糖尿病（全英文版）DiabetesMellitusppt课件

1、Diabetes Mellitus Teaching objectives grasp the definition and types of diabetes mellitus realize etiology and pathogenesis realize diagnosis and classification grasp the clinical manifestation for the patient with diabetes mellitus be aware of the main lab examination realize the treatment for the

2、patient with diabetes mellitusIntroduction There are more and more people suffer from diabetes with the development of society, population aging and changes of life style. Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia which results from the defects of ins

3、ulin secretion or function, or both.Long-standing diabetes may lead to multisystem damage such as eye, kidney, nerve, heart, blood vessels and so on.Etiology Etiology and pathology are complex, and still unknown. But it is a syndrome results from compound etiological factor and has relation to inher

4、itance, autoimmune and environment. Factors associated with diabetes include obesity, aging, and ethnic group. ClassificationnType 1 diabetesnStage 1: genetics emotivitynStage 2: start autoimmunenStage 3: immunology abnormality uStage 4: progressive dysfunction of beta cellsuStage 5: clinical diabet

5、esuStage 6: beta cells of the clients who have longtime diabetes are damaged thoroughly, blood insulin level is very lownType 2 diabetesngenetics emotivitynhyperinsulinism and or insulin resistancenimpaired glucose tolerance IGTnclinical diabetes nOther types ninclude beta cell genetic defects, endo

6、crinopathies, and drug or chemical-induced diabetesngestational diabetes mellitusClinical manifestation nMetabolic disorders syndrome: polyuria, polydipsia, polyphagia and weight lossnAcute complications of diabetes: DKA, hyperosmolar nonketotic diabetic coma, infectionDKA evocation factors surgery,

7、 stress, infection, deficiency of insulin dosage, pregnancy, delivery, anesthesia, or illness may trigger DKAuClinical featuresuClassic symptoms of hyperglycemia polyuria, polyphagia, polydipsia precede DKA.u uOther symptoms: nausea, vomiting, abdominal pain, headache, weakness, fatigue, hyperpneauL

8、ab testu Laboratory values will reveal blood glucose from 300 to 600 mg/dl16.7-33.3mmol/l, and metabolic acidosis. Urine will be positive for glucose and ketones.hyperosmolar nonketotic diabetic comauevocation factors u include illness or other stressor such as infection, cerebrovascular events, or

9、some drugs.uClinical featuresu lethargy, illusion, disorientation, seizure u and coma.uLab test u blood glucose is higher than 33.3 mmol/l, usually 33.3-66.6 mmol/l and serum osmolality 350 mmol/linfectionuSkin infection, septicaemia, pulmonary tuberculosis,infection of urinary systemnChronic compli

10、cations of diabetes: cardiovascular diseases, nephropathy, diabetic neuropathy, retinopathy, diabetic foot infectionCardiovascular diseases pain, paresthesia of lower extremeties and intermittent claudication heart failure, arrhythmia, cardiogenic shock,and sudden deathNephropathy nephrosclerosis ed

11、ema, proteinuria, hypertensiondiabetic neuropathy numbness, pain and paresthesia of extremeties, muscular atrophyretinopathy : microangiopathydiabetic foot infection: gangrenous Lab test nurine glucose nblood glucose nIGTTreatment nDietn maintain as near-normal blood glucose level as possible, achie

12、ve optimal serum lipid levels, provide adequate energy.nActivity: aerobic exercisenOral glucose-lowering agents: sulfonylurea, biguanides, glucosidasenInsulin therapy Insulin Therapy notice administer insulin as ordered, inject insulin on time with correct type and precise dosage time, position and

13、method of injection side effects of insulin therapy: hypoglycemia, insulin allergy, subcutaneous fat atrophy or proliferationnTransplantation of pancreas and islet nTreatment for gestational diabetes nTreatment for DKA : intravenous infusion, insulin therapy, keep balance of electrolyte and acid-bas

14、e, prevent and manage complicationsnHyperosmolar nonketotic diabetic comaNursing process nAssessment nSubjective datanObjective data Nursing diagnosis 1: Deficient Knowledge: Diabetes, medical regimen, diet, exercise, self-care management skills insulin injection, SMBG related to new diagnosis or changes in treatment Nursing diagnosis 2: Imbalanced N u t r i t i o n : L e s s t h a n b o d y requirements related to imbalance between insulin, diet, and activity Nursing diagnosis 3: risk for