Page 352 - Critical Care Nursing Demystified

Chapter 7 CARE OF THE PATIENT WITH ENDOCRINE DISORDERS 337

The risk for developing diabetes mellitus (DM) increases with age. It is a meta-
bolic disorder characterized by hyperglycemia and defects in insulin secretion.
There are two main types of Diabetes Mellitus: Type 1—Insulin-Dependent
Diabetes Mellitus and Type 2—Noninsulin-Dependent Diabetes Mellitus.

Type 1—Insulin-Dependent Diabetes Mellitus, Previously Known as Juvenile Diabetes
What Went Wrong? A complete deficiency of insulin secretion occurs and is
caused by destruction of the beta cells of the pancreas. The onset is rapid and
acute, usually occurring during childhood or at puberty.

Hallmark Signs and Symptoms Classic symptoms include the 3 Ps: polyphagia
(excessive hunger), polydipsia (excessive thirst), and polyuria (excessive urina-
tion). Weight loss can occur as the body seeks other sources of energy such as
fats and protein. Lifelong insulin replacement therapy is required.

Type 2—Noninsulin-Dependent Diabetes Mellitus,
Previously Known as Maturity-Onset Diabetes
What Went Wrong? An insufficient amount of insulin is available to prevent
hyperglycemia. Many of those affected can control their illness through diet,
exercise, and oral antihyperglycemic medications. Initially, insulin medications Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
may not necessarily be required. Type 2 diabetes mellitus can develop due to
obesity or illnesses such as infection, trauma, or a myocardial infarction. It can
go undetected for many years and progress slowly. It is best treated with weight
loss, exercise, and oral antidiabetic medications.
Hallmark Signs and Symptoms The patient might experience some of the same
classic symptoms associated with Type 1 DM. Additional symptoms include
fatigue, recurrent infections, prolonged wound healing, and visual changes.

3 Physical Assessment of the Patient With Diabetes Mellitus A multisystem approach
is advised when assessing the patient with diabetes mellitus because glucose
dysfunction affects literally every major body system. Obtain a family history
to determine if others are also afflicted with DM. Question dietary habits such
as too much food or inactivity, specific medications they are taking, symptoms
such as the 3 Ps, weight changes, fatigue, blurred vision, frequency of urination,
nocturia, chronic vaginitis in women, unhealing wounds, and frequency of den-
tal cavities. Determine status of fluid hydration, skin turgor, weight, vital signs,
breathing patterns, neurological status, urine specific gravity, and electrolytes.
Individuals with DM require much education regarding diet and a plan of
healthy eating, exercise, foot care, medication administration, obtaining blood