Medical Surgical Nursing

1
Medical Surgical Nursing

• Diabetes Mellitus

2
Endocrine Pancreas

• Islets of Langerhans
• Beta cells
• Insulin

3
Insulin

• Produced and secreted by
• Beta cells

4
Insulin

• Primary function
• Stimulates the active transport of glucose
• from the blood into muscle, liver and adipose
  tissue ?
• __?__ blood glucose levels
• i

5
Glucose Content of Food

• Consume food ? glucose ? blood stream
• Carbohydrates
• Starch
• Simple
• Complex

6
Secretion of Insulin

• Is stimulated by
• What change in homeostasis causes the beta cells
  to secrete insulin?
• Hyperglycemia
• Glucose levels in the bloodstream regulate the
  rate of insulin secretion

7
The major action of insulin

• i blood glucose levels
• h the permeability of target cell membrane to
  glucose
• Main target cells
• Muscle
• Liver
• Adipose tissue

8
Pathophysiology sumamry

• Increased blood glucose levels ?
• Gland
• Pancreas ?
• B cells ?
• Insulin ?
• Target cells (muscles) ?
• (insulin pulls glucose from the blood into the
  muscles) ?
• Decrease blood glucose levels

9
Insulin info

• In the absence of insulin, glucose is not able to
  get into the cells and it is excreted in the
  urine
• Glycouria
• Brain cells are not dependent on insulin for
  glucose intake

10
Function of Insulin

• Need insulin for glucose to cross cell membrane
• No insulin ? no glucose into the cell
• Glucose stays in the blood ?
• Hyperglycemia

11
Diagnostic tests

• Blood glucose / Fasting blood glucose
• Glycosylated Hemoglobin Assay

12
Blood Glucose Fasting blood Glucose

• Measures blood glucose levels after fasting
• Results
• Normal 70-115 mg/dL
• Diabetic level gt 126 mg/dL
• Critical gt 400 mg/dL
• Critical lt 50 mg/dL

13
Fasting Blood GlucoseNursing Responsibility

• Fast 6-8 hours
• Water OK
• No insulin or anti-diabetic meds
• Exercise will effect results

14
Glycosylated Hemoglobin Assays (Hgb A1C)

• of glycosylated hemoglobin
• RBC lifecycle
• _at_ 120 days (4 months)
• Glucose slowly binds with Hgb ? glycosylated
• h serum glucose level ? h glycosylated Hgb
  levels

15
Hgb A1C

• Provides an average blood glucose levels
• Past 2-3 months
• Can be taken any time

16

• Normal levels (non-diabetic)
• 4-6
• Diabetic level (goal)
• lt8

17
Small group questions

1. What are the Islets of Langerhans?
2. What cells of the pancreas secrete insulin?
3. What stimulates insulin to be secreted?

18
What is diabetes mellitus?

• Group of disordered characterized by chronic
  hyperglycemia
• Due to faulty insulin production
• (Not Diabetes Insipidus)

19
Type 1 Diabetes Mellitus

• Destruction of the Beta cells
• Result in
• NO insulin production
• Insulin dependent

20
SS of Type 1 DM

• Hyperglycemia
• ? blood glucose levels
• No insulin ?
• Glucose stays in the blood stream

21
SS of Type 1 DM

• Glycosuria
• Glucose in the urine

22
SS of type 1 DM

• Polyuria
• Nocturia

23
SS of Type 1 DM

• Polydipsia
• Excessive thirst

24
SS of Type 1 DM

• Polyphagia
• Excessive hunger

25
SS of Type 1 DM

• Dehydration
• Assessment?
• Skin turger
• Mucus membranes
• Thirst
• BUN level

26
Small Group Questions

1. Why would a person with high glucose levels have
   polyphagia?
2. Explain why polyuria is a common symptom of
   diabetes Mellitus Type 1.
3. What is hyperglycemia?
4. Why does hyperglycemia happen in Type 1 diabetes
   mellitus?

27
Small Group Questions

• 5. What is a normal level for a FBS?
• 6. Define the following terms Glucose,
  Glycosuria.
• 7. What does an Hgb A1c measure? What are normal
  values for a diabetic and non-diabetic?

