Control the execution of the prescription of the doctor.
- Conduct a conversation with relatives about creating comfortable conditions for staying patient with diabetes mellitus, after discharge from the hospital, the specifics of nursing care.
- Teach the patient to use the glucometter, to make a diabetic menu, recognize GI, AI on the food table.
- To convince diabetics to control the disease, to undergo surveys from narrow specialists constantly. To customize the diary of the diary, the design of the passport of the disease, overcome difficulties in care of yourself.
The algorithm of the work of the nursing process consists of 5 main stages. Each one puts a certain goal before the doctor and implies competent actions.
| Stage | purpose | Methods |
|---|---|---|
| Nursing examination | Collect information about the patient | Distribution, conversation, examination of the patient's card, inspection |
| Nursing diagnostics | Get data on pressure, temperature, blood sugar level at the moment. Rate skin condition, body weight, pulse | Palpation, external inspection, use of apparatus for measuring the pressure of the pulse, temperature. Identify potential problems and complications. |
| Drawing up a plan of the nursing process | Select the priority tasks of nursing care, designate the provision of assistance | Analysis of patient complaints, the preparation of the goals of nursing care:
|
| Realization of the nursing plan | Implementation of the planned plan for nursing care for a patient with diabetes in the hospital | Choosing a diabetic help system:
|
| Evaluation of the effectiveness of the nursing process | Analyze the work of medical personnel, assess the results obtained from the process, compare with expected, conclude about the nursing process |
|
Important! All data, the result of inspection, survey, laboratory analyzes, tests, a list of procedures conducted, appointments The nurse lies in the history of the disease.
The nursing process behind adults and older diabetics has its own characteristics. The list of care for medical sisters includes the following daily responsibilities:
- Control of glucose levels.
- Measurement of pressure, pulse, temperature of the fluid output.
- Creating a recreation mode.
- Control over medication.
- Introduction insulin.
- Inspection of the Stop for the presence of cracks, non-healing wounds.
- Performing a doctor's prescriptions about exercise, even minimal.
- Creating a comfortable environment in the ward.
- Linen change with patients.
- Power control, diet observance.
- Disinfection of skin cover, in the presence of wounds on the body, legs, patient's hands.
- Cleaning the oral cavity diabetics, prevention of stomatitis.
- Caring for the emotional calm of the patient.
Presentation of the nursing process behind people with diabetes mellitus can be found here:
Features of care for patients with diabetes
When careing children with diabetes mellitus, medical sisters are required:
- Carefully monitor the child's nutrition.
- Control the amount of urine and drinking liquid (especially during non-car diabetes).
- Inspect the body for injuries, damage.
- Monitor blood glucose indicators.
- Teach a self-control of the state, the introduction of insulin. Watch the video Instructions here you make insulin injection correctly
Children with diabetes are very difficult to get used to the fact that they differ from their peers. The nursing process when caring for minors diabetics should take into account. The medical staff is recommended to conduct conversations about life with diabetes, explain that it is not worth loaning on the disease, to increase the self-esteem of a small patient.
What is a "Sugar Diabetes School Diabetes"?
Every year, a large number of residents of Russia are diagnosed with sugar diabetes. Their number is growing. For this reason, with hospitals, medicine centers open "Schools of Diabetes School". Learning in classes pass diabetics and their relatives.
At the lectures on diabetology on the care process, you can find out:
- What is diabetes, how to live with him.
- What is the role of nutrition with diabetes mellitus.
- Features of physical exertion at SD.
- How to develop a children's and adult diabetic menu.
- Learn to independently control sugar, pressure, pulse.
- Features of the hygiene process.
- Learn to introduce insulin, find out the rules of its use.
- What preventive measures can be taken if there is a genetic predisposition to diabetes, the process of the disease is already visible.
- How to suppress fear of the disease, to hold the process of calm.
- What kind of sd varieties are found, its complications.
- How is the process of pregnancy during diabetes mellitus.
Important! Claims to inform the population about the features of the SD, diabetes care are conducted by graduate specialists, nurses with great experience. Following their recommendations, you can free yourself from many problems with diabetes, improve the quality of life, make the process of care simple.
Lectures for diabetics, their relatives for nursing care are held free of charge with specialized medical centers, clinics. Classes are dedicated to individual topics or have a general nature, acquaintance. It is especially important to attend lectures to those who first encountered an endocrine disease, does not have practical experience in care for sick relatives. After a conversation with the medical staff, memo, books about diabetes, patient care rules.
It is impossible to overestimate the importance and importance of the nursing process with diabetes mellitus. The development of health care, a medical care system in the 20-21 century, made it possible to understand the causes of failures in the work of the thyroid gland, which greatly facilitated the struggle with the complications of the ailment, reduced the percentage of patient mortality. Contact qualified service in hospitals, learn how to take care of a sick relative or yourself at home, then diabetes will really become a way of life, and not a sentence.
Ministry of Health and Social Development of the Russian Federation
Ministry of Health of the Orenburg Region
GAU SPO "Orenburg Regional Medical College"
COURSE WORK
under the discipline, nursing assistance in violation of the patient's health of the pediatric profile
Topic: Nursing care for diabetes mellitus in children I
Performed Student Group 304
Nursing business specialty
Nesterova N.S.
Leader:
Vanchinova O.V.
Orenburg 2014
Introduction
Chapter I. Clinical features of diabetes
1 Risk of sugar diabetes
2 clinical manifestations of diabetes
3 signs of the disease and primary manifestations
4 Complications of diabetes
Chapter II. Nursing care for diabetes
1 nursing assistance in hyperglycemic and hypoglycemic coma
2 The role of M / S in the organization of schools "School diabetes"
Conclusion
List of references
Introduction
In recent decades, the frequency of diabetes is steadily increases, the number of patients in developed countries is up to 5% of the total population, in reality the prevalence of SD is higher, since its latent forms are not taken into account (another 5% of the overall population). Children and teenagers up to 16 years old are 5-10% of all patients with diabetes. SD manifests itself at any age (there is even congenital diabetes), but most often during periods of intensive growth (4-6 years, 8-12 years, publity). Breast-age children are affected in 0.5% of cases. SD is more often detected between the ages of 4 and 10 years, in the autumn-winter period.
In this regard, the prevention of early diagnosis, control over 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 health care. According to the statistics submitted by the World Health Organization, there are currently 346 million people in diabetes in the world. Of particular alertness is the increase in the frequency of diabetes among children. In this regard, the problem of providing children and their parents with knowledge and skills necessary for its independent "reference", crises and lifestyle changes, which is the basis for the successful treatment of the disease is becoming increasingly relevant. Currently, in many regions of Russia, schools of diabetes are functioning, which are created as part of therapeutic and prophylactic institutions (health centers) on a functional basis.
Subject of study:
Nursing assistance when careing children with type I diabetes
Object of study:
Nursing care for diabetes mellitus in children I type
Improve the quality of nursing assistance when careing children with diabetes.
To achieve this goal of the study, it is necessary to study:
etiology and predisposing diabetes factors in children
clinical picture and features of diagnosis of diabetes in children
principles of primary nursing assistance in hyperglycemic and hypoglycemic coma
organization of medical nutrition in diabetes
Chapter I. Clinical Features of Sugar Diabetes
1 Risk of sugar diabetes
The big risk of diabetes are the development of diabetes, which were born from patients with diabetes mothers. Even above the opportunity to get diabetes in a child, both parents of diabetics. In children born from patients with mothers, pancreatic cells producing insulin, retained genetic sensitivity to the effects of certain viruses - rubella, measles, herpes, epidemic vapotitis. Therefore, the impetus for the development of diabetes in children is transferred sharp viral diseases.
Thus, hereditary predisposition is only one side of the problem, the prerequisite for which other equally important factors are superimposed leading to this genetic program, causing the development of the disease. The problem is that the child in a woman suffering from any type of diabetes (even gestational) is very often born large, with significant fatty sediments. Obesity is one of the most important factors affecting the development of diabetes and implement the organism's hereditary predisposition. Therefore, it is very important not to overflow a child, carefully monitor its diet, eliminating the easily-friendly carbohydrates from it. From the first days of life and at least a year, such a child should receive maternal milk, and not artificial mixtures. The fact is that the mixtures contain protein of cow's milk, which can cause allergic reactions. Even the weak allergyization of the body disrupts the immune system and contributes to the violation of carbohydrate and other metabolism exchanges. Therefore, the prevention of diabetes mellitus in children is breastfeeding and baby diet, as well as thorough control of his weight.
Preventive diabetes merases include:
natural breastfeeding;
diet and monitoring body weight of the child;
hardening and improving the general immunity protecting against viral infections;
lack of overwork and stress.
1.2 Clinical manifestations of diabetes
Sugar diabetes is a disease due to absolute or relative insulin insufficiency leading to a violation of metabolism, primarily carbohydrate, manifested chronic hyperglycemia.
Children have sugar diabetes only 1 type, 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 still there are significant differences, because the child's body is growing, forming and still very weak. The pancreas of the newborn is very small - only 6 cm, but by 10 years it increases almost twice, reaching the size of 10-12 cm. The pancreas of the child is very close to other organs, all of them are closely connected and any violation of one body leads to the pathology of another . If the pancreas of the child is poorly producing insulin, that is, it has a certain pathology, then there is a real danger of engaging in the painful process of the stomach, liver, gallbladder.
The production of the pancreas insulin is one of its intracerecretory functions, which is finally formed by the fifth year of the life of the baby. It is from this age and about 11 years old children are particularly susceptible to diabetes mellitus. Although the child can acquire this disease at any age. Sugar diabetes occupies the first place among all endocrine diseases in children. However, temporary changes in the blood sugar level in the child still do not indicate the presence of sugar diabetes. Since the child is constantly growing and developing and develops, all of its bodies develop with it. As a result, all exchange processes in the body in children proceed much faster than adults. A carbohydrate exchange is also accelerated, so the child needs to consume from 10 to 15 g of carbohydrates by 1 kg of weight. That is why all the children love sweets very much - this is the need of their body. But the kids cannot, unfortunately, will stop in their preferences and consume sweets sometimes in much larger quantities than they need it. Therefore, moms need not to deprive the children of sweet, but control their moderate consumption.
The carbohydrate exchange in the children's body occurs under insulin control, as well as a number of hormones - glucagon, adrenaline, hormones of adrenal cortex. Sugar diabetes arises precisely because of pathologies in these processes. But the exchange of carbohydrates regulates the nervous system of the child, which is still completely immature, so it can give failures and also affect the level of blood sugar. Not only the immaturity of the nervous system of the child, but also its endocrine system sometimes leads to the fact that the child is disturbed by the regulation of metabolic processes, as a result of which the blood sugar level changes and periods of hypoglycemia appear. But it is not a sign of diabetes at all. Although the level of blood sugar in the child should be permanent and can only fluctuate in small limits: from 3.3 to 6.6 mmol / l, but even more significant oscillations that are not affected by the pathology of the pancreas are not dangerous and passed with age. After all, they are the result of imperfection of the nervous and endocrine systems of the children's body. Usually, premature, underdeveloped children or adolescents during puberty and having significant physical exertion are subject to such states. As soon as the functions of the nervous and endocrine systems are stabilized, the mechanisms of regulation of carbohydrate metabolism will become more perfect and the level of sugar in the blood is normalized. At the same time, hypoglycemia bouts will be held. However, despite the seeming harmlessness of these states, they are very painful for the baby and can affect his future health. Therefore, to follow the state of the child's nervous system must be necessary: \u200b\u200bno stress and increased physical exertion
Sugar diabetes has two stages of development, the same in adults and children. The first stage is a violation of glucose tolerance, which in itself is not a disease, but speaks of a serious risk of diabetes mellitus. Therefore, in violation of glucose tolerance, the child must be carefully examined and taken under prolonged observation of doctors. With the help of diet and other methods of therapeutic prevention, diabetes can not develop. The most important task is to prevent its manifestation. Therefore, it is necessary to take blood on sugar once a year.
