Question

what is type 2 diabetes mellitus assessment, Nursing Diagnosis, Scientific Explanation, Planning, Nursing Interventions, Rationale, and Evaluation

Subjective and objective. 1-Assessment

2-Nursing Diagnosis

3- Scientific Explanation

4-Planning

5- Nursing Interventions

6- , Rationale

7-  Evaluation

Answer 1

Assesment:

1. Assess for signs of hyperglycemia.

Hyperglycemia results when there is an inadequate amount of insulin to glucose.

2. Assess blood glucose levels before meals and at bedtime.

Blood glucose should be between 140 to 180 mg/dL. Non-intensive care patients should be maintained at pre-meal levels <140 mg/dL.

3. Monitor the patient’s HbA1c-glycosylated hemoglobin.

This is a measure of blood glucose over the previous 2 to 3 months. A level of 6.5% to 7% is desirable.

4. Weight daily.

To help assess the adequacy of nutritional intake.

5.Assess for anxiety, tremors, and slurring of speech. Treat hypoglycemia with 50% dextrose.

These are signs of hypoglycemia and D50 is the treatment for it.

6. Assess feet for temperature, pulses, color, and sensation.

To monitor peripheral perfusion and neuropathy.

7. Assess bowel sounds by auscultation and note any reports of abdominal pain, bloating, nausea or vomiting.

8. Monitor urine albumin to serum creatinine for renal failure.

9. Assess the pattern of physical activity. Physical activity helps lower blood glucose levels. Regular exercise is a core part of diabetes management and reduces risk for cardiovascular complications.

10. Monitor for signs of hypoglycemia

The signs of hypoglycemia are the result of both increased adrenergic activity and decreased glucose delivery to the brain, therefore, the patient may experience: changes in LOC, tachycardia, diaphoresis, dizziness, headache, fatigue, cold and clammy skin, hunger, shakiness, and visual changes.

11.Explore patient’s health beliefs about physical exercise and review exercise program recommendations with the patient.

12. Determine the blood glucose levels of the patient before exercising.

13. Assess the patient’s adeptness in self-monitoring of blood glucose.

Diagnosis:

Type 2 diabetes is usually diagnosed using the: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. Normal levels are below 5.7 percent, and a result between 5.7 and 6.4 percent is considered prediabetes.It's like an average of your blood glucose over the past 2 or 3 months.

Fasting plasma glucose.

This is also known as a fasting blood sugar test. It measures your blood sugar on an empty stomach. You won't be able to eat or drink anything except water for 8 hours before the test.

Oral glucose tolerance test (OGTT).

This checks your blood glucose before and 2 hours after you drink something sweet to see how your body handles the sugar.

Scientific explanation:

Your pancreas makes a hormone called insulin. It helps your cells turn glucose, a type of sugar, from the food you eat into energy. People with type 2 diabetes make insulin, but their cells don't use it as well as they should.

At first, your pancreas makes more insulin to try to get glucose into your cells. But eventually, it can't keep up, and the glucose builds up in your blood instead.

Usually, a combination of things causes type 2 diabetes. They might include:

Genes. Scientists have found different bits of DNA that affect how your body makes insulin.

Extra weight.

Being overweight or obese can cause insulin resistance, especially if you carry your extra pounds around your middle.

Metabolic syndrome.

People with insulin resistance often have a group of conditions including high blood sugar, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.

Too much glucose from your liver.

When your blood sugar is low, your liver makes and sends out glucose. After you eat, your blood sugar goes up, and your liver will usually slow down and store its glucose for later. But some people's livers don't. They keep cranking out sugar.

Bad communication between cells. Sometimes, cells send the wrong signals or don't pick up messages correctly. When these problems affect how your cells make and use insulin or glucose, a chain reaction can lead to diabetes.

Broken beta cells.

If the cells that make insulin send out the wrong amount of insulin at the wrong time, your blood sugar gets thrown off. High blood sugar can damage these cells, too.

Planning:

The following will help you to prevent diabetes mellitus type 2:

Weight loss.

Dropping extra pounds can help. While losing 5% of your body weight is good, losing at least 7% and keeping it off seems to be ideal. That means someone who weighs 180 pounds can change their blood sugar levels by losing around 13 pounds. Weight loss can seem overwhelming, but portion control and eating healthy foods are a good place to start.

Healthy eating.

There’s no specific diet for type 2 diabetes. A registered dietitian can teach you about carbs and help you make a meal plan you can stick with. Focus on:

Eating fewer calories

Cutting back on refined carbs, especially sweets

Adding veggies and fruits to your diet

Getting more fiber.

Exercise.

Try to get 30 to 60 minutes of physical activity every day. You can walk, bike, swim, or do anything else that gets your heart rate up. Pair that with strength training, like yoga or weightlifting. If you take a medication that lowers your blood sugar, you might need a snack before a workout.

Watch your blood sugar levels.

Depending on your treatment, especially if you’re on insulin, your doctor will tell you if you need to test your blood sugar levels and how often to do it.

Nursing Interventions and Rationale

1. Administer basal and prandial insulin.

Adherence to the therapeutic regimen promotes tissue perfusion. Keeping glucose in the normal range slows the progression of microvascular disease.

2. Watch out for signs of morning hyperglycemia.

Morning hyperglycemia, as the name suggests, is an elevated blood glucose level arising in the morning due to insufficient level of insulin. Causes include the dawn phenomenon (normal blood glucose levels until 3 AM then levels begin to rise), insulin waning (progressive increase in glucose levels from bedtime to morning), and Somogyi effect (nocturnal hypoglycemia then rebound hyperglycemia).

3. Teach patient how to perform home glucose monitoring.

Blood glucose is monitored before meals and at bedtime. Glucose values are used to adjust insulin doses.

4. Report BP of more than 160 mm Hg (systolic). Administer hypertensive as prescribed.

Hypertension is commonly associated with diabetes. Control of BP prevents coronary artery disease, stroke, retinopathy, and nephropathy.

5. Instruct patient to avoid heating pads and always to wear shoes when walking.

Patients have decreased sensation in the extremities due to peripheral neuropathy.

6. Instruct patient to take oral hypoglycemic medications as directed

7. Stress the importance of achieving blood glucose control.

8. Educate the patient on maintaining consistency in the amount of food and the approximate time intervals between meals.

9.Educate the patient about the health benefits and importance of exercise in the management of diabetes.

10.Provide instructions to patients using self-monitoring blood glucose (SMBG).

Evaluation:

The ADA, WHO, and IHS guidelines recommend that adults be evaluated for type 2 diabetes if they are overweight (BMI ≥ 25 kg/m2) and have one or more of the following risk factors: first-degree relative with diabetes, women who delivered a baby weighing > 9 lb, diagnosis of hypertension > 140/90 mmHg, diagnosis of polycystic ovarian syndrome, history of gestational diabetes mellitus (GDM).1,2,4 However, several minor differences do exist among the guidelines. The ADA 1 recommends that adults with prediabetes be screened annually and that adults who are ≥ 45 years of age without preexisting conditions be screened every 3 years. The WHO2 recommends that adults with a history of vascular disease be screened for diabetes every 3 years.