A. Definition
Diabetes mellitus is a heterogeneous group of disorders characterized by increased levels of glucose in the blood or hyperglycemia. (Brunner and Suddarth, 2002).
Melllitus diabetes is a collection of symptoms that occur in a person caused by an increase in blood sugar (glucose) insulin deficiency of blood due to either absolute or relative
B. Classification
Classification of diabetes mellitus as follows:
1. Type I: insulin dependent diabetes mellitus (IDDM)
2. Type II: Diabetes mellitus is independent of insulin (NIDDM)
3. Diabetes mellitus associated with other conditions or syndromes
4. Gestational diabetes mellitus (GDM)
C. Aetiology
1. Diabetes Type I:
a. Genetic factors
Do not inherit diabetes type I diabetes itself, but inherits a genetic predisposition or a tendency toward the occurrence of DM type I. This genetic predisposition is found in individuals with an HLA antigen types.
b. Immunological factors
The existence of an autoimmune response which is an abnormal response in which antibodies directed against normal tissue by the body reacts to these networks is considered as if in a foreign network. Otoantibodi namely the cells of Langerhans islands and endogenous insulin.
c. Environmental factors
Viruses or certain toxins can trigger an autoimmune process that causes destruction selbeta.
2. Diabetes Type II
Precise mechanisms that cause insulin resistance and insulin secretion disorders in type II diabetes is still unknown. Genetic factors play a role in the process of insulin resistance.
Risk factors:
a. Age (insulin resistance tended to increase at age above 65 years)
b. Obesity
c. Family history
D. Pathophysiology / Pathways
Insulin deficiency
glucagon? decrease consumption
glucose by cells
gluconeogenesis hyperglycemia
fat, protein glycosuria
ketogenesis BUN? Osmotic diuresis
Nitrogen ketonemia urine? Dehydration
? pH Hemokonsentrasi
Acidosis Thrombosis
Atherosclerosis
E. Signs and Symptoms
Public Complaints DM patients as polyuria, polydipsia, polifagia the DM is generally no. Instead of often disturbing the patient is complaining of complications from chronic degenerative diseases in the blood vessels and nerves. In elderly DM have pathophysiological changes due to aging process, so that the clinical picture varies from asymptomatic cases to cases with extensive complications. A recurring complaint is the presence of visual impairment due to cataracts, tingling in the legs and muscle weakness (peripheral neuropathy) and limb wounds that were difficult to heal with normal treatment.
the symptoms due to DM in old age is often found are:
1. Cataracts
2. Glaucoma
3. Retinopathy
4. Itching all over body
5. Pruritus Vulvae
6. Bacterial skin infections
7. Fungal infections in the skin
8. Dermatopati
9. Peripheral neuropathy
10. Visceral neuropathy
11. Amiotropi
12. Ulcer Neurotropik
13. Kidney disease
14. Peripheral vascular disease
15. Coronary disease
16. Brain blood vessel disease
17. Hypertension
Osmotic diuresis due to delays caused glukosuria high renal threshold, and may be accompanied by nocturia complaints of sleep disturbance, or even urinary incontinence. Feelings of thirst in the elderly DM patients is less felt, as a result they do not react inadequate to dehydration. Because it does not happen or a new polydipsia occurred in an advanced stage.
Disease that initially was only mild and usually found in older DM patients can change suddenly, when patients experience acute infection. Deficiency of insulin which had now become relative and absolute state of ketoacidosis occur with symptoms typical of hyperventilation and dehydration, decreased consciousness with hyperglycemia, dehydration and ketonemia. Symptoms usually occur in hypoglycemia such as hunger, yawning and sweating a lot is generally not present in older DM. Usually appear manifest as headaches and sudden confusion.
In old age vegetative reactions may disappear. While the symptoms of confusion and coma, which is the cerebral metabolic disturbances appear more clearly.
F. Examination Support
1. Blood glucose during
2. Fasting blood glucose levels
3. Glucose tolerance test
Blood levels during fasting and filters as standard diagnosis of DM (mg / dl)
Not sure yet DM DM DM
Blood glucose levels during
- Plasma venous
- Blood capillary
Fasting blood glucose levels
- Plasma venous
- Blood capillary
WHO diagnostic criteria for diabetes mellitus at least 2 times the examination:
1. While plasma glucose> 200 mg / dl (11.1 mmol / L)
2. Fasting plasma glucose> 140 mg / dl (7.8 mmol / L)
3. Plasma glucose from samples taken 2 hours later after consuming 75 grams of carbohydrate (2 hours post prandial (pp)> 200 mg / dl
G. Management
The main goal of therapy of diabetes mellitus is trying to normalize the activity of insulin and blood glucose levels in an effort to reduce vascular complications and neuropathy. Therapeutic goals in each type of diabetes is to achieve normal blood glucose levels.