The second stage of diabetes is its development. Now this process is no longer stopped, but it is necessary to keep it from the very first days under control. This is related to certain difficulties. The fact is that diabetes mellitus in children develops very quickly, has a progressive nature, which is associated with the general development and growth of the child. This consists of his difference from adult diabetes. The progression of diabetes is that there is a high probability of developing labile diabetes with sharp blood sugar oscillations in blood and poor insulin therapy. In addition, labile diabetes provokes the development of ketoacidosis and hypoglycemia attacks. The flow of diabetes is also complicated by the fact that children often sick infectious diseases that contribute to diabetes decompensation. The younger child, sick diabetes, the hardest disease flows and the more threat of various complications.
Diseases worsening diabetes in children and contributing to decompensation
Infectious inflammatory diseases.
Endocrine diseases.
3 signs of disease and primary manifestations of diabetes
In childhood, clinical symptoms of diabetes are usually rapidly, and parents often indicate the exact date of the disease. Less often diabetes develop gradually. The most characteristic signs of diabetes are the rapid weight loss, an indomitable thirst and abundant urination. This and you need to pay attention to parents. The child loses weight so fast that "melts" right in front. And objectively he can lose weight by 10 kg in just a few weeks. Do not notice it is impossible. The separation of urine is also superior to any norms - more than 5 liters per day. And of course, the child constantly asks to drink and can not get drunk. This even seems strange to him, and children usually do not pay attention to similar nuances. With all these signs, you need to immediately go to the doctor who will not only give a direction to the blood test and urine on sugar, but also examine the child visually. Indirect signs of diabetes mellitus are as follows: Dry skin and mucous membranes, crimson, low skin elasticity. Laboratory studies, as a rule, confirm the assumption of a doctor, based on classical signs of diabetes. The diabetes diagnosis is raised if the blood sugar content in an empty stomach exceeds 5.5 mmol / l, which is a sign of hyperglycemia, sugar (glucose) was found in the urine, and thanks to the content in the urine glucose, the urine itself has an increased density.
Sugar diabetes in children can begin with other signs: total weakness, sweating, increased fatigue, headaches and dizziness, as well as constant thrust to sweet. The child begins to tremble hands, it becomes pale and sometimes fainted. This state of hypoglycemia is a sharp decrease in blood sugar. The exact diagnosis will put a doctor based on laboratory studies.
Another option of the start of child diabetes is a hidden course of the disease. That is, insulin is already poorly produced by the pancreas, sugar in the blood gradually rises, and the child does not feel any changes yet. However, the manifestation of diabetes can still be seen by the state of the skin. It is covered with small guns, boils or fungal lesions, the same lesions appear on the mucous membrane of the mouth or genital organs in girls. If the child has non-coming acne and guns, as well as stomatitis, you need to urgently investigate blood on sugar. With such symptoms, there is a certain risk of already started diabetes, which flows in a hidden form.
4 forms of complication of diabetes
Fine diagnosis or improper treatment lead to complications that are developing either in a short time or over the years. The first type includes diabetic ketoacidosis (DCA), which is the defeat of various organs and systems that are not always manifested in childhood and youthful age. The largest danger is the first group of complications. The causes of the development of diabetic ketoacidosis (DCA) are unspecified diabetes, gross errors in the treatment (refusal to introduce insulin, large errors in the diet), the addition of severe concomitant disease. Often, hypoglycemic states develop in diabetes patients. First, the level of sugar in the blood of the child is raised, and it must be controlled by carefully selected doses of insulin. If the insulin turned out to be more than it is required to power the cells glucose, or the child has experienced stress or physical overvoltage on this day, the blood sugar level falls. A sharp decrease in blood sugar causes not only insulin overdose, but also the insufficient content of carbohydrates in the baby food, non-compliance with the power mode, delay with food intake and, finally, the labile diabetes. As a result, the child comes the state of hypoglycemia, which is manifested by lethargy and weakness, headache and feeling of strong hunger. This condition may be the beginning of the hypoglycemic coma.
Hypoglycemic coma.
Already at the first signs of hypoglycemia - lethargy, weakness and sweating - you need to beat the alarm and strive to increase blood sugar. If this is not done, the hypoglycemic coma can quickly develop: the child will have a trembling limbs, convulsions will begin, it will be in a very excited state for some time, and then the loss of consciousness will come. At the same time, breathing and blood pressure remain normal, the body temperature is also normal, the smell of acetone is missing, the skin is wet, the blood sugar level falls below 3 mmol / l.
After the blood sugar level correction, the child's health is restored. However, if such states are repeated, then diabetes can go to the labile stage, when the selection of insulin dosage becomes problematic, and more serious complications threaten the child.
If diabetes fails to compensate, i.e. for some reason, the child does not normally normalize the blood glucose level (there is a lot of sweet, do not pick up the insulin dose, misses insulin injections, there is no regulation of physical exertion, etc.), this is fraught very Serious consequences, up to ketoacidase and diabetic coma.
This is an acute state that arises against the background of decompensated diabetes in children, that is, when the blood sugar level in the blood is uncontrollably and quickly changes. The main characteristics are as follows. The child looks very weak and sluggish, his appetite disappears and irritability appears. This is joined by bias in the eyes, pain in the heart, in the lower back, in the abdomen, nausea and vomiting, which does not bring relief. The child suffers from insomnia, complains of bad memory. The smell of acetone is felt. This is a clinical picture of ketoacidosis, which can grow into an even more terrible complication, if not to take urgent therapeutic measures. This complication is called ketoacidotic coma.
Ketoacidotic coma.
This complication is developing after ketoacidosis for several days - usually from one to three. Signs of complications during this period change and deteriorate. Under a komoy, they understand the complete loss of consciousness and the absence of normal reflexes.
Signs of ketoacidotic coma.
A coma begins with general weakness, increased fatigue, frequent urination.
Then join the abdominal pain, nausea, multiple vomiting.
Consciousness will slow down, and then completely lost.
From the mouth is felt by a strong smell of acetone.
Breathing becomes uneven, and pulse is frequent and weak.
Arterial pressure drops greatly.
Then the frequency of urination is reduced, and they generally stop. Anury develops.
If someone does not stop, the liver and kidney defeat begins. These clinical manifestations confirm the laboratory diagnosis. In a state of ketoacidotic coma, laboratory studies show the following results:
high blood sugar (more than 20 mmol / l); ^ The presence of sugar in the urine;
reducing the acidity of blood to 7.1 and below, which is called acidosis (this is a very dangerous state, since the level of acidity is 6.8 is considered fatal);
the presence of acetone in the urine;
increasing the ketone bodies in the blood;
due to the damage to the liver and kidney in the blood, the amount of hemoglobin, leukocytes and red blood cells increases;
a protein appears in the urine.
For the reasons for the ketoacidotic coma include long-term and poorly treatable diabetes, stressful situations, heavy physical exertion, hormonal restructuring in the body of adolescents, coarse long impaired carbohydrate diets, acute infectious diseases. This type of diabetic coma is very dangerous because it strikes all organs and systems. So, the diseases can become irreversible. It is impossible to run a complication, it must be stopped at the very beginning. This requires therapeutic impacts that will be discussed in the chapter "Treatment of diabetes and its complications", as well as a diet and regime.
Hyperosmolar Coma.
This is another type of diabetic coma that may occur in a child with a launched, long-term or non-treating disease. Rather, in diabetes, the parents were poorly engaged, because the child could not seriously refer to their fear, carefully control the diet, physical exercise and the introduction of insulin. All of this should be done by the mother, which it is necessary to understand that the misused injections missed or not in time - this is the first step towards the development of diabetes decompensation and, as a result, to its complications.
Hyperosmolar coma is developing slower than DCA, and manifests itself with strong dehydration of the child's body. In addition, the nervous system of the child is affected. Laboratory tests show a very high blood sugar level (more than 50 mmol / l) and increased hemoglobin and hematocrit, which make blood too thickened.
The diagnosis of the hyperosmolar coma is placed after laboratory studies will confirm another very important and characteristic indicator increase in blood plasma osmolarity, that is, a very high content of sodium ions and nitrogenous substances.
Signs of hyperosmolar coma in a child
Weakness, fatigue.
Strong thirst.
Cramps and other disorders of the nervous system.
Gradual loss of consciousness.
Breathing Frequent and superficial, the smell of acetone is felt.
Increase body temperature.
Increased the amount of urine isolated first, then decreases.
Dry skin and mucous membranes.
Although hyperosmolar coma is found in children much less often than other complications, it represents a serious danger due to strong dehydration of the body and disorders of the nervous system. In addition, the rapid development of this variety coma does not allow to slow down with medical care. The doctor needs to be called immediately, and the parents themselves provide emergency care to the child.
However, banal truth says that it is better to prevent such complications and carefully follow the condition of a child who is sick diabetes
Milk-sour koma
This type of coma develops quite quickly, for several hours, but has other characteristic signs - pain in the muscles and lower back, shortness of breath and gravity in the heart. Sometimes they are joined by nausea and vomiting, which does not bring relief. With frequent pulse and uneven breathing, blood pressure is lowered. Coma begins with the inexplicable excitement of the child - he chips, nervous, but soon the drowsiness comes, which can go into loss of consciousness. At the same time, all the analyzes familiar for diabetes are normal - the level of sugar is normal or slightly elevated, there is no sugar in the urine, nor acetone. Yes, and the amount of urine allocated is also within the normal range.
To the milky and sour, which is determined by other laboratory signs: In the blood, the increased content of calcium ions, lactic and grape acids is found.
sugar diabetes kids coma
CHAPTER II. SERINSK Help with diabetes
1 nursing assistance in hypoglycemic and hyperglycemic coma
Emergency care for hypoglycemic coma.
It depends on the severity of the state: if the patient is conscious, it is necessary to give food rich carbohydrates (sweet tea, white bread, compote). If there is a patient without consciousness, the inkjet introduction 20-50 ml of 20-40% of the glucose solution. In the absence of consciousness for 10 -15 minutes-internal drip administration of a 5-10% glucose solution until the Barn will come into consciousness.
Emergency care for hyperglycemic coma
Immediate hospitalization. Heat the patient. Rinse the stomach 5%
sodium hydrocarbonate solution or isotonic solution of sodium chloride (part of the solution is left in the stomach). The consistency of the enema with a warm 4% sodium hydrocarbonate solution. Oxigenotherapy. Intravenous drip administration of an isotonic solution of sodium chloride at the calculation of 20 ml / kg body weight (kocarboxylase, ascorbic acid, heparin) is added to the dropper). Insulin in a dose of 0.1 units / kg / h in 150-300 ml of istonic sodium chloride solution (in the first 6 hours are injected 50% of the total amount of fluid)
2 The role of M / S in the organization of schools "School diabetes"
The purpose and task of the school is to train patients with diabetes melligent methods of self-control, adaptation of the treatment to specific living conditions, preventing acute and chronic complications of the disease.
As for children, training in the "Sugar Diabetes" school must be adapted to age and the degree of puberty of the patient. In this principle, the formation of age groups of students is based.
) The first group includes parents of newborns and children of the first years of life, patients with diabetes mellitus. Small patients are fully dependent on parents and medical personnel (eating, injection, monitoring), so need to form close relationship with providing medical assistance to the employee. It is important to create psychological contact with the mother of a sick child, because against the background of an increasing stress, it decreases with a child with a child and depression is noted. Problems that need to solve the training "brigade" of medical workers in this case are: mood oscillation in a patient with diabetes of a newborn baby; Contingence of injection and control of blood glucose in the blood with pain, which arise as a result of medical manipulations and are associated with a child with a white galat of the doctor. These obstacles determine the need to establish confidence relations with the family of a sick child and learning monitoring over diabetes, since hypoglycemia in newborns occurs often and can lead to severe complications.
) In many countries of the world, the expediency of learning preschoolers with diabetes mellitus is widely discussed, and whether the final outcomes of diabetes are dependent on learning in this age group. However, parents report the need, the significance of training and support.
