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DIABETES MELLITUS/DIABETIC KETOACIDOSIS Diabetes affects 18% of people over the age of 65, and approximately 625,000 new cases of diabetes are diagnosed annually in the general population. Conditions or situations known to exacerbate glucose/insulin imbalance include (1) previously undiagnosed or newly diagnosed type 1 diabetes; (2) food intake in excess of available insulin; (3) adolescence and puberty; (4) exercise in uncontrolled diabetes; and (5) stress associated with illness, infection, trauma, or emotional distress. Type 1 diabetes can be complicated by instability and diabetic ketoacidosis (DKA). DKA is a life-threatening emergency caused by a relative or absolute deficiency of insulin. CARE SETTING Although DKA may be encountered in any setting and mild DKA may be managed at the community level, severe metabolic imbalance requires inpatient acute care on a medical unit. RELATED CONCERNS Amputation Fluid and electrolyte imbalances Metabolic acidosis (primary base bicarbonate deficit) Psychosocial aspects of care Patient Assessment Database Data depend on the severity and duration of metabolic imbalance, length/stage of diabetic process, and effects on other organ function. ACTIVITY/REST May report: Sleep/rest disturbances Weakness, fatigue, difficulty walking/moving Muscle cramps, decreased muscle strength May exhibit: Tachycardia and tachypnea at rest or with activity Lethargy/disorientation, coma Decreased muscle strength/tone CIRCULATION May report: History of hypertension; acute myocardial infarction (MI) Claudication, numbness, tingling of extremities (long-term effects) Leg ulcers, slow healing May exhibit: Tachycardia Postural BP changes; hypertension Decreased/absent pulses Dysrhythmias Crackles; jugular venous distension (JVD) (if heart failure [HF] present) Hot, dry, flushed skin; sunken eyeballs EGO INTEGRITY May report: Stress; dependence on others Life stressors including financial concerns related to condition May exhibit: Anxiety, irritability ELIMINATION May report: Change in usual voiding pattern (polyuria), nocturia Pain/burning, difficulty voiding (infection), recent/recurrent urinary tract infection (UTI) Abdominal tenderness, bloating Diarrhea May exhibit: Pale, yellow, dilute urine; polyuria (may progress to oliguria/anuria if severe hypovolemia
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occurs) Cloudy, odorous urine (infection) Abdomen firm, distented Bowel sounds diminished or hyperactive (diarrhea) FOOD/FLUID May report: Loss of appetite; nausea/vomiting Not following diet; increased intake of glucose/carbohydrates Weight loss over a period of days/weeks Thirst Use of medications exacerbating dehydration, such as diuretics May exhibit: Dry/cracked skin, poor skin turgor Abdominal rigidity/distension Thyroid may be enlarged (increased metabolic needs with increased blood sugar) Halitosis/sweet, fruity odor (acetone breath) NEUROSENSORY May report: Fainting spells/dizziness Headaches Tingling, numbness, weakness in muscles Visual disturbances May exhibit:
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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