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Friday, June 15, 2007

Diabetes Mellitus (DM)

What is Diabetes Mellitus? Diabetes Mellitus (DM) is chronic metabolic disorder in which the body does not produce enough insulin or deficiency of insulin. Insulin is a hormone produced in the pancreas, and it is needed to turn sugar and other food into energy.

Type of Diabetus Mellitus :
- Type 1 Diabetes Mellitus
Type 1 on diabetes mellitus called as insulin-dependent diabetes mellitus [IDDM] or juvenile-onset diabetes, is characterized by loss of the insulin-producing beta cells of the islets of Langerhans of the pancreas leading to a deficiency of insulin. Type 1 diabetes usually occurs in children and young adults in which without daily injections of insulin, people with type 1 diabetes won’t survive.

Till now, type 1 diabetes can be treated only with insulin therapy and this treatment must be continued indefinitely. People with diabetes mellitus Type 1 are needed careful monitoring of blood glucose levels using blood testing monitors. Children with significant dehydration, persistent vomiting, serious intercurrent illness, require inpatient management and intravenous rehydration.

- Type 2 Diabetes Mellitus
Diabetes mellitus type 2 called as non–insulin-dependent diabetes mellitus [NIDDM] or adult-onset diabetes, this case due to a combination of defective insulin secretion and insulin resistance or reduced insulin sensitivity (defective responsiveness of tissues to insulin) as heterogeneous disorder, which almost certainly involves the insulin receptor in cell membranes.

Diabetes mellitus type 2 is the most common form of diabetes mellitus and is highly associated with a family history of diabetes, older age, obesity and lack of exercise. Diabetes mellitus type 2 appears most often in middle-aged adults.

In some countries, 20% or more of new patients with diabetes in childhood and adolescence have NIDDM, a change associated with increased rates of obesity. Another case is may have inherited disorders of insulin release leading to maturity onset diabetes of the young (MODY).

Diabetes mellitus type 2 usually treated by attempts to change physical activity (generally an increase is desired) such as exercise, the diet as well as to decrease carbohydrate intake, and weight loss. Then the next treatment for diabetes mellitus type 2 is oral antidiabetic drugs (if necessary).

Certain diseases and drugs can affect the way the body uses insulin and can lead to type 2 diabetes. Diabetes can occur temporarily during pregnancy and also may occur in people with excess production of growth hormone (acromegaly) and in people with certain hormone-secreting tumors. Patient with pancreatitis and other diseases that directly damage the pancreas can lead to diabetes mellitus.

Sign and Symptom of Diabetes Mellitus :
Patients with Diabetes Mellitus has possible systemic signs and symptoms include polyuria (increased frequency of urination), polydipsia (increased thirst), polyphagia (increased appetite), glycosuria, weakness, weight loss, neuropathy, and nephropathy, blurred vision, cuts and bruises that are slow to heal.

The early symptoms of diabetes mellitus are related to the direct effects of high blood sugar levels. Normally, blood glucose levels for fasting (at least eight hours but not more than 16 hours) is 4 to 7MMol/L and less than 10MMol/L two hours after meals.

Acute complications on the diabetes mellitus patients may occur Diabetic ketoacidosis , Nonketotic hyperosmolar coma , Hypoglycemia , and Diabetic coma. Chronic complications may appear as Vascular disease (microvascular disease in which due to damage to small blood vessels and Macrovascular disease, due to damage to the arteries).

Others related cases of Diabetes Mellitus are : Diabetic retinopathy, Diabetic neuropathy, Diabetic nephropathy.
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Sunday, June 03, 2007

Nursing Care Plan for MCI

Nursing care plan to the patients with Myocardial Infarction. Patients who suffer Myocardial Infarction they have many symptom include chest pain, shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety or a feeling of impending doom. In physical examination to the patient with Myocardial Infarction cases appear some of general symptom like comfortable, or restless and in severe distress with an increased respiratory rate.

The Nurse in medical care to take an action as nursing intervention they will collecting data and priority nursing care plane according to the patients condition. This is some nursing care plan (NCP) for patients with Myocardial Infarction related to patient condition :

1. Nursing care plan for chest discomfort (pain) due to an inbalance Oxygen (O2) demand supply.
- Asses the severity, location & duration of pain (report)
- Administer O2 with semi-fowler's position
- Obtain a 12 lead ECG during pain
- Monitor vital signs
- Administer Nitroglycerine & Narcotic analgesics as ordered
- Administer & Monitor Thrombolytic therapy
- Ensure rest & sleep, provide a comfortable environment
- Monitor patient's response to drug therapy