) The third group of learning includes children of school age. Classes for these patients include topics:
ü assistance and regulation of the transition to the lifestyle of the schoolchildren, the development of self-esteem (self-esteem) and peer relations; ü training in the skills of injection and monitoring of glycemia; ü recognition and understanding of symptoms of hypoglycemia; ü improving the understanding of independent "maintenance" of the disease; ü adaptation of diabetes mellitus for school learning, reception in school, physical activity and sports activities; ü inclusion of blood glucose monitoring and injection into school regime; ü tips for parents on the gradual development of the independence of the child with the transfer of relevant responsibility. In school children, there is dissatisfaction with the fact that the doctors speak with their parents, and not with them. Educational programs focused on the age of patient are effective in children and their families. Third, school, group you can include sick children of adolescence. The adolescent period is the transitional phase of development between childhood and adult life and has a number of biological and psychological features that cause some problems in making diabetes in such patients. The deterioration in the course of diabetes in this age group is often associated with irregular nutrition, insufficient physical activity, fuzzy performances of the doctor's appointments, endocrine changes associated with a pubertal period and other factors. Features of the areas of work at the Sugar Diabetes School for adolescents include: ü development of trust relationships between adolescent, group of students and "brigade" of specialists; ü helping a teenager in determining priorities and setting small goals achieved, especially if there are contradictions between the social needs of a teenager and restrictions related to the presence of diabetes; ü ensuring an understanding of the physiological changes in the pubertal period, their influence on the dose of insulin, the solution of emerging problems with the control of body weight, regulation of the diet; ü explanation of the importance of screening early symptoms of complications of diabetes and improving metabolic control; ü trust conversations in the adolescent about the process of puberty, strengthening in it sense of confidence, but at the same time preserving confidence and support from parents; ü help teenage and parents in the formation of relations with a new level of parents involving the tasks of treating diabetes. Surnery for diabetes mellitus: Action Plan1. Inform the patient and his relatives that "diabetes is not a disease, but a lifestyle" ü The patient's right is ensured. ü The child and his relatives understand the feasibility of fulfilling all activities of care2. Organize the nutrition of the child with the restriction of accessible carbohydrates (honey, jam, sugar, confectionery, grapes, figs, bananas and the like) ü Easily-friendly carbohydrates give a "volley" increase in blood glucose3. Organize meals 6 times a day (3 main reception and 3 "snack") ü Stable glucose indicators in blood are achieved. Top patient or its relatives and techniques of insulin administration, monitor the regular intake of anti-diabetic preparations and insulin ü Prevention of ketoacidotic (hyperglycemic) coma (hyperglycemic) coma5.stretch follows meals after administration of insulin ü Prevention of development of insulin (hypoglycemic) coma6.Dell physical and emotional load of the patient's child. ü Prevention of the development of comatose states7.streat follow the hygiene of the skin and mucous membranes ü Gnove skin diseases are indirect signs of diabetes 8. Baby from the attachment of concomitant infections, colds ü Diabetes diabetes immunity - ChBD (often ill children) 3 Organization of medical nutrition with diabetes Dietherapy. Mandatory with all clinical forms of diabetes. Its main principles: individual selection of daily calories: balanced and physiological in the content of proteins, carbohydrates, minerals, fats, vitamins diet (table number 9); fractional hectares with uniform distribution of calories and carbohydrates (breakfast-25%, second breakfast - 10% , Lunch is 25%, afternoon school-10%, dinner-25%, second dinner-15% daily calorie). The food diet exclude easily durable carbohydrates. It is recommended to replace the carbohydrates containing a large amount of fiber (it slows down the absorption of glucose). They are replaced with sorbitol or xylitol. Moderate limitation of animal fat. Medical treatment. The main in the treatment of diabetes is the use of insulin preparations. The dose depends on the severity of the disease and the loss of glucose with the urine during the day. For every 5 grams of glucose derived from the urine, 1 units are prescribed. The drug is injected subcutaneously, intramuscularly and intravenously. There are insulins of a short action (peak of action in 2-4 hours from the moment of administration, the duration of pharmacological action is 6-8 hours) -akrapide, insulrap, humulin r, housing; average duration of action (peak after 5-10 hours, action 12-18 hours) -b-insulin, tape, long, insonong, monotttern, Homofan; Long-term action (peak in 10-18 hours, Action 20-30 hours) -Ultraulg, ultravente, ultrall nm. With a stable course of the disease, combinations of brief and prolonged insulin preparations are used. In addition, sulfonilamide drugs (I and II generation) are prescribed - Diabeton, Burban (obanilla), diabeton, and also use Biguenides-Fenformin, Dibiton, adebit, silin, glucophag, dormyn, metformin. Conclusion Currently, sugar diabetes is among the leading medical and social problems. This is due primarily to its large prevalence, which continues to further increase the number of patients and the damage that causes sugar diabetes, which has developed in childhood, society. Analysis of extensive clinical material, the study of the dynamics of the appeal convince us that in addition to the increase in incidence, the age structure is changed, the "rejuvenation" of diabetes mellitus. If a few years ago, diabetes mellitus in children of the first years of life was a casuity, now he is not uncommon. Traditionally, it is believed that in children prevail insulin-dependent forms of the disease. The prevalence of insulin-dependent diabetes in the children's population is still unclear and requires learning. The most important achievement of diabetology over the past thirty years has increased the role of nurses and the organization of their specialization in diabetology; Such nurses provide high-quality care for patients with diabetes; Organize the interaction of hospitals, general practitioners and outpatient patients; Conduct a large number of research and training of patients. The progress of clinical medicine in the second half of the 20th century allowed much better to understand the causes of the development of diabetes and its complications, and also significantly alleviate the suffering of patients, which another quarter of a century it was impossible to even imagine. List of references 1. L.V.Arzamasseva, M.I. Martynova - the socio-demographic characteristics of families of children with diabetes mellitus. - Pediatrics, 2012. V.G.Baranov, A.S.S.S.S.-Diabetes in children. - M., Medicine, 2011 3. Dispensary observation of children in the clinic (ed. K.F. Shiryayeva). L., Medicine, 2011 M.A. Zhukovsky Children's Endocrinology.-m., Medicine, 2012 Yu.A. Knyazev - epidemiology of diabetes in children. - Pediatrics, 2012 V.L.Liss - diabetes mellitus. In the book: Children's diseases (ed. A. F. Shabalova) .- SPB, SOTIS, 2013. V.A. Mimikelson, I.G. Almazov, E.V. Neudakhin - Comatous states in children. - L., Medicine, 2011 8. Methodical instructions on the cycle of childhood endocrinology (for students from the LPMA course). - L., 2012 9.U. Mak-Morrai.-exchange of substances in humans. -M, World 2006 10. M. Skordok, A.Sh.Stroykova Sugar diabetes. In the book: childhood diseases (ed. A.F.Tura, etc.) - M., Medicine, 2011.Similar works on - nursing care for diabetes mellitus
In the world, more than 100 million people are sickly diabetes, while there is a constant tendency to rejuvenation. Diabetes is found in children of all ages, including at heart age and even newborns, but most often observed in the younger school and adolescent period.
The disease is equally affecting both sexes.
Diabetes has a progressive course and represents the danger to the child due to the development of complications in the form of diabetic and hypoglycemic comers requiring urgent events, as well as violations of the function of the cardiovascular system, liver, kidney, early development of atherosclerosis, retinopathy, leading to loss of vision, etc. .
Timely recognition of the disease and adequate treatment contribute to the prevention of serious complications.
Insulin-dependent type (I type, juvenile, ISR) is 12-15% of all cases.
Insulin-dependent type (II type, adult, INSD).
Children are most often developed by type I diabetes - insulin-dependent diabetes mellitus.
Causal factors for the development of diabetes:
Genetic factor (80%) - a genetic defect of the VI chromosome is detected, leading to a change in the membrane proteins of the β-cells of the pancreas of the pancreas, which is confirmed by the presence of references from relatives.
Viral damage to the island apparatus of the pancreas (enterovirus, rubella viruses, epidemic vapor, chickenpox, cytomegalovirus, etc.).
An autoimmune damage to the β-cells of the inusular apparatus of the pancreas, which is confirmed by the detection of antibodies to the islet cells and to insulin in patients in the early duration of the disease of the insulin when inflammation of the pancreas.
Congenital pancreatic hypoplasia.
Other provoking factors:
hormonal disorders in different periods of children's age (increasing the activity of the counterinsular hormones - glucocorticoids, catecholamines, etc.).
Insulin provides transport through the cell membranes of glucose, potassium, amino acids, glucose translation into fats, glycogen formation in the liver. Insulin brakes the process of the formation of glucose from protein and fat.
The basis of the development of diabetes mellitus is a change gomeostasisAs a result of the relative or absolute insulship failure, which leads to violations of carbohydrates, proteins and fats.
Hyperglycemia (over 8.8 mmm \\ l) leads to glucosuriaSince more sugar is filtered into primary urine and it cannot be completely reabined in the proximal kidney channels. The relative urine density increases due to the isolation from the urine of sugar, which is a characteristic sign of the disease.
Glucosuria causes polyuria. As a result
increased urine osmotic pressure due to violation of protein, glycogen and fat synthesis. The high concentration of glucose in blood serum and polyuria determine hyperosmolarity Serum and thirst symptom ( polydipsy). The conversion of carbohydrates into fats is disturbed, reinforced mobilization of fatty acids from fatty depots occurs, develops lose weightwhich in addition, due to dehydration ( dehydration) organism. Insulin deficiency causes significant violations of fat exchange. A large amount of fatty acids arrive in the blood, and as a result of the incomplete combustion, there are accumulated non-optic fat metabolism ( ketone tel), which leads to an increase in cholesterol formation, triglycerides and development of the renal threshold of glucose
appearance acetone in exhaled air.
The mechanism for the appearance of acetone during diabetes mellitus.
As a result of the dinner of the liver glycogen, the fat is postponed in it, which leads to fat intiltribution of the liver and increases it. Insulin deficiency causes hypercholesterolemiawhat contributes to early development atherosclerosis. It matters in the development of diabetic angiopathy, leading to severe vascular changes in the eyes, kidneys, heart, liver, gastrointestinal tract and other organs. As a result, insulin deficit is also violated water and mineral exchangeIt is largely due to hyperglycemia, glucosuria and ketoacidosis. In diabetic ketoacidosis, reinforced selection with urine electrolytes: sodium, potassium, chlorides, nitrogen, ammonia, phosphorus, calcium, magnesium is noted. The toxic effect of ketoacidase and sharp water-broadcast disorders determine the development of comatose states in diabetes mellitus.
Clinical manifestations of diabetes
During the disease, three stages are distinguished: a potential disruption of glucose tolerance (potential diabetes), violation of glucose tolerance (latent diabetes), explicit (manifest) diabetes.
At childhood risk factors are the presence of diabetes in close relatives, a large body weight at birth (over 4100g), diabetes mellitus in single-person twin, obesity, spontaneous hypoglycemic states, ptosis, chronic pancreatitis, recurrent stomatitis, purulent-inflammatory skin diseases, thyrotoxicosis. Careful examination It is necessary to spend children with the first time detected by Niccounture.
thirst ( polydipsy), often night;
excessive appetite ( polyphagia);
frequent, abundant urination ( polyuria) Over 3-4 liters of urine per day;
the predominance of the night diurea over the day ( nicturia);
dehydration syndrome ( dehydration): dry skin and mucous membranes, bright raspberry tongue, cracks, snacks, body weight loss in a short period of up to 5-10kg;
recurrent purulent infections of the skin and mucous membranes: stomatitis, pyodermium, furunculosis, vulvovaginitis in girls (due to the decrease in immunity);
functional disorders of the central nervous system: increased excitability, sleep disorder, fatigue, lethargy, worsening memory;
changes from the peripheral nervous system: pain in the lower limbs, reduced tendon reflexes.