28
Type 2 DM

• Pathophysiology
• The pancreas cannot produce enough insulin for
  bodys needs
• Impaired insulin secretion

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Type 2 DM

• Weakened Beta cells Due to over use

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Insulin and Type 2 DM

• Not all clients require insulin
• 1/3 will at some time
• Stress
• Illness

31
Risk Factors for Type 2 DM

• Family history
• Obesity
• Gestational diabetes or large baby

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Type 1 vs. Type 2

• Age of onset
• Usually lt 30

• Age of onset
• Usually gt 40

33
Type 1 vs. Type 2

• Body wt at onset
• Normal to thin
• Insulin production
• None
• Insulin injections
• Always

• Body wt at onset
• 80 overweight
• Insulin production
• Not enough
• Insulin injections
• Sometimes

34
Type 1 vs. Type 2

• Management
• Insulin
• Diet
• Exercise

• Management
• Diet (wt. Loss)
• Exercise
• Possibly oral hypoglycemic meds
• Possibly insulin

35
Other specific types of Diabetes Mellitus

• Gestational
• Pancreatitis
• Drug or chemical induces diabetes (steroids)

36
SS of Diabetes Mellitus

• Definition
• A group of disorders characterized by chronic
  Hyperglycemia
• 3 Ps
• Polydipsia
• Polyuria
• Polyphagia

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SS of Hyperglycemia

• Neurological
• C/O headache
• Dull senses
• Stupor
• Drowsy
• Blurred Vision

38
SS of Hyperglycemia

• Cardiovascular
• Tachycardia
• Decreased BP
• (Dehydration)
• Respiratory
• Kussmaul's respirations
• Sweet and fruity breath
• Acetone breath

39
SS of Hyperglycemia

• Gastro-intestinal
• Polyphagia
• N/V
• Polydipsia

40
SS of Hyperglycemia

• Genital-urinary
• Polyuria
• Glycosuria
• Skeletal-muscular
• Weak

41
SS of Hyperglycemia

• Integumentary
• Dry skin
• Flushed face

42
Small Group Questions

• Mr. McMillan is a 50 year old client brough into
  the ER with extreme fatigue and dehydration.
  After the MD sees him the nurses asks Mr.
  McMillan some additional questions. Based on the
  clients answers the nurse requests that the MD
  add a glucose level to the lab work. The results
  are 800mg/dL.

43
Small group questions

1. What question did the nurse most likely ask?
2. Why was Mr. McMillan fatigued?
3. Why was he dehydrated?

44
Medical Management of DM

• No cure
• Goal is Control! And prevent complications
• Individualized treatment plans
• Diet
• Exercise
• Meds

45
Dietary management of DMFoundation of Diabetic
control

• Goals
• Maintain near-normal blood glucose levels
• Achieve optimal serum lipid levels
• Provide adequate calories for reasonable weight
• Prevent treat acute complications of
  insulin-treated diabetes
• Improve overall health through optimal nutrition

46
The exchange system

• Six categories
• Starch
• Meat
• Milk
• Vegetable
• Fruit
• Fat

47
General guidelines of Dietary Management

• Protein
• 20
• Fat
• 20
• Carbohydrates
• 60
• ADA American Diabetic Association

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Diabetic Meal Plan

• Small frequent meals
• CONSISTENCY!
• Amount of calories
• Amount of carbohydrates
• Time
• Snacks

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Diabetic Meal Plan

• If the client is obese, the key to treatment is
• Weight loss!

50
Meal Plan considerations

• Food preferences
• Lifestyle
• Schedule
• Ethnic / Cultural background

51
Alcohol and Diabetes

• Increase risk of
• Hypoglycemia
• Moderation

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Exercise and Diabetes

• i blood glucose levels

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More Benefits of exercise

• Increases circulation
• Improve serum lipid levels
• Improves cardiovascular status
• Assist with wt control
• Decreases stress

54
Rules for the exercising diabetic

• Talk to MD first
• Regular vs. sporadic
• Correlate exercise and glucose levels
• Dont exercise when hypoglycemic
• Dont exercise when hyperglycemic gt250

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Rules for the exercising diabetic

• Do not exercise when insulin is peaking
• Carry a quick source of sugar
• Best time 60-90 minutes after a meal

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Rules for the exercising diabetic

• Proper footwear
• May need a pre-exercise snack
• Consistency!

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Monitoring Glucose

• Glucometers
• FSBS
• 2-4 times a day

58
Small Group Questions

1. Give signs symptoms of hyperglycemia by body
   system (Why do they manifest these symptoms?)
2. A diabetic meal plans main goal is to maintain
   near normal glucose levels. How is this done?
3. The exchange diabetic meal plan is divided into
   six categories, what are they?