There are 5 components in the management of diabetes:
1. Diet
2. Exercise
3. Monitoring
4. Therapy (if needed)
5. Education
H. Assessment
* Family Health History
Are there families who suffer from illnesses such as client?
* Patient Health History and Previous Treatment
How long suffered from DM client, how to handle, get what kind of insulin therapy, how to take the medicine whether regular or not, what is done to cope with illness clients.
* Activity / Rest:
Tired, weak, hard Moves / walking, muscle cramps, decreased muscle tone.
* Circulation
Is there a history of hypertension, AMI, claudication, numbness, tingling in the extremities, ulcers on the feet long healing time, tachycardia, changes in blood pressure
* Ego Integrity
Stress, anxiety
* Elimination
Changes in the pattern of urination (polyuria, nocturia, anuria), diarrhea
* Food / Fluids
Anorexia, nausea, vomiting, do not follow the diet, weight loss, thirst, the use of diuretics.
* Neurosensori
Dizziness, headache, numbness, muscle weakness numbness, paraesthesia, visual disturbances.
* Pain / Leisure
Abdominal strain, pain (is / weight)
* Respiratory
Cough with / without purulent sputum (infection tergangung / no)
* Security
Dry skin, itching, skin ulcer.
I. Nursing Problems
1. High risk of nutritional deficiencies: lack of demand
2. Lack of fluid volume
3. Disruption of skin integrity
4. A risk of injury
J. Intervention
1. High risk of nutritional deficiencies: lack of demand reduction associated with oral input, anorexia, nausea, increased metabolism of proteins, fats.
Destination: the patient’s nutritional needs are met
Results Criteria:
? Patients can digest the amount of calories or the right nutrients
? Stable weight or additions to the range typically
Intervention:
? Measure your weight every day, or according to the indication.
? Determine the diet and eating patterns of patients and compare it with food that can be spent on patients.
? Auscultation bowel sounds, noted the existence of abdominal pain / abdominal bloating, nausea, vomit food that has not had time to digest, maintain a state of fasting according to the indication.
? Give liquid diet containing foods (nutrients) and the electrolyte immediately if the patient is able to tolerate the oral.
? Involve the patient’s family at this meal digestion in accordance with the indication.
? Observation of the signs of hypoglycemia such as changes in level of consciousness, skin moist / cold, rapid pulse, hunger, sensitive stimuli, anxiety, headaches.
? Collaboration blood sugar checks.
? Collaboration giving insulin treatment.
? Collaboration with dieticians.
2. Lack of fluid volume associated with osmotic diuresis.
Destination: liquid or hydration needs of patients are met
Results Criteria:
Patients showed an adequate hydration evidenced by stable vital signs, palpable peripheral pulse, skin turgor and capillary filling good, right haluaran individual urine and electrolyte levels within normal limits.
Intervention:
? Monitor vital signs, note the change ortostatik
? Monitor breathing patterns such as the respiratory kusmaul
? Examine the frequency and quality of breathing, use of aids breathing muscles
? Kaji peripheral pulse, capillary filling, skin turgor and mucous membranes
? Monitor intake and expenditure
? Maintain a fluid to provide at least 2500 ml / day within tolerable limits heart
? Note things such as nausea, vomiting and distension of the stomach.
? Observations of increased fatigue, edema, increased BB, irregular pulse
? Collaboration: a normal fluid therapy given with or without copy dextrosa, monitor laboratory examination (Ht, BUN, Na, K)
3. Integrity of skin disorders associated with changes in metabolic status (peripheral neuropathy).
Destination: the integrity of skin disorders can be reduced or showed healing.
Results Criteria:
Wound condition showed improvement and non-infected tissue
Intervention:
? Examine the wound, the epitelisasi, color changes, edema, and discharge, the frequency of dressing change.
? Review vital signs
? Review of pain
? Perform wound care
? Collaboration delivery of insulin and medication.
? Collaboration appropriate antibiotic treatment indications.
4. A risk of injury associated with decreased visual function
Destination: patients do not experience injury
Criteria Results: patients can meet their needs without experiencing injury
Intervention:
? Avoid slippery floors.
? Use a low bed.
? Orient clients to the room.
? Help clients in daily activities
? Aids patients in ambulasi or change of position
REFERENCES
Doenges, Marilyn E, Farm Plan Guidelines for Planning Nursing and Patient Care Documentation
Carpenito, Lynda Juall, Pocket Books edition of Nursing Diagnosis
Smeltzer, Suzanne C, Brenda G Bare, Ajar Book Medical Surgery Nursing Brunner & Suddarth Issue 8 Vol 2
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