In children, the disease occurs more hard with pronounced metabolic disorders and a tendency to ketoacidosis.
The disease is manifested by a sharp concern, children greedily capture the nipples and chest, calm down for a short time only after drinking. There is a decrease in body weight. Characteristic resistant diallos, especially in the field of external genital organs. Foci of purulent infection are often joined, there is an inclination to diseases of the upper respiratory tract. Often, parents pay attention to unusual, as if "starchy", diapers due to the deposits of sugar crystals, sticky urine.
incression symptoms are enhanced: headache, dizziness, violation, weakness, muscle hypotension;
a diabetic blush appears on the cheeks, in the region of zilly arc;
there is a smell of acetone from the mouth;
glossite symptoms: mouth mucosa bright, dry tongue with white plates, cracks in the angles of the mouth;
dyspeptic violations are expressed: anorexia, nausea, vomiting, gravating pain in the stomach, liquid chair.
Changes in laboratory indicators:
hyperglycemia (sugar level on an empty stomach of more than 7.7mmmol / l);
glucosuria of varying degrees of severity (from 2 to 8%);
high urine density (more than 1030);
hypercoomeururia and acetoneuria (with ketoacylosis);
pH violation below 7.3 (metabolic acidosis);
increasing cholesterol level (above 5.2 mmol / l), lipoproteins, peer-grade and lactic acids;
Patients with manifestic (explicit) diabetes need inpatient treatment for the selection of insulin dose, the correction of acidosis, water-electrolyte violations and the appointment of the diet adequate state.
If a patient was not timely assistance, then the dehydration of the alkaline reserve of blood, the increase in dehydration, metabolic acidosis and ketone bodies leads to the development of comatose states.
Ketoacidotic (diabetic) coma.
I. Diabetic ketoacidotic coma.
In early age children, often for the first time identified diabetes is diagnosed in a state of ketoacidotic coma.
late diagnosis of the disease;
coarse disorders (skipping insulin injection, long-term inadequate dose, use of inactive insulin);
errors in the diet (abuse of oily and sweet food);
attachment of intercurrent diseases;
physical and mental overload.
The main clinical signs of the ketoacidotic coma:
gradual increase in respiratory disorder (by the type of Kussmouul);
violation of consciousness (due to disorder of exchange and hyperketonemia);
muscle hypotension, hypotension of eyeballs;
non-corrosive vomiting, constant abdominal pain, stomach smeared;
dehydration on hypotonic type is rapidly developing: a sharp dryness of the skin and mucous membranes, the features of the face are sharpened;
hemodynamic disorders, tachycardia, decreased blood pressure, acricyanosis, muffling of heart tones;
oligo, or Anuria is noted;
changes in biochemical indicators: deep metabolic acidosis, hyperketonemia, hyperglycemia (blood sugar content exceeds 20.0mmol / l), violation of electrolyte equilibrium.
II. Hyperosmolar Coma.
Children are rare. It is based on a significant increase in blood osmolarity as a result of a significant fluid loss.
dyspeptic disorders (vomiting, diarrhea);
uncontrollable diuretic drugs;
insufficient compensation of diabetes;
attachment of intercurrent diseases.
Clinical signs of hyperosmolar coma:
extremely high hyperglycemia (50-100mmol / l);
hyperosmolarness due to hypernatremia;
high hemoglobin and hematocrit (with non-pronounced ketoacidosis).
III. Lacacidotic coma.
Developed against the background of hypoxia (in children with congenital heart defects, heavy pneumonia, anemia). Coma is due to accumulation in the organism of lactic acid.
pain in muscles of various location;
shortness of breath (acycotic breathing);
pronounced acidosis S. high level of lactic acid (lactate) in serum and a sharp decline in standard bicarbonates;
relatively low hyperglycemia (14mol / l);
IV. Hypoglycemic coma.
In hypoglycemia, the absorption of glucose cells is sharply reduced and primarily brain cells. Glucose is the main source of brain energy. The appearance of hypoglycemia is the result of the CNS reaction to reduce blood sugar levels and the oppression of the metabolism of the brain.
insufficient power after insulin administration;
long break in food intake;
Coma comes quickly, sometimes within a few minutes.
feeling of hunger, dizziness, weakness;
feeling of heat, sweating;
shivery in the whole body, motor excitement.
Clinical signs of the hypoglycemic coma:
there is a darkening of consciousness;
motor excitement, convulsions of various muscle groups appear, the triumism of chewing muscles;
pupils are expanded, eyeballs of ordinary density;
in the urine there are no glucose and acetone;
the blood glucose level is reduced (less than 3,3mol / l).
Diabetic damage to vessels (angiopathy) of various location (retino-, nephro-, neuro-, arthro-, gastro, hepato, cardiopathy).
Double-sided diabetic cataract.
Lipodystrophy, lipomas (due to violation of the rules for the introduction of insulin).
Moriak's syndrome in children (physical and sex infantilism).
Syndrome Somoga (chronic insulin overdose, leading to frequent hypoglycemic states).
Reducing immunity and the addition of concomitant diseases (stomatitis, pyodermia, vulvovaginitis, pyelonephritis, candidiasis, etc.).
Development of comatose states.
Basic principles of treatment of diabetes.
Compliance with the regime of the day.
Training in the "School of Diabetes".
In the initial stage of diabetes, a stationary examination and development of an individual protocol of treatment, lifestyle learning, assistance in adaptation to life with diabetes.
Power must be balanced in all respects (given the lifelong nature of therapy).
Diet number 9 It is necessary to make the most appropriate to the food stereotype of the family and the food preferences of the child.
Food and its volume should be fixed.
Refined carbohydrates are excluded from food, preference is given to carbohydrate products containing a sufficient amount of dietary fiber, with special "diabetic" products and special culinary processing during cooking dishes is not required.
After each meal, the child should feel a sense of saturation.
Power must be organized in such a way that the food brings pleasure, created a good mood.
The child needs to be trained by the basic rules of diet and therapy, an adequate replacement of products, conducting insulin therapy self-control, advance nutrition planning at home and outside the house.
Insulin preparations are used with different hypoglycemic effects in different periods of day:
Preparations quick, but short action: The effect occurs after the duration of 5-8 hours ultrashort action - Start in 10 minutes, duration of 2-3 hours (simple insulin, rapid insulin, maxirapid, etc.).
Preparations medium duration of action: The effect occurs after 1.5-3 hours, the duration of the action (insulin-Bazal 100, Insulin-Radepard, Khumulin-M, Semille, etc.).
Preparations prolonged action: The effect occurs after 4-6 hours, the duration of the action (insulin-tape, protafant, insonong, humulin-l, etc.).
Preparations overprolved action: The effect occurs after 3 hours, the maximum action is sharply, the duration of action is 36 hours (insulin ultravente, ultramong, ultrald, etc.).
Preparations are selected individually by indicators glycemic and glucosuric profile. Treatment is recommended to begin short-acting preparations and quickly move on combinations with insulin of long-term action in individually selected adequate doses. When the dose of insulin is distributed, it is necessary to remember that the higher need for insulin is marked during the daytime, especially after eating, relatively low - at night.
Recently, the method of calculating the insulin of a short action is obtained, depending on the amount of carbohydrates in food, adopted during breakfast, lunch and dinner. Such an insulin dispensing allows you to avoid a sharp increase in blood sugar levels after meals. At the same time, the daily caloric content of the edible diet is calculated, the daily amount of carbohydrates in the bread units (xE) and their amount distributed for breakfast, lunch and dinner. Accordingly, the insulin of a short action is dosed: in front of breakfast - 2d to 1sh, before dinner - 1.5ied at 1sh, in front of dinner - 1,2d to 1sh with an insulin dose correction in terms of glycemia (bolus therapy). The amount of insulin (from a total daily dose) remaining after this calculation (from insulin of extended action (basic therapy).
Adequate therapy provides a clear mode of insulin administration (multiplicity, clock of administration, dose of drugs), taking into account the mode of day and the ability of a patient or family members in urgent situations to independently adjust the treatment plan (if necessary, enter an additional insulin dose or reduce it, or even abandon the next introduction ).
lack of sharp fluctuations in blood sugar levels (normoglycemia);
the absence of sugar in the urine (agyutyosuria);
physical and sexual development in accordance with age;
adequate mental and physical activity;
3. Pathogenetic therapy.
The use of anticoagulants, antiagregants, hypolypidemic drugs, angioprotectors, drugs containing phosphate compounds (ATP), vitamins C, B (with microcirculation disorders, lipid, electrolyte and vitamin exchanges) are shown. When attaching concomitant diseases, the symptomatic therapy is carried out.
The urgent hospitalization of the child is needed to the specialized branch of intensive therapy.
Oral rehydration: Alkaline mineral degassed water, oral, regider, diluted juice, sweetened tea.
Parenteral rehydration: With a thrust vomiting - intravenous administration of isotonic sodium solution of chloride with cocarboxylase.
Insulinotherapy - at the rate of 1-1d / kg / mass subcutaneously or intramuscularly (early-age children), starting with ½ daily dose, then 0.2-0 cps / kg / kg / kg after 4-6 hours. Precaution! Before each introduction of insulin is obligatory is the study of glucose in the blood, urine.
With a coma II-III degree:
Acidoza correction By removing ketone bodies from the gastrointestinal tract by washing the stomach 2% sodium solution of hydrocarbonate or isotonic solution of sodium chloride and cleansing enema.
Parenteral rehydration: It is carried out by an isotonic solution of sodium chloride, and with a decrease in glycemia to 12.0mmol / l, a solution of glucose is translated by 5-10%. In the first 6 hours, ½ daily amount of fluid is introduced, after 1-2 hours, potassium preparations are added from the beginning of infusion therapy. Daily need for liquid - 2000 ml / sq. M body surface. At the same time, with a sharp decline in blood pH
8.00-8.30 hour - 25% daily calorie
10.00-11.30 hour - 10-15% daily calorie
14.00-15.00 Hour - 25-30% daily calorie
16.30-17.00 Hour - 6-10% daily calorie
19.00-19.30 Hour - 20-25% daily calorie
20.30-21.00 Hour - 5-10% daily calorie
Patients trained in the self-control of the level of glycemia and owning the methodology for correction of the insulin dose may refuse to be fixed meals, while "Physiological" insulin therapy Let them change the hours of food intake, the amount of carbohydrates, depending on the appetite, conditions, desires.
Calculation of the insulin dose is carried out on the basis of glycemia indicators using a conditional concept "Bread Unit" (HB) and the table of equivalent replacement of products for carbohydrates.
To assist parents for organizing a regime as appropriate to the familiar family's life estimate with the inclusion of all therapeutic measures (diet therapy, caloric content of food, dose and time of injection), learn to live with a child who is chronically sick, live with "diabetes." Recommend regular to keep a diary of life.
date, day of the week;
self-control of state, glycemia, glucosuria, hell, body weight (breakfast, lunch, dinner);
bread units (breakfast, lunch, dinner);
dose Insulin (breakfast, lunch, dinner);
note (the presence of hypoglycemia, dry mouth, polyuria, etc.).
To learn to evaluate the condition of the child, to promptly recognize the symptoms of decompensation of diabetes and independently (before consulting a doctor) take urgent measures to prevent serious complications.
Advise parents, satisfy the physical, emotional, psychological needs of the child, follow the level of intellectual development, to educate as a healthy, but at the same time he must realize that in non-compliance with the rules that make it relatively healthy, he exposes himself to the dangers that can lead to heavy Complications and worsen the forecast of the disease.
To advise the child and parents on the organization of physical exertion (when compensating for the disease):
help choose the optimal time for physical culture (conducted during the maximum increase in blood glucose, i.e. 1-1.5 hours after meals);
in accordance with the volume of physical exertion, learned to carefully conduct self-control of the state and level of glycemia;
to be able to adjust the dose of insulin and nutrition: with non-planned physical exertion to provide additional reception of carbohydrates if the motor overload is planned - to reduce the insulin dose by 2-10-20 g.