59
Small Group Questions

• 4. What affect does alcohol have on a diabetic?
• 5. What affect does exercise have on a diabetic?
• 6. What council would you give a diabetic
  regarding exercise?

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Onset Peak - Duration

• Onset
• The time period from injection to when it begins
  to take effect
• Peak
• When insulin is working its hardest and therefore
  blood glucose levels are at their lowest

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Onset Peak - Duration

• Duration
• Length of time the insulin works or lasts

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Types of Insulin Very short acting/ rapid
acting

• Lispro (Humalog)
• Aspart (Novolog)
• Insulin pumps
• Rapid reduction of glucose level

Appearance Onset Peak Duration
Clear ¼ hour 1 hour 3 hours
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Types of Insulin Short-acting / regular

• Humalog R Novolin R Iletin II Regular

Appearance Onset Peak Duration

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Types of Insulin Short-acting / regular

• Humalog R Novolin R Iletin II Regular

Appearance Onset Peak Duration
Clear
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Types of Insulin Short-acting / regular

• Humalog R Novolin R Iletin II Regular

Appearance Onset Peak Duration
Clear ½ - 1 hr (1 hour)
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Types of Insulin Short-acting / regular

• Humalog R Novolin R Iletin II Regular

Appearance Onset Peak Duration
Clear ½ - 1 hr (1 hour) 2-3 hrs (3 hour)
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Types of Insulin Short-acting / regular

• Humalog R Novolin R Iletin II Regular
• Administered 20-30 minutes before meals
• IV
• Usually given 4 x a day

Appearance Onset Peak Duration
Clear ½ - 1 hr (1 hour) 2-3 hrs (3 hour) 4-6 hrs (5 hours)
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Types of Insulin Intermediate-acting

• NPH Humulin N Lente Novolin L Novolin N

Appearance Onset Peak Duration

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Types of Insulin Intermediate-acting

• NPH Humulin N Lente Novolin L Novolin N

Appearance Onset Peak Duration
Cloudy
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Types of Insulin Intermediate-acting

• NPH Humulin N Lente Novolin L Novolin N

Appearance Onset Peak Duration
Cloudy 2-4 hrs (2 hrs)
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Types of Insulin Intermediate-acting

• NPH Humulin N Lente Novolin L Novolin N

Appearance Onset Peak Duration
Cloudy 2-4 hrs (2 hrs) 6-12 hrs (12 hrs)
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Types of Insulin Intermediate-acting

• NPH Humulin N Lente Novolin L Novolin N
• Administer after meals
• Usually given 2x a day
• Eat at onset!

Appearance Onset Peak Duration
Cloudy 2-4 hrs (2 hrs) 6-12 hrs (12 hrs) 16-20 hrs (24 hrs)
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Learning Tip Even and Odd

• Short-acting think odd
• (1-3-5)
• Intermediate-acting think even
• (2-12-24)

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Regular vs. Intermediate (NPH)
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When should insulin be administered

• Short-acting / regular
• 30 min before meals (ac)
• Do not allow more than 30 min to pass by without
  eating
• ? hypoglycemia
• Intermediate acting
• After meals (pc)
• If mixed (regular intermediate)
• 30 min before meals

76
What route is insulin administered

• IV
• Regular
• Sub-cutaneous

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Syringe Types

• Insulin syringe
• 27-29 gauge

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Route (Self Administration)

• Subcutaneous tissue
• If you can pinch an inch
• 90 degree angle
• If you cant pinch an inch
• 45 degree angle

79
Areas of injection

• Abdomen
• Arm
• Thigh
• Hips

80
Factors affecting absorption rates

• Quickest
• Abdomen

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What would you do?

• Which of the following is frequently best to
  teach / do first when doing initial diabetic
  training?
• How where to purchase insulin
• Preparation storage of insulin
• Mixing insulin with return demonstration
• Self-injection of insulin
• Learning O-P-D of insulin types

82
Insulin Pumps

• Portable infusion pump
• Subcutaneous needle
• Continuous/basal rate
• Additional bolus if needed
• Change site q24-48 hours

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Insulin Pumps

• S/E - risks
• Hypoglycemia
• Infection
• Hyperglycemia

84
Small Group Question

• Mrs. Evans is 60 year old women with type 2 DM.
  She is on Intermediate Acting Insulin Novolin L
  (Lente) every morning. She normally eats her
  meals at 800 AM, 1200 PM, and 600 PM.
• What time should she take her morning insulin?
• When will this dose onset?
• When will this does peak?
• What does this insulin look like?

