Item of evaluation

DIABBETES MELLITUS
Grading Rubric items’
definition

Pathophysiology Insulin allows the glucose to enter the cells, lack of insulin or problems in insulin function results in increased or
.decrease blood glucose levels (Hyperglycemia , Hypoglycemia )
Disease process\definition Def: group of metabolic disorders characterized by hyperglycemia that results from defects in insulin secretion,
insulin action, or both
:Types
Type 1: absence of insulin secretion from beta cells of islets of Langerhans due to autoimmune destruction of them. *
 Called insulin dependent
 Most common among adults less than 30 years old when diagnose
 Usually thin on diagnosis
 Develop a complication Called DKA (Diabetic Keto Acidosis)
Type 2: decreased insulin production, action, or increased insulin resistance
 Called insulin independent
 Most common among people older than 30 years old when diagnose
 Usually obese on diagnosis (Obesity is the main Risk factor for Type 2 diabetes)
 Develop a complication Called HHS (Hyperglycemic Hyperosmolar Syndrome)
:Hypoglycemia
Def: Case of blood sugar less than 70 mg/dl, in severe cases less than 40mg/dl
Causes: o Alcohol o Exercise o Insulin Peak times o Excessive antidiabetic agents
Manifestations  Polyuria: too much urine
  Polyphagia too much thirst
 Polydipsia too much hunger
o Weight loss
o Blurred vision
o Fatigue
o Hyperglycemia
Hypoglycemia
:Signs and symptoms
o Headache
o Irritability
o Weakness
o Anxious and unconsciousness
o Sweating (Diaphoresis)
o Hunger
Risk factors o in type 1: Its genetic problem
o in type 2: BBOL
 B: Blood pressure (High blood pressure)
 B: blood sugar (High blood sugar)
 O: obesity
 L: Lipids (High cholesterol levels -Hyperlipidemia)
Diagnostic procedures Physical Examination
 Blood pressure (sitting and standing to detect orthostatic
changes)
• Body mass index (height and weight
 Funduscopic examination and visual acuity
 Foot examination (lesions, signs of infection, pulses)
• Skin examination (lesions and insulin injection sites)
* Neurologic examination
Vibratory and sensory examination using monofilament Deep tendon reflexes
* Oral examination
Laboratory Examination
HbA1c: measure average blood glucose in the last 3 months
 Normal: less than 5.7%  Pre: 5.7%-6.4%  Diabetes: higher than 6.5%
o Random
:  Normal: less than 200  diabetes: higher than 200
o fasting (8 hours)
 Normal: less than 100  Pre: 100-124  diabetes: higher than 125
o OGTT: give sweet drink then measure after 2 hours
 Normal: less than 140  Pre: 140- 199  Diabetes: higher than 200
Complications o Atherosclerosis
o Hypertension
o Heart failure
 o Kidney failure
o Retinopathy
o Neuropathy
o Diabetic Foot
o Stroke
Treatment

Life style modifications Sleep: Adequate rest (7-9 hours per night)
(Sleep, diet, exercise,
others) Diet: Balanced diet with controlled carbohydrate intake, low in saturated fats, high in fiber, avoiding sugary beverages
and snacks
Exercise: Regular physical activity (at least 150 minutes of moderate-intensity exercise per week)
Others: Stress management techniques, avoiding smoking, limiting alcohol intake
Nursing diagnosis .Risk for unstable blood glucose levels related to insufficient knowledge of diabetes management
Risk for infection related to hyperglycemia and impaired immune response
 Risk for impaired skin integrity related to poor circulation and neuropathy
Goal + objectives The main goal of diabetes treatment is to normalize insulin activity and blood glucose levels to reduce the
development of vascular and neuropathic complications.
Objectives: Patient will demonstrate correct use of blood glucose monitoring equipment and understand the effects of
diet and exercise on glucose levels within one month.
Interventions Educate patient on diabetes management, including blood glucose monitoring, medication administration, and
recognizing signs of hyperglycemia and hypoglycemia
Assist with developing a personalized meal plan that considers carbohydrate counting and glycemic index
Encourage regular physical activity tailored to the patient’s ability and preferences
Monitor blood glucose levels and adjust treatment plans as necessary
Promote skin care and foot care routines to prevent infections and ulcers
Expected outcomes .Patients maintain blood glucose levels within the target range
.Patient demonstrates understanding and adherence to diabetes management plan
.Patients experience a reduction in symptoms and improved overall health
Patient avoids acute and chronic complications of diabetes