Recommend the child to visit special groups of health or sports sections (with medical control), where communication with peers having such a disease will contribute to the development of psychological adequacy, as well as the creation of an atmosphere of self-learning, self-and mutual assistance.
Help the family in overcoming the situational crisis, support parents at all stages of the child's disease, give them the opportunity to express their doubts and anxiety, to teach live without constant fear, feelings of hopelessness and perceive the disease, as an inevitable inconvenience that needs to be overcome to live a full-fledged active life. To convince that the level of disease compensation, life expectancy, well-being and ability to depend on both the child himself and the mutual assistance of all family members, from the competent and timely fulfillment of all medical recommendations.
It is necessary to make a social adaptation of the child as soon as possible in society, to motivate him to choose professions that are not related to physical overloads, actively help develop his hobbies and hobbies.
Recommend parents to communicate with families with children with similar diseases, attend classes in the "School of Diabetes". Provide parents of the address of public organizations, funds dealing with diabetes problems.
To convince the parents in the need for dispensary observation of the child with doctors - an endocrinologist, an oculist, nephrologist, a neurologist, a dentist, a psychologist.
Table of equivalent replacement of products for carbohydrates
The amounts of products contain 12G carbohydrates (1sh)
Millet (raw weight)
Prostokvash, yogurt, kefir
Orange juice without sugar
a) gradually reduce the dose of assigned hormones
b) stop treatment after improving the child's condition
c) take appointed drugs constantly
d) cease treatment to achieve a child of puberty
1. Right Answer: The medical sister should give mom's recommendations on the constant use of prescribed drugs.
2. If the answer is correct, go to the next question; If the answer is incorrect - read the following text and try again to answer question number 1.
Treatment of congenital forms of hypothyroidism is carried out by the type of substitution therapy with drugs of thyroid hormones throughout life, since in the absence of timely treatment, the function of the brain is disturbed, the mental and physical development of the child is delayed.
A) laptop iodine in food and water
B) excess iodine in food and water
C) when using a large number of easily digestible carbohydrates
D) after transferred viral infection
1. Right answer: with a lack of iodine in food and water.
2. If the answer is correct, go to the next question; If the answer is incorrect - read the following text and try answering Question number 2 again.
The main role in the development of endemic goiter is given by iodine deficiency: iodine deficiency in the atmosphere, entering the iodine body in an inaccessible to suction form, the hereditary violation of iodine exchange.
a) boiled beef and chicken meat
b) soups on strong meat and fish broths
c) confectionery
d) porridge from buckwheat and oatmeal
e) bananas, grapes, figs
2. If the answer is correct, go to the next question; If the answer is incorrect - read the following text and try answered again to question number 3.
You are a nurse school. In the medport led from the class of a 12-year-old child. From the anamnesis it is known that it is registered with diagnosis of sugar diabetes. Insulin introduces itself with a syringe knob. After the next introduction of insulin, late to school, did not eat. After 20 minutes, weakness, nausea, feeling of hunger, headache appeared. With a nursing examination identified: the skin is pale, covered with cold later, pulse 100 shots per minute, ad 100 \\ 60 mm.rt. The questions assigned to the question with difficulty. There is no smell of acetone from the mouth.
Put a trial help
What should be prepared for the arrival of an ambulance?
You are a nurse of the reception office, a 10-year-old child delivered to you, which is registered with diabetes diagnosis. From the anamnesis it is clear that for several days he reduced himself a dose of insulin. A few days later there were pain in the abdomen, thirst, rapid urination up to 12 times a day, nausea, vomiting, headache. At the nursing examination, the pallor and dryness of the skin were revealed, on the cheeks of the blush, the muscle tone and eyeballs are reduced. The smell of acetone, the child, hesitated, is responsible for questions with difficulty. Pulse 98 per minute, hell 90/60 mm.rt.st.
Determine and justify an urgent state.
Put a trial help
What should be prepared for the doctor's arrival?
You are a medical sister of the endocrinological department, observe. 11-year-old child who receives treatment for diabetes mellitus. The disease was revealed for the first time. It makes complaints of increased thirst, frequent urination, skin itching, increased appetite. With a nursing examination identified: the skin is pale, dry, there are traces of combs. The bedside table is hidden candy. Constantly asks the nurse not to make insulin injections, because It is very afraid of injections.
Reflect the violated needs and determine the problems.
Put the target and make a plan of nursing intervention.
Tell your child about a diet with diabetes mellitus.
What care and treatment requires a child?
Medical sister conducts primary patronage to the newborn. A child from the first pregnancy that occurred with nephropathy in the II half (increased blood pressure, swelling, an increase in the rise of body weight, added in weight 15kg). In the first trimester there was anemia. Child desired. Mom by profession an x-ray laboratory manner is transferred to another job under a period of pregnancy 10 weeks (after registering in women's consultation).
Birth late, under the deadlines, the child was born with a mass of 4100g, 50cm long, shouted after suction of the mucus. In the maternity hospital, they paid attention to the fact that the child has widespread eyes, the eye cracks are narrow, large, edema, not fitted in the mouth, semi-open mouth. Neck short, thick, hand brushes wide, thumbs, short, dry skin, edema, with a yellowish tint, marble and acrocianoz is expressed. The diagnosis of hypothyroidism was confirmed by screening test.
Currently, Mama complains that the child is sluggish, sleepy, indifferent, sucks badly, a rare chair - once every two days.
Mom knows the diagnosis of a child and asks for advice on his proper treatment and upbringing.
Give mom the Council for the correct treatment of the child.
What care needs a child.
What was the possible cause of the occurrence of hypothyroidism in this case.
You are a nurse clinic. For you a neighbor for advice. Her 12-year-old daughter became irritable, sleeping badly, decreased academic performance, worried about the rise of temperature to 37.0-37.2 °, a small trembling of fingers.
Is there any need to appeal to the doctor.
What advise mom?
The purpose of the nurse in the event of an endocrine disease is, on the one hand, assisting and the organization of care for the child, on the other hand, the implementation of measures to prevent the progression of this disease, the development of complications and the restoration of the quality of life.
Features of nursing care during diabetes
Many patients who have just learned about their diagnosis or that their child is diabetic, scared and panic. However, although modern medicine still does not know how to restore the pancreas cells, with a properly selected treatment and a diet, the lifestyle of the patient with diabetes is almost no different from the usual!
Of course, the disease imposes some restrictions on him. But having understood what was happening with the organism in diabetes, it is easy to learn how to coexist with your illness, and over time - to fully control it.
And the first person who turns out to be next to the patient after establishing a medical diagnosis is a nurse. She will give the first knowledge of his ailment (most of us imagine diabetes only as a condition when "can not be sweet and need to prick insulin") and start teaching the sick "live with agreement" with its body.
Nursing examination
The nursing process in diabetes megins when the doctor, appointing treatment, is opposed to the patient a medical sister. It examines the patient, examines the history of the disease, asks him to find out:
- does he have concomitant endocrine or other diseases;
- whether the patient insulin was used to the current examination, and if so, what kind of doses, in what scheme; What other antidiabetic and other drugs he takes;
- does he keep a diet if the bread unit is able to use the table;
- is there a patient a glucometer, whether he can use it; Whether he enters the insulin with a conventional insulin syringe or a syringe knob, how much it does this right and does it know about possible complications;
- how long he sick, whether he had hyper- or hypoglycemic coma or other complications, and if so, the fact that they were the reason; Can he have a self-help.
The nurse will ask questions about the day mode, physical exertion, patient habits. If the patient is a child or an elderly man, she will talk with his parents or relatives. Such a survey method is called subjective, because the fullness of the information received largely depends on the experience of the nurse, its ability to ask questions and find a common language with people.
The second part is an objective examination, that is, physical. It includes:
- general external inspection. For example, "bags under the eyes" or other edema talk about the problems with the kidneys or heart;
- skin inspection, with special care - leather stop; Inspection of mucous membranes - their pallor speaks of dehydration;
- measurement of body temperature, pulse frequency and respiratory movements, measurement of growth, weight, blood pressure.
After the survey, the nursing process in diabetes continues to create a special, nursing history of the disease. It differs from medical. The doctor on the basis of a survey and analyzes describes "what is happening in the body", and the nurse on the basis of observations fixes which health problems arise in a patient due to these violations. In its history of the disease, additional information are recorded: whether the ward is able to serve themselves, does it suffer from neurosis, whether it is easy to contact, is it inclined to violate a diet, the regime, whether the doctor's prescriptions neatly fulfills the prescriptions, etc.
Help nurse in hospital
To see "its" history of the disease, a nurse sees the main problems of a particular patient: and those that are already there, and those that may arise. Some of them are dangerous, others are easily prevented, others are unlikely, but they need to be prepared. It reveals the factors that can cause complications: a tendency to violate diet, neurosis and others, and takes into account them when care for the patient.
The competent nursing process in diabetes is impossible without a clear plan. Therefore, a nurse enters into its version of the medical history Special care guide in which existing and possible problems are listed in detail and responds are planned. It may look like this:
Implementation of the prescriptions of the doctor nurse conducts under its control or observation. These are insulin therapy and the issuance of drugs, including for the prevention of complications (vitamins, preparations for the normalization of metabolism, etc.); Preparation for medical diagnostic procedures and / or their conduct and so on. With an outpatient treatment - conducting analyzes and regular control examinations. There are three types of nursing interventions. This is the implementation of medical prescriptions, actually nursing care, and actions that are conducted jointly with a doctor or after consulting with him.
- Nursing care (independent nursing intervention) is actions that the nurse exercises at its discretion based on his experience and on the basis of the "sister" history of the disease. These include training skills of self-control, nutrition basics and control of how the patient complies with the regime of the day, diet and prescriptions of the doctor. When careing for children, she will definitely talk with the baby, and with his parents. The child will be not so scary in the hospital, and parents will learn about the peculiarities of children's diabetes, about the correct compilation of the menu and the skills of life with the disease.
- Interdependent is called such a nursing intervention, in which the nurse is divided into observation physicians for a particular patient, and he decides on the change or addition of therapeutic tactics. The nurse will not appoint the diabetics sceners itself, but she will tell the doctor about his problems with a dream, and the doctor will pick up the right drug.
One of the peculiarities of diabetes is that the quality of life of diabetics is equally dependent on medical care and treatment, and from its self-discipline. The nurse will not visit the patient daily and watch it, whether he fulfills medical prescriptions! Therefore, the nursing process in diabetes is not possible without learning self-control.
Training of self-control techniques
Training of self-control techniques is especially important for people with a newly diagnosed diagnosis. The nurse will explain to them why diabetes occurs, what violations in the body it causes how medicine, diet and proper hygienic care can compensate for and what makes the disregard for them.
The first special knowledge that receive diabetics is tuned by self-control over blood sugar and sugar levels in the urine (with the help of glucometers and indicator strips), the rules for calculating the grain units and the insulin administration technique. In addition to the ability to use a syringe or a syringe handle, diabetic should:
- understand how insulin acts;
- know possible complications when used - both are general and in the field of introduction on the skin;
- if necessary, be able to independently adjust the dose (for example, it is invited to a restaurant or, on the contrary, forced to skip meals). The need for insulin may vary with the usual Orz and even depending on the time of year;
- understand how and why urgent states occur in diabetes (hyper- and hypoglycemic coma), know how to prevent them and what to do if it becomes bad.
However, not only people who recently learned about their illness, but also to diabetics with experience stands from time to time to replenish and update their knowledge. Medicine does not stand still! Every year it offers increasingly convenient means of control over diabetes - for example, insulin pumps or insulin plasters.