85
Mrs. Sweet Peas takes 13 units of Short-Acting
Insulin Humalog R q ac. Her meals are B-800
AM, L-1200 PM, D-700PM

1. What time should Mrs. Peas take her mid-day
   (lunch)dose of insulin?
2. When this dose onset?
3. When will this dose peak?
4. What does this insulin look like?

86
Mrs. Gumdrop takes 6 units of Intermediate Acting
Insulin NPH at HS (10PM). She eats her meals
at B-7AM, L-11AM, D-5PM.

• When will this dose onset?
• 9 AM
• 730 AM
• 7 PM
• 1030 PM
• 12 AM

87
Mrs. Gumdrop takes 6 units of Intermediate Acting
Insulin NPH at HS (10PM). She eats her meals
at B-7AM, L-11AM, D-5PM.

• When will this dose peak?
• 1 AM
• 10 PM
• 10 AM
• 9 PM
• None of the above

88
Mrs. Gumdrop takes 6 units of Intermediate Acting
Insulin NPH at HS (10PM). She eats her meals
at B-7AM, L-11AM, D-5PM.

• What does this insulin look like?
• Clear
• Cloudy

89
Mr. Chocolate Chip Cookie takes 10 units of
Regular Insulin Novolin R q AM. His meals are
at B-7AM, L-11AM, D-5PM.

• When should he take his morning does of insulin?
• 6 AM
• 630 AM
• 7 AM
• 730 AM
• None of the above

90
Mr. Chocolate Chip Cookie takes 10 units of
Regular Insulin Novolin R q AM. His meals are
at B-7AM, L-11AM, D-5PM.

• When will this does peak?
• 730 AM
• 830 AM
• 930 AM
• 1030 AM
• None of the above

91
Mr. Chocolate Chip Cookie takes 10 units of
Regular Insulin Novolin R q AM. His meals are
at B-7AM, L-11AM, D-5PM.

• What does this insulin look like?
• Clear
• Cloudy

92
Ms. Eng Ewe takes 10 units of Short-Acting
Insulin Iletin II Lente and 5 units of
Intermediate Acting Insulin NPH q AM. Her
meals are B-8AM, L-12PM, D-7PM

• When should she take her insulin injection?
• 700 AM
• 800 AM
• 900 AM
• 1000 AM
• None of the above

93
Ms. Eng Ewe takes 10 units of Short-Acting
Insulin Iletin II Lente and 5 units of
Intermediate Acting Insulin NPH q AM. Her
meals are B-8AM, L-12PM, D-7PM

1. When will her insulin onset
2. When will her insulin peak

94
Mixing Insulin How to

• 1 Assemble equipment
• Insulin
• Syringe
• Alcohol swab
• MD order

95
Mixing insulin How to

• 2 Check MD order for dose and types

96
Mixing insulin How it

• 3 Roll the bottle of intermediate acting
  insulin (DO NOT SHAKE)

97
Mixing insulin How it

• 4 Wipe the top of both vials with alcohol swab

98
Mixing insulin How it

• 5 Draw up and inject an amount of air equal to
  the dose of intermediate acting insulin into the
  cloudy vial. Then remove syringe from the vial

99
Mixing insulin How it

• 6 Draw up and inject an amount of air equal to
  the amount of short-acting insulin into the clear
  vial. Leave syringe in the vial

100
Mixing insulin How it

• 7 Draw up the correct amount of clear/regular
  insulin.

101
Mixing insulin How it

• 8 Double check with another nurse if this is the
  institutions policy.

102
Mixing insulin How it

• 9 Remove the syringe and insert into the cloudy
  vial. Carefully draw up the correct amount of
  insulin.

103
Mixing insulin How it

• 10 Double check with another nurse before
  removing the syringe from the vial

104
What do you do if you draw up too much
intermediate acting insulin with mixing?

1. Push it back into the vial and re-draw up the
   correct amount.
2. Waste the med and start over with the same
   syringe.
3. Waste the med and start over with a clean
   syringe.
4. Who cares, a little extra never hurt anyone!
   Just give it to the patient.

105
What do you do if you draw up too much
Regular/clear insulin when mixing?

1. Push it back into the vial and re-draw up the
   correct amount.
2. Waste the med and start over with the same
   syringe.
3. Waste the med and start over with a clean
   syringe.
4. Who cares, a little extra never hurt anyone!
   Just give it to the patient.