2. Nursing care plan for potential Arrhythmias related to decrease cardiac output.
- Monitor cardiac rate, rythm & conduction (report any change)
- Observe vital signs, ECG, urine output, skin temp & colour
- Administer prophylactic anti-arrhythmic & other drugs as ordered
- Administer IV fluids
- Promote physical & mental rest & comfort
- Monitor laboratorium result
- Keep anti-dysrhythmic drugs & defibrillator ready

3. Nursing care plan for respiratory difficulties (dyspnoea) due to decrease CO
- Asses for any dyspnoea, abnormal breath sound (report)
- Ensure propped up position, rest & comfort
- Administer O2 & drugs as ordered
- Psycological support, give liquid diet

4. Nursing care plan for anxiety & fear of death
- Encourage patient & family to express fear or anxiety by interest, listening, caring
- Explain the procedures being done on him
- Psycological & spiritual support
- Administer morphine or other anti-anxiety drug

5. Nursing care plan for activity intolerance related to limitations imposed by Myocardial Infarction
- Explain to the patient if he need Bed rest to decrease O2 consumption
- give liquid diet & stool softners to avoid constipation
- help for personal hygienic activity
- Watch for dyspnoea, chest pain during activity
- Administer O2 as needed

6. Nursing care plan for potential for complications of thrombolytic therapy
- Watch for sign & symptom of bleeding, arrhythmias ect
- Fix cannula for IV medication & blood collection
- Protect patient from any injury
- Monitor bleeding time & coagulation profile
- Keep anti-coagulant antidote ready (protamine sulphate ect)
- Monitor vital signs

7. Nursing care plan for discharge medications, follow up & Health teachings
- Explain the name, purpose & side effect of each medicine
- Ask for regular follow up & continuing medications at home
- Teach about management of chest pain at home
- Teach how to take Nitroglycerine
- Explain diet to avoid large meals, rest after meals
- Ask to seak immediate medical aid if chest pain not relieved after taking GTN and rest.
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Myocardial Infarction (Heart Attack)

Myocardial Infarction (MI) occurs when the blood supply to part of the heart is cut off, Without prompt treatment, this can lead to damage to the affected part of the heart.

Acute Myocardial Infarction sometimes called a heart attack or a coronary thrombosis, It's result when severe prolonged myocardial ischemia cause death & necrosis of the hearth muscle. MI ussually follows the sudden occlusion of coronary artery & abrupt cessation of blood & Oxygen (O2) flow to the hearth muscle resulting in localized necrotic area in myocardium.

The most common site for Myocardial Infarction is the anterior wall of the left ventricle, another site are posterior and inferior wall of the left ventricle. More then half the deaths case of MI occur during the first and second hours before hospitalized, and Majority of hospital deaths occur during the first 24 hours discharged's patient.

1. Risk Factor for Myocardial Infarction

  • Unavoidable factor such as age, sex (male more then female), heredity (family history of atherosclorosis).

  • Major (controllable) such as cigarette smoking, hypertension, hyperlipoproteinemia and diabetes Mellitus.

  • Contributing factors such as obesity, physical activity, emotional stress, excess alcohol use, sometime also effect from oral contraceptives (estrogen).

  • 2. Symptoms of Myocardial Infarction
    Patient with Myocardial Infarction has severe chest pain as main symptom, pain may also spread up into your jaw, and down your left arm, or down both arms. Patient may also sweat, feel sick, and feel faint. The pain may be similar to angina, but it is usually more severe and lasts longer. (Angina usually goes off after a few minutes.
    Myocardial Infarction pain usually lasts more than 15 minutes - sometimes several hours.)

    3. Complications of Myocardial Infarction
    Complications of
    Myocardial Infarction include Arrhythmias (abnormal heart rhythms or heartbeat), ischemic shock, pulmonary embolic, cardiac failure, pulmonary edema, reccurrent Myocardial Infarction, cardiac rupture.

    4. Rehabilitation for Patient Myocardial Infarction
    On this stage the goals is how to give health education to the patient with Myocardial Infarction cases by assist the patient to achieve and maintain optimum helath & a productive life within the limitations.

  • Develop a programe of progressive physical activity

  • Give learning guidelines to patient & significant others

  • Help patient to accept the limitations imposed by illness

  • Aid patient in adujusting to changes in occupational goals

  • Modification of risk factors such as :

  • - control hypertension, hyperglycemia, hyperlipidemia
    - changing dietary habits, maintain optimum body weight
    - stop smoking, quit alqohol consumption
    - regular exercise, avoid strenuous activity
    - resuming work after 6 -8 weeks (change to less hard work)
    - sexual life after 6 -8 weeks
    - follow up medications & regular check ups.
    - managing chest pain at home.
    Read more!