"I observe all the rules! Why do I need a nurse? "
- follow hygiene rules;
- observe the day of the day, go to bed on time. Everyone knows that people suffering from "lack of sleep" are more often ill, but in diabetes a shortage of sleep or insomnia weakens the effectiveness of treatment;
- more move, and better - daily, let it gradually, to do physical education;
- comply with the diet, understanding exactly what products and why it is harmful to it, and which are useful. Diabesec must be able to independently draw up its menu, given the volume and caloric content of food and using the cereal unit table;
- monitor your weight (when obesity, diabetes is heavier).
But if a healthy person, prone to completeness, can not be advised later than two hours before sleep, then diabetics that use prolonged insulin, this advice is not suitable. He needs half an hour before sleeping drink a glass of kefir or eat fruit.
It is very important to remember that it is not easy to comply with the rules of hygiene for diabetics, as healthy people, but vital! They often occur more and harder the diseases of the dyssen and teeth, and the danger of damage to the skin of the stop is so large that there is a special term - "diabetic foot syndrome".
The sensitivity and blood supply stop decreases, so close shoes are imperceptible to the patient leads to their deformation, and ulcers and even gangrene may occur over time.
\u003e An experienced nurse will definitely tell the patient about these features and in time will notice the danger. Therefore, after writing out of the hospital, you should not forget the way to the clinic for a long time or ignore the school of diabetes. Even if you picked up the correct scheme, diabetes is well compensated and you do not need specific medical care.
Nursing care for diabetes
In this regard, the patient is often needed by qualified care and assistance of a professional who can be a nurse. It takes place with patients all stages: from examination and diagnostics before implementing composed along with a diabetic care plan for it.
The nurse and the patient delimit the duties and medical actions that each of them should exercise. For more information about the nursing process in diabetes, I suggest to read in the articles collected by me on this topic.
Features of the nursing process with diabetes
Nursing process with diabetes mellitus. Sugar diabetes is a chronic disease characterized by disruption of products or action of insulin and leading to violation of all types of metabolism and, first of all, carbohydrate metabolism. Classification of diabetes, adopted by WHO in 1980:
- Insulino-dependent type - 1 type.
- Insulin-dependent type - 2 type.
Type 1 diabetes mellitus is more common in persons of young age, 2 type of diabetes mellitus - among middle and elderly people.
With diabetes mellitus, the reasons and risk factors are so closely intertwined that it is sometimes difficult to delimit them. One of the main risk factors is hereditary predisposition (hereditaryly adversely adverse type of type 2 diabetes), obesity, unbalanced nutrition, stress, pancreas, toxic substances play an important role. In particular, alcohol, diseases of other endocrine organs.
The 1st stage is predictable - a state of predisposition to diabetes.
- Persons with hereditary heredity.
- Women who gave birth to a living or dead child with a body weight of more than 4.5 kg.
- Persons suffering from obesity and atherosclerosis.
The 2nd stage is the latent diabetes - proceeds asymptomatic, the level of glucose is normal - 3.3-5.5 mmol / l (according to some authors - up to 6.6 mmol / l). Latent diabetes can be revealed by a test for glucose tolerance, when a patient after taking 50 g of glucose dissolved in 200 ml of water, an increase in blood sugar is increased: after 1 h above 9.99 mmol / l. And after 2h - more than 7.15 mmol / l.
The 3rd stage is clear diabetes - the following symptoms are characterized: thirst, polyuria, elevated appetite, weight loss, skin itch (especially in the crotch area), weakness, fatigue. In the blood test, an increased glucose content is also possible to release glucose with urine.
With the development of complications associated with the damage to the vessels of the CNS. Eye bottom. The kidneys, hearts, lower extremities join the symptoms of the defeat of the relevant organs and systems.
Nursing process with diabetes
Patient problems:
- thirst;
- polyuria:
- skin itching, dry skin:
- increased appetite;
- weight loss;
- weakness, fatigue; reduction of visual acuity;
- heartache;
- pain in the lower limbs;
- the need to constantly comply with the diet;
- the need for constant introduction of insulin or taking antidiabetic preparations (maninyl, diabeton, amaryl, etc.);
Knowledge deficit about:
- the essence of the disease and its causes;
- diet and therapy;
- self-help in hypoglycemia;
- leg care;
- calculation of bread units and making a menu;
- using a glucometter;
- complications of diabetes (coma and diabetic angiopathy) and self-help with kits.
- premate and comatose states:
- gangremen lower limbs;
- acute myocardial infarction;
- chronic renal failure;
- cataracts and diabetic retinopathy with impairment of vision;
- secondary infections, mercury skin diseases;
- complications due to insulin therapy;
- slow healing of wounds, including postoperative.
Collection of information during primary examination:
Patient question about:
- compliance with the diet (physiological or diet number 9), on power mode;
- conducted treatment;
- insulin therapy (insulin name, dose, duration of its action, treatment diagram);
- antidiabetic tableted preparations (name, dose, features of their reception, tolerance);
- limitations of research tests and urine for the content of glucose and surveys from the endocrinologist;
- the presence of a patient a glucometer, the ability to use them;
- ability to use the camp unit table and make a menu using bread units;
- the ability to use an insulin syringe and a syringe knob;
- knowledge of places and techniques of insulin introduction, prevention of complications (hypoglycemia and lipodystrophy in injections);
- maintaining diary diary patient with diabetes mellitus:
- visiting in the past and now "school diabetics";
- development in the past hypoglycemic and hyperglycemic com, their causes and symptoms;
- ability to provide self-help;
- the patient's "passport of diabetics" or "Diabetic Business Card";
- hereditary predisposition to diabetes;
- concomitant diseases (diseases of the pancreas, other endocrine organs, obesity);
- patient complaints at the time of inspection.
- color, humidity of skin, presence of combs;
- determining body weight;
- measuring blood pressure;
- definition of the pulse on the radial artery and the artery of the rear of the foot.
Nursing interventions, including work with the patient's family
- Conduct a conversation with a patient and its closest nutritional features depending on the type of diabetes, power mode. For a patient with type 2 diabetes, give several menu samples per day.
- To convince the patient as the need to comply with the diet appointed by the doctor.
- Convince the patient in the need for physical exertion recommended by the doctor.
- Conduct a conversation about the reasons, the essence of the disease and its complications.
- Inform patient about insulin therapy (types of insulin. The beginning and duration of its action, connection with food intake. The features of storage, side effects, types of insulin syringes and syringe knobs).
- Provide the timely introduction of insulin and the reception of antidiabetic drugs.
- Control the condition of the skin, body weight, pulse and blood pressure, pulse on the arteries of the foot rear, adherence to the diet and power mode, transmission to the patient from its loved ones.
- Recommend constant control of blood glucose and urine.
- To convince the patient in the need for constant observation by the endocrinologist, conducting a diary of the observation, which indicates the level of glucose levels in the blood, urine, the level of blood pressure, eaten products, obtained therapy, changes in well-being.
- Recommend periodic inspections of the eyepiece, surgeon, cardiologist, nephrologist.
- Recommend classes at the School of Diabetics.
- Inform patient about the causes and symptoms of hypoglycemia, comatose states.
- Condemble the patient as needed with a slight deterioration of well-being and blood indicators to immediately contact the endocrinologist.
- To teach the patient and its relatives to calculate the bread units, making a menu by the number of bread units per day, the set and subcutaneous insulin injection by an insulin syringe, leg care rules, to provide self-help with hypoglycemia, measuring blood pressure.
Urgent states in diabetes
A. Higoglycemic state. Hypoglycemic coma.
- Overdose insulin or antidiabetic tableted tools.
- Lack of carbohydrates in the food diet.
- Insufficient meal or meal passage after insulin administration.
Hypoglycemic states manifest themselves with a feeling of strong hunger, sweating, trembling limbs, harsh weakness. If this state does not stop, then the symptoms of hypoglycemia will increase: a shiver will increase, confusion will appear in thoughts, headache, dizziness, bias in the eyes, overall anxiety, fear, aggressiveness in behavior and the patient flows into anyone with loss of consciousness and convulsions.
Self-help with hypoglycemic state:
It is recommended at the very first symptoms of hypoglycemia to eat 4-5 sugar pieces, or drink warm sweet tea, or take 10 glucose tablets of 0.1 g, or drink from 2-3 ampoules 40% glucose, or eat several candies (better caramel ).
Proponial assistance in hypoglycemic condition:
- Call a doctor.
- Call as a laboratory.
- Press the patient a steady lateral position.
- Put 2 pieces of sugar for the cheek on which the patient is lying.
40 and 5% glucose solution. 0.9% sodium chloride solution, prednisone (AMP), hydrocortisone (AMP), glucagon (AMP).
B. hyperglycemic (diabetic, ketoacidotic) coma.
- Insufficient dose of insulin.
- Violation of the diet (increased carbohydrate content in food).
- Infectious diseases.
- Stresses.
- Pregnancy.
- Injuries.
- Operational intervention.
Harbinger: Strengthening thirst, polyuria. It is possible to vomiting, a decrease in appetite, fuzzy vision, extraordinarily strong drowsiness, irritability.
Symptoms of coma: Consciousness is absent, the smell of acetone from mouth, hyperemia and dry skin, noisy deep breathing, reduced muscle tone - "soft" eyeballs. Pulse-filament, blood pressure is reduced. In the analysis of blood - hyperglycemia, in the analysis of urine - glucosuria, ketone bodies and acetone.
When the harbingers coma urgently turn to the endocrinologist or cause it to the house. In the signs of the hyperglycemic coma, the urgent challenge of emergency care.
- Call a doctor.
- Posses to the patient a steady lateral position (preventing language of language, aspiration, asphyxia).
- Take the urine catheter for express diagnostics of sugar and acetone.
- Provide intravenous access.
- insulin of short action - Aktropyid (FL);
- 0.9% sodium chloride solution (FL.); 5% glucose solution (FL.);
- cardiac glycosides, vascular means.
Providing nursing care for sick diabetes: "School diabetes"
Unfortunately, diabetes mellitus is a diagnosis of not only adults or the elderly, but also in children increasingly identify this disease. The role of nurses in creating comfortable conditions for normal life is large. What could a medical worker with secondary education help? For example, you can organize schools where anyone can get the most useful information about this disease.
What is a "School diabetes"?
In the "Sugar Diabetes School" training people undergo different age categories. Groups are formed even among children, and age is taken into account with a degree of puberty. The purpose of the school is to teach people with diabetes mellitus by self-control methods. Also in the task of the school included adaptation of patients to new living conditions and prevention of complications of the disease. Nursing assistance in patients includes the following work plan:
- Explanation of the patient himself and its relatives that diabetes is not a disease that can be cured, but the way of life to which you need to get used to.
- Development and organization of a children's menu that limits easily driving carbohydrates (confectionery, honey, grapes, bananas, jam, sugar, etc.).
- Organization of hexide meals, where there will be three main techniques and three snacks.
- Training technique for introducing insulin, nuances and rules for its application.
- Control over the reception of antidiabetic drugs.
- Development of the dosage of physical and mental load for a child suffering from diabetes.
- Strict patient hygiene control.
- Playing a child from the purchase of colds and concomitant infections.
Groups in School of Sugar Diabetes
Groups in School Diabetes School are divided into three main categories.
Newborn and children of the first few years of life. These patients are not able to secure independent care and control, so they are completely dependent on their parents, and from medical personnel. In this group, the establishment of psychological contact with the mother of the kid is of great importance. After all, because of stress, moms often fall into depression, and contact with the child weakens. There are special problems that require solutions of medical workers. Namely:
- patient mood oscillation;
- pain sensations from injection and control level of glucose;
- suppression of the baby's fear at the sight of white bathrobes of medical workers who can be associated with painful sensations.
All of the above factors require the establishment of trust relationships between the doctor and the parents of a small patient, as learning how to continuously monitor the disease is extremely necessary, although it is difficult.
The second group includes preschool children. It must be said that the debate was previously conducted on the feasibility of learning such young patients with independent control. However, most parents found this learning necessary.