106
How would you do it?

• Give 8u Humulin R and 12u NPH sub-q, qAM.

107
Sliding Scale

• Used during
• Surgery
• Illness
• Stress
• Determines insulin dose based on FSBG
• FSBS check usually every 4-6 hrs
• Usually regular insulin is used

108
Sample Sliding Scale

• Check FSBS before meals and at HS (2200)
• 4u Humulin R insulin for glucose 151-200 mg/dL
• 6u Humulin R insulin for glucose 201-250 mg/dL
• 8u Humulin R insulin for glucose 251-300 mg/dL
• 10u Humulin R insulin for glucose 301-350 mg/dL
• Call MD for glucose gt350 mg/dL

109
Questions for sliding scale

• If FSBS 189 how much insulin would you give?
• None
• 4 units
• 6 units
• 8 units
• 10 units

• Check FSBS before meals and at HS (2200)
• 4u Humulin R insulin for glucose 151-200 mg/dL
• 6u Humulin R insulin for glucose 201-250 mg/dL
• 8u Humulin R insulin for glucose 251-300 mg/dL
• 10u Humulin R insulin for glucose 301-350 mg/dL
• Call MD for glucose gt350 mg/dL

110
Questions for sliding scale

• If FSBS 309 how much insulin would you give?
• None
• 4 units
• 6 units
• 8 units
• 10 units

• Check FSBS before meals and at HS (2200)
• 4u Humulin R insulin for glucose 151-200 mg/dL
• 6u Humulin R insulin for glucose 201-250 mg/dL
• 8u Humulin R insulin for glucose 251-300 mg/dL
• 10u Humulin R insulin for glucose 301-350 mg/dL
• Call MD for glucose gt350 mg/dL

111
Questions for sliding scale

• If FSBS 120 how much insulin would you give?
• None
• 4 units
• 6 units
• 8 units
• 10 units

• Check FSBS before meals and at HS (2200)
• 4u Humulin R insulin for glucose 151-200 mg/dL
• 6u Humulin R insulin for glucose 201-250 mg/dL
• 8u Humulin R insulin for glucose 251-300 mg/dL
• 10u Humulin R insulin for glucose 301-350 mg/dL
• Call MD for glucose gt350 mg/dL

112
Questions for sliding scale

• If FSBS 60 how much insulin would you give?
• None
• 4 units
• 6 units
• 8 units
• 10 units

• Check FSBS before meals and at HS (2200)
• 4u Humulin R insulin for glucose 151-200 mg/dL
• 6u Humulin R insulin for glucose 201-250 mg/dL
• 8u Humulin R insulin for glucose 251-300 mg/dL
• 10u Humulin R insulin for glucose 301-350 mg/dL
• Call MD for glucose gt350 mg/dL

113
Pre-mixed insulin

• NPH Regular
• Novolin 70/30
• 70 NPH
• 30 regular

114
Insulin Storage

• Vial NOT being used ?refrigerate
• Vial in use ? room temperature
• Storage life un-refrigerated 1 month

115
Insulin Therapy Complications

• Hypoglycemia
• Causes
• Too much insulin
• Too little food
• Extreme exercise

116
SS of Hypoglycemia

• Neuro
• Dizzy / faint
• Nervous / Irritability
• Blurred vision
• Numb tongue or lips

117
SS of Hypoglycemia

• Cardiovascular
• Full bounding pulse
• Respiratory
• Shallow breathing
• Gastro-intestinal
• Polyphagia

118
SS of Hypoglycemia

• Genital-urinary
• No polydipsia
• No polyuria
• Skeletal/muscular
• Weak
• Trembling / tremor
• Integumentary
• Perspiring/ Moist
• Pale

119
Small group Questions

1. When is a sliding scale commonly used?
2. A tuberculin syringe is also calibrated in units.
   Is it OK to use a TB syringe to draw up insulin?
3. What route is insulin administered?
4. Compare the signs and symptoms of hyper and
   hypoglycemia

120

• How come they are not all opposite signs and
  symptoms?
• Why are some so similar?
• Which symptoms can you look for to tell the
  difference between hyper and hypoglycemia? ()
• What is the biggest risk factor in using an
  insulin pump?