Students. For patients of this group, there are also their mandatory training programs:
- children teach self-esteem and adaptation to a new way of life;
- mandatoryly taught to make independently injections and monitor glucose in the blood;
- teach to recognize the symptoms of glycemia;
- also learn to understand in detail in the nuances of this disease;
- children are trying to help learn to adapt to the monitoring of the disease combined with school learning.
Teenage children include the third group. At this age, a person is experiencing the strongest hormonal changes, manifested in psychological changes, and in physical. It may often meet deterioration in monitoring of diabetes mellitus. And in order to ensure proper assistance to patients in the pubertal period, the School Diabetes School has developed additional programs. They include:
- the education of the trust relationship of the teenager and the group in which he is engaged;
- establishment of trust relationships between medical personnel and adolescent;
- psychological assistance and support for the adolescent in their arms licked;
- reducing the possible ways of the barrier between the objectives of the teenager and the needs of a new lifestyle;
- development of diets, body weight adjustment, constant monitoring of the necessary rate of injection;
- trust conversations on puberty, help him in strengthening self-confidence, help in finding a common language between adolescence and his parents (taking into account the nuances of treatment).
The work of School Diabetes School Diabetes is necessary for all three groups of patients and their parents. After all, facing the first time with such a diagnosis, anyone can easily be confused, fall into despair, even decide that life from now on lost its meaning! It is important to patients and their relatives to understand that diabetes is not a sentence. And if you comply with all the conditions for the right monitoring, you know that there is always help from school specialists, you can completely live without problems and unpleasant sensations.
Nursing process with diabetes mellitus: what is it needed for what
There is a huge number of various diseases, in the treatment of which not only the work of the doctor is quite important, but also the nursing process. In diabetes, modern medical institutions impose basic work, as well as control over the implementation of various appointments from the doctor on the shoulders of the younger medical staff. Therefore, it is impossible to underestimate such work, because this category of employees in certain situations plays a far from a minor role.
Sugar diabetes: Does the control need?
The nursing process in diabetes is carried out in accordance with the current standards. According to the adopted classification, two main types of this disease are distinguished:
- insulin-dependent;
- insulin-dependent.
Both can often be found in modern people, and the nursing process with diabetes can be required almost at any age. The reasons for the development of illness may be the most diverse, but they, anyway, have a direct connection with the process of producing insulin hormone.
It is not always about the lack of the lack of this substance, since its volume may be normal or even exceed it, but the cells of the internal tissues of the person do not perceive the hormone, which leads to an increase in the total level of blood sugar.
The nursing process in diabetes is also complicated by the fact that the disease does not have any pronounced symptoms, so for a long time it can remain absolutely unnoticed, inflicting significant harm to the body. This is what it is dangerous, because when a person learns about his diagnosis, some things can be irreversible, and far from rare are situations that for the first time this phrase patient can hear after the transfer of the hyperglycemic coma.
Stages
There are three main stages of the development of this disease:
- Preparate. In this case, the main risk groups are indicated, that is, those who have relatives with a similar diagnosis, patients suffering from overweight, face older than 45 years old or women who gave birth to dead children or babies with a mass of more than 4.5 kg.
- Latent shape. At this stage, the disease occurs absolutely unnoticed and most often in the morning sugar remains within the normal range. It is possible to determine it by conducting a specialized test sensitivity test to glucose.
- Diabetes. The disease is in no way "hiding" and, with due attention, it can be easily diagnosed on various external signs. The nursing process with diabetes is prescribed often after the patient has a permanent thirst, rapid urination, a sharp set or loss of weight, finding sugar in the urine or skin itch.
After and in the process of determining the diagnosis, as well as further clarification of a specific reason for the occurrence of this ailment, a person may require not only the help of a qualified physician, but also support for nurses. In this case, not everyone understands that it includes a map of the nursing process with diabetes mellitus and what it represents.
Main goals
First of all, it is worth noting that the nursing process is a certain patient care technology, which has a justification from a medical and scientific point of view. Its main purpose is the maximum improvement in the quality of life of the patient, as well as ensuring assistance in finding a decision not only to existing problems, but also those that may appear in the future. Based on this, a map of the nursing process is drawn up with diabetes mellitus.
How are the work?
The Complex itself includes the following:
The first stage from which the nursing process begins with diabetes is a survey when assistance is provided in the preparation of a full-fledged picture of the development of this disease. It is necessary to correctly understand that each person should have its own history of the disease, which includes all analyzes and observations and conclusions are recorded about the state of the patient's health.
In this case, another important point for which the nursing process is carried out in diabetes is to collect information about the patient, as it also helps to make an accurate picture of the problem.
The patient's problems are determined by a nurse, and it constitutes a list of parables that can make some difficulty in the patient's life. At the same time, checking the card and a simple survey is not all that is limited in this case, the nursing process with diabetes mellitus. The stages of this kind are already required by preventive and psychological activities, including work with close relatives.
In the third stage, the systematization of all the information received is carried out, after which the nurse put certain goals that are not only short-term, but also can be calculated for a longer period of time. All this is indicated in the action plan, and then entered into the individual history of the patient who had diabetes mellitus. The nursing process with a given disease will be directly dependent on what particular problems managed to determine.
It is worth noting that an individual nursing process with diabetes can be assigned to each individual patient. The organizational stage here depends entirely on how difficult the disease is and what measures do the doctor should take to save the patient from this ailment. In the standard case, the nurse will work under the continuous observation of the doctor, performing all its instructions.
It often happens that the nursing process with type 1 diabetes mellitus or even the second provides for the interaction between the doctor and the nurse, that is, when they work, and in each other, any activities will take advantage. Among other things, absolutely independent nursing intervention can be appointed.
In this case, the peculiarities of the nursing process in diabetes are provided for independent actions by a medical officer to provide the assistance to the patient at the moment, without the need for prior approval with the attending physician.
Key Features
Regardless of which species include the actions of the nurse, it should maximize control and predict possible options for the development of events, which provides for the organization of the nursing process (of any type of diabetes mellitus).
In particular, even the nursing process with type 2 diabetes mellitus provides for the need to introduce and draw up a new menu, providing primary information on the testing of HE, calorie and carbohydrates, as well as consulting relatives who must learn to help the patient.
If we are talking about an insulin-dependent diabetics, then in this case an additional lecture is carried out regarding the injections used by drugs, as well as the correct introduction of each of them. The daily rate in this case is selected exclusively by the doctor and is not included in the nursing process with diabetes mellitus.
Each such specialist is a slightly psychologist who helps to accept the occasion of the disease and will help teach the patient how to fully live with him and what physical exercises will need to be done.
Survey
As mentioned above, this process begins after appointing the treatment and implementation of the patient's nurse. It is engaged in a thorough examination of the patient, studying the history of his illness and a detailed survey in order to find out the following facts:
- does a person have some endocrine and other diseases;
- insulin was received by the patient before this examination, and if so, what was specifically accepted and in which dosage, which were still applied antidiabetic and other drugs;
- does it be complied with some specific diet at the moment, whether it uses the cereal unit table;
- if there is a glucometer, then in this case the nurse checks if the patient can use it;
- checked, introduces insulin man with a standard syringe or a special syringe, how correctly this procedure is performed and a person knows about the possible appearance of complications;
- as far as this disease is present, whether hypo-or hyperglycemic coma and other complications arose, and if this happened, the fact that specifically caused whether a person acts in such situations.
The nurse sets a huge number of questions regarding the routine of the day, the main habits and physical exertion of your patient. If we are talking about a child or an elderly person, then in this case there is a preliminary conversation with relatives or parents.
This survey technology is customary to be called subjective, since the fullness of information in this case directly depends on the surprise of the nurse, as well as its ability to set the right questions and find a common language with people.
The second part of
The second part is a physical examination that includes the following activities:
- General external inspection. In this case, for example, "bags under the eyes" or similar edema can say that a person has certain kidney problems or heart.
- Extremely attentive skin inspection. It is also worth noting that special attention is drawn to the state of mucous membranes, and if they are pale, it indicates the presence of dehydration.
- Measurement of temperature, respiratory movements and pulse frequency, as well as carrying out a standard trial inspection.
After this procedure, the nursing process continues, in particular, the preparation of the nursing history of the disease, which, accordingly, differs from the medical person. It is necessary to understand that the doctor, based on the results obtained and surveys, records that specifically at the moment occurs in the patient's body, while the nurse, conducting its own observations, records which problems occur in a patient due to the disorders that have arisen. In the history of the disease, it is also written a number of additional information, such as the occurrence of neurosis, the possibility of self-service and so on.
Help in the hospital
By drawing up its own history of the disease, the nurse can notice any specific problems in the patient, that is, indicates those that are currently present, and takes into account those that may appear in the future. Some of them are sufficiently dangerous, while others can be easily prevented enough, but to any changes you need to be prepared.
It is for this reason that in its own version of the history of the disease, the nurse enters specialized care guides in which it extremely detailed all possible problems, and also plans to respond.
Example
All this may look something like this. Certain prescriptions of the doctor are performed, which are carried out under its direct supervision or control.
In particular, we are talking about insulin therapy and issuance of drugs, preparation for medical and diagnostic procedures or their holding and much more. In the process of outpatient treatment, analyzes are taken and regular control inspections.
Intervention options
It is worth noting that there are three main types of nursing intervention - this is the implementation of specific medical prescriptions, direct care for patients, as well as various actions that are held with the doctor or after prior consultation. Nursing care includes manipulations that the nurse makes exclusively at its discretion based on the experience gained and the "sister" disease history.
In particular, we are talking about learning self-control skills, basic nutrition principles and control of how the patient is complied with the established mode of the day, diet and special prescriptions of the doctor. If a nursing process is provided with diabetes mellitus in children, it will necessarily hold a conversation not only with a child, but also his parents.
The child will not be afraid of anything in the hospital, while parents will be able to learn about the peculiarities of this disease, the proper compilation of the menu and the main skills that will be useful in life with such a notch. The interdependent sister process in diabetes mellitus in children and adults is a set of measures, in which the sister is constantly divided with the attending physician of various observations, and then the doctor independently makes decisions on the change or addition of the healing tactics used.
A medical sister will not come home every day to the patient in order to trace how well the medical prescriptions are being performed. It is for this reason that the nursing process in the occurrence of diabetes is simply impossible if the patient is not accustomed to self-control.
Care for diabetics in private pension
The aging process is not without consequences for the health status of an elderly person. Physiological changes lead to the emergence of such ailment as diabetes mellitus. This disease develops individually for everyone: someone is faster, someone is slower, depending on food and physical activity.
That is why each individual case requires an exceptional approach in treatment, care and rehabilitation. Our diabetic boarding houses offer a comprehensive restoration of the health of elderly patients suffering from a disease of the SD and high-quality nursing care during diabetes.
Features of diabetic care
Care of patients with diabetes is an important component in the process of restoring the health status of elderly patients, and includes the following rehabilitation program with diabetes mellitus:
- massage promoting improvement in microcirculation in tissues and exchange processes;
- walking outdoors in dosage quantities;
- diet and therapy aimed at compliance with the proper nutrition. The developed diet by the doctors of nutritionists excludes refined carbohydrates and animal fats;
- treatment with alternative medicine, such as ozone therapy;
- therapeutic physical education is aimed at improving performance, strengthening muscles and improving metabolism;
- a gradual decrease in insulin dose in the implementation of the rehabilitation program;
- round-the-clock nursing care for patients with diabetes, which includes monitoring the overall health of the patient, providing the necessary assistance in daily procedures and domestic issues, as well as constant care and attention to each patient.
Medical workers not only take care of guests, but also teach elderly patients to independently adhere to the right diet, a new way of life and timely adoption of drugs.
Treatment of diabetes at different stages
Sugar diabetes is divided into two main types:
- Insulino-dependent - leads to a rapid deterioration of health and has pronounced symptoms. Patients need permanent insulin injections and conducting special therapy so that the disease does not lead to a diabetic coma.
- Insulin and independent - characteristic of patients over 40 years old. An excessive body and physical passivity leads to this fear. Treatment of second type of diabetes mellitus is a balanced nutrition and an increase in physical activity. This approach will make rid of a number of symptoms of the disease.
We offer competent drug treatment by professional specialists, nursing care during diabetes, round-the-clock attention and care from medical professionals, as well as modern methods for restoring health status during diabetes mellitus.
The specificity of the nursing process with diabetes of II degree
Since the patient always has several problems, the sister must determine the priority system. Priorities are classified as primary and secondary. The primary priority has problems that primarily have a detrimental effect on the patient.
The second stage is completed by the establishment of a nursing diagnosis. There is a difference between the medical and nursing diagnosis. The medical diagnosis is concentrated on the recognition of pathological conditions, and nursing is based on the description of patient reactions on health-related problems.
The American Medical Sisters Association, for example, as the main health-related problems allocates the following: limited self-service, violation of the normal life of the body, psychological and communicative violations, problems associated with life cycles.
As a nursing diagnosis, they use such, for example, phrase, as "deficiency of hygienic skills and sanitary conditions", "Reducing the individual ability to overcome stressful situations", "anxiety", etc.
Defining the goals of nursing care and planning of nursing activities
The nursing plan should include operational and tactical objectives aimed at achieving certain results of a long-term or short-term nature. Forming goals, it is necessary to take into account the action (execution), the criterion (date, time, distance, expected result) and the conditions (with which and whom).
For example, "Purpose - Patient by January 5 with the help of a nurse should get up from the bed." Action - get out of bed, criterion on January 5, the condition is the help of nurses. Having defined the goals and objectives for care, the sister is a written care guide in which special actions are listed in detail by special care nurses recorded in the nursing history of the disease.
Implementation of planned actions
This stage includes measures that adopts a nurse for preventing diseases, surveys, treatment, patient rehabilitation. There are three categories of nursing intervention. The choice of category is determined by the needs of patients:
- performing a doctor's prescriptions and under its supervision.
- an independent nursing intervention provides actions carried out by a nurse on their own initiative, guided by their own considerations, without a direct requirement from the doctor. For example, patient training with hygienic skills, the organization of leisure patient and others.
- interdependent nursing intervention provides for the joint activity of the sister with a doctor, as well as with other specialists.
With all types of interaction, the responsibility of the sister is exceptionally large.
Evaluation of the effectiveness of nursing care
This stage is based on the study of dynamic patient reactions on sister intervention. The sources and criteria for estimating nursing care are the following factors:
- assessment of the patient's response to nursing interventions;
- evaluation of the degree of achievement of the goals of nursing care;
- evaluation of the effectiveness of the influence of nursing care for the patient's condition;
- active search and evaluation of new patient problems.
An important role in the reliability of the evaluation of the results of nursing care plays comparison and analysis of the results obtained.
- Balanced diet;
- Physical activity;
- Prevention of obesity or its treatment;
- Exclude from food products containing easily driving carbohydrates, and food rich in animal fats
- Compliance with the rational regime of labor and life;
- In a timely manner and adequately use drugs.
Currently, diabetes mellitus. The duration of the life and working capacity of the patient largely depends on the timeliness of the detection of the disease, its severity, the age of the patient and the right treatment. The earlier diabetes, the more he shortens the life of the patients.
The prognosis for diabetes mellitus is mainly determined by the degree of damage to the cardiovascular system. Sick diabetes mellitus is able-bodied. In diabetes mellitus, the average and severe disgraceability is estimated individually depending on the course of the disease and concomitant diseases.
Conclusion
Sugar diabetes is a disease for life. The patient has to constantly show perseverance and self-discipline, and this can psychologically abandon anyone. In the treatment and care of patients with diabetes, perseverance, humanity, careful optimism is also needed; Otherwise, it will not be possible to help the patients overcome all obstacles on their life path.
The progress of clinical medicine in the second half of the 20th century allowed much better to understand the causes of the development of diabetes and its complications, and also significantly alleviate the suffering of patients, which another quarter of a century it was impossible to even imagine.
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Situation number 2.
The therapeutic department came, patient K. 56 years old. At the time of the abuse, the patient presented complaints about periodically emerging dryness in the mouth, the feeling of thirst, frequent urination, including the night (up to 4 times), weight loss by 13 kg in a few months, a sharp impairment of vision, frequent dizziness attacks, genital itch. The patient indicates weakness, quick fatigue when performing homework, also bother dizziness and headaches accompanying an increase in blood pressure to 150/90 mm. RT. Art., numbness numbers, gravity in motion.
I Stage Nursing Survey:
Exercising the I stage of the nursing process - the nursing examination. With a nursing examination, we received the data: objectively: the general condition of the patient is satisfactory, the consciousness is clear. The position is active. The appearance corresponds to age. Type of Constitution - normostic, growth - 166 cm, Weight - 75 kg. Body mass index - 27.8. Skin cleanings are clean, in the abdomen area, itching in the abdomen area, and vulva, visible mucousse - unchanged. The subcutaneous fatty fiber is evenly distributed. Atrophy of the muscles of the lower extremities, there are no edema, the pulsation is saved.
When examining the respiratory organs - the shape of the chest is normal, it is symmetrically involved in the act of breathing. The frequency of respiratory movements is 18 per minute. Blood pressure 150/90 mm.rt.st., heart rate - 75, no pulse deficit. The boundaries of the heart are not changed. Heart tones - rhythmic muffled. Language - dry, stomach - symmetrical, in the lower part of the front abdominal wall there is a postoperative scar from cesarean sections. The symptoms of peritonean irritation are negative.
II stage Nursing diagnostics:
II stage of the nursing process - violated needs, identifying problems - real, potential, priority.
Patient problems:
Priority: thirst, itching of the skin and vulva, a decrease in vision, an increase in blood pressure, frequent urination.
Real: weakness, itching of the skin and vulva, an increase in body weight, a decrease in vision, an increase in blood pressure. Frequent urination, numbness of limb, refueling.
Potential: acute myocardial infarction, chronic renal failure, cataract and diabetic retinopathy, arhypathy limbs.
Short-term - eliminate itching, thirst, normalize the number of urination.
Long-term - normalize vision, pressure, powered by diet to the moment of discharge.
III Stage Planning of nursing interventions:
a) preparation of the patient and take biological material for laboratory research;
b) holding a conversation about the need to comply with the diet;
c) daily nursing examination, identification of patient problems and solving them by implementing independent nursing interventions;
d) performing medical appointments.
IV Stage Implementation of the Plan of Nursing Interventions:
a) psychologically support.
b) to provide assistance to the patient in meeting the basic vifble needs.
c) control over blood pressure, pulse, blood sugar level, body weight.
d) perform dependent interventions.
V stage Evaluation of efficiency:Assessment of the results of nursing interventions: the patient's condition has improved. The goal is achieved.
Nursing History
inpatient patient No.20453/683
The name of the medical institution _ MU TsGB Torez
Date and time of arrival_ _05/06/2017 at 13:25 _Data and post statement _ 15.05.2017
Who is directed to the patient _TSPMSP Family doctor Simushina TA
Directed in the hospital for emergency testimony: yesno (emphasize)
Across __year__ hours after the start of the disease, injury
hospitalized as planned manner: yes, not (emphasize)
Types of transportation: on the catal, on the chair - rentingmay go (emphasize)
Department therapeutic department Ward __ №7__
Translated into the department _________ was held days 6______
FULL NAME. Khimka Galina Ivanovna
Floor __ Female__ Age __ 56 years (full years, for children up to 1 year - months, to 1 month - days)
Place of work, position ____ pensioner ____
Professional Harm: Yes, not (emphasize), indicate which _____________
For disabled people and a group of disability ______________________________________
Permanent place of residence (phone) b. Ilyich House 13 square meters. 44__The: 0666443214.
Daughter: Bedilo Valentina Ivanovna Torez Ul. Moskovskaya_35__The: _0506478997
(enter the address, specifying for visitors, area, settlement, address and phone relatives)
Family / close people Daughter: Bedilo Valentina Ivanovna
Blood type __ I. __ Rus - belonging ___ ___ RH + _____________
Allergological history:
medications ____not ____
Food allergen- ____ not_______
other _______________________________
Side effect of drugs ____ ____________________ _________
title of the drug, the nature of side effect
Epidemiological history __ ______________________
(Contact with infectious patients, departure outside the city or state, hemotransfusion, injections, operational interventions over the past 6 months)
Medical diagnosis type 2 diabetes mellitus, first identified, severe form, decompensated.
Complications Diabetic retinal angiopathy. Diabetic peripheral angiopathy of the lower extremities. The distal-sensory polyneeropathy of the lower limbs.
Nursing diagnoses: Thirst, polyuria, weakness, loss of body weight, itching of the skin and vulva, dizziness, impairment of vision, numbness of the limb.
Subjective examination
Anamnesis of the disease:
1. Cause of circulation, self-esteem for a long time, there is a feeling of thirst and increased urination, dizziness, a decrease in body weight, itching body.
2. Disease attitude: adequate, denial, underestimation of the severity of the state, exaggeration of gravity of the state, disease care __ adequate______________________
3. Motivation for recovery (there is weak, no) ____ there is____________________
4. Expected result ___ the health of the patient will improve________________
5. Recommend to procedures: Adequate, inadequate __ adequate_____________
6. Sources of information: Patient, Family, Medical Documents, Friends, Medical Personnel and other sources ___ medical personnel _____
7. Patient complaints are currently Thirst, increased urine, weakness, loss of body weight, itching of the skin, dizziness, violation of vision, numbness of the limb.
8. Date of the disease _06.05.2017_ Cause overweight and improper nutrition.
the sequence of symptoms appear, their dynamics, intensity, pain localization.
________________________________________________________________________
In chronic flow: illness of the disease, frequency and duration of exacerbations
9. What provokes deterioration further maintenance of this lifestyle.
10. What facilitates the condition (drugs, physiotherapeutic methods, etc.) sugarpporting tablets and diet number 8-9
11. As affected the disease on the lifestyle of the patient began to eat right.
Anamnesis of life:
1. Conditions in which grew and developed grew and developed under normal conditions
2. Environment: the proximity of harmful production, parking lots, motorways, etc.
No environment.
3. Transferred diseases, operations cesarean section aged 26 years
4. Sexy life (age, contraception, problems ) There is no sex life.
5. Gynecological anamnesis not burdened , preventive inspections annually.
the last inspection of the gynecologist, the beginning of menstruation, frequency, pain, abundance, duration, last day,
_______pregnancy is one, menopause from 45 years old.
Number of pregnancies, abortion, miscarriages; menopause - age)
6. Allergic history (intolerance to food, drugs, household chemicals) _ not __
7. Features of nutrition (which prefers) prefers sweet dishes, sharp food, oily food.
8. Harmful habits (smokes, with how many years, how many pieces per day, drinking alcohol, drugs) i do not smoke
9. Spiritual status (culture, beliefs, entertainment, rest, moral values) orthodox
10. Social status (role in the family, at work, at school, financial position) in the family mother, grandmother.
11. Heredity: the presence of blood relatives of the following diseases (emphasize): diabetes,
hypertensive disease, IBS, stroke, obesity, tuberculosis, mental illness, etc. ___________________
Objective study (need to emphasize)
the date 05.05.2017
1. Consciousness: clear, confused, missing.
2. Position in bed: Active, passive Forced.
3. Growth _ 166 The weight _ 75 _ Due weight __ 66kg __ Weight to losing weight __88kg_
4. Body Temperature __ _36.7 __
5. Skin condition and visible mucous membranes:
color ( pink, hyperemia, pallor, cyanosis, jaggility)
tour reduced
humidity normal
defects combs on the stomach.
calculations, diameters, breakdown, scars, rash
Rubet after Cesarean__
damage, traces of injection, scars, varicose veins (specify localization)
outlet: Yes, no __ not___
skin Pud: Nails __fine__ Hair __ fine_______ not detected
fitness, fungal lesions Pediculosis
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FULL NAME. Khimka Galina Ivanovna
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