121
Oral Hypoglycemic Agents

• SulfonylureaCholpropamide (Diabanese)
• Glipizide (Glucotrol)
• Glimepride (Amaryl)
• Glyburide (Diabeta, Micronase)

122
Oral Hypoglycemic Agents

• Biguanides
• Metformin (Glucophage)
• Glucovance
• SulfonyureaBiguanide

123
Oral Hypoglycemic Agents

• Oral hypoglycemic meds are not Insulin
• Oral hypoglycemic meds require some production of
  insulin
• Oral hypoglycemic agents are used in the
  treatment of type ___DM
• Type 2
• Oral hypoglycemic meds are meant to supplement
  diet and exercise, not replace them

124
Oral Hypoglycemic Agents

• Oral hypoglycemic meds cannot be used during
  pregnancy
• Oral hypoglycemic meds may need to be held
  temporarily and insulin prescribed if BS levels
  rise due to stress or illness etc.
• Action varies so effect may be enhanced by use of
  multiple meds

125
Sulfonylureas

• Sulfonylureas work primarily by h the secretion
  of insulin by directly stimulating the pancreas

126
Sulfonylurea

• Side-effects of Sulfonylurea
• Hypoglycemia
• GI upset

127
Biguanides

• Biguanides work primarily by aiding insulins
  action on peripheral receptor sites (target
  cells)
• Biguanides are NOT associated with episodes of
  hypoglycemia
• Biguanides sulfonylurea may h the glucose
  lowering effect

128
Biguanides

• Major side effects of Metformin are
• Anorexia/ wt. Loss
• Metformin is contraindicated in patients with
  Renal impairment

129
Can diabetes pills help me?

• Only Type 2 DM
• Results vary
• Effectiveness wears off
• Insulin may still need to be taken occasionally
• Pregnant

130
Small Group Questions

• Its your turn!

131
Small Group Questions

• A type 1 DM asks you Why do I have to have
  insulin injections, why cant I just take the
  Insulin pills? How would you answer him?
• Mrs. Murdock is a Type 2 DM. She was taking
  Glucatrol 20 mg BID. The MD changed her meds
  today to Micronase 5 mg PO BID and Glucophage 500
  mg PO BID. Mrs. Murdock asks you why she is
  taking two medications now, instead of just
  increasing the dose of Glucatrol?

132
Hypoglycemia

• Definition When blood glucose levels fall below
  70mg/dL
• lt 50mg/dL severe

133
Hypoglycemia Etiology

• Any time
• Usually Before meals or a night
• Too much insulin or oral hypoglycemic meds
• Too little food
• Excessive exercise

134
Hypoglycemia Dx Assessment

• Signs Symptoms
• Can occur suddenly!
• If pt is a long time diabetic ?
• No early SS

135
Hypoglycemia Dx Assessment

• 1 Dx tool
• Lab Values
• FSBS

136
Hypoglycemia can result

• When a patients baseline blood glucose level is
  100mg/dL ?
• Drops to 60 mg/dL

• When a patients baseline blood glucose level is
  200mg/dL ?
• Drops to 120 mg/dL

137
Hypoglycemia Medical Management

• Assess for SS
• P blood sugar level
• Admin. fast sugar

138
Hypoglycemic Protocol Sample

• For BG lt60 mg/dL
• If patient can take PO, give 15g of fast acting
  carbohydrate.
• Check FSBG q 15 minutes and repeat above if
  BGlt80.

139
Glucose Fast!

• 15 g fast acting carbohydrate
• 4-6 oz. Juice/soda

140
Rules to remember

• Do not add sugar to OJ
• Recheck FSBS q 15 min until WNL
• Avoid high fat ? slows absorption of glucose
• Instruct carry fast sugar
• NPO if unconscious or confused
• If meal is gt1 hr away, follow with a protein and
  complex carbohydrate

141
Hypoglycemia treatmentUnconscious

• Position side lying

142
HypoglycemiaGerontological Consideration

• Cognitive deficits ?
• not recognize SS
• Decreased renal function ?
• oral hypoglycemic meds stay in body longer
• More likely to _________a meal
• Skip
• Vision problems ?
• inaccurate insulin draws

143
HypoglycemiaNursing measures

• Follow protocol
• Teach
• Carry simple sugar at all times
• SS or hypoglycemia
• How to prevent Hypoglycemia
• Check FSBS if you suspect ? NOW!

144
Treating Hyperglycemia

• Assess for
• SS
• Check
• FSBS
• Administer
• insulin per MD order

145
Medical Management/treatment

• Monitor Fluid and electrolytes
• Especially K
• Push fluids