The nursing process is a method of scientifically based and practically implemented actions of a nurse to provide care to patients. The goal of this method is to ensure an acceptable quality of life in illness by providing the maximum possible physical, psychosocial and spiritual comfort for the patient, taking into account his culture and spiritual values. When carrying out the nursing process in patients with diabetes, the nurse, together with the patient, draws up a plan for nursing interventions, for this she needs to remember the following: 1. During the initial assessment (examination of the patient), it is necessary: ​​Obtain information about the health and determine the specific needs of the patient for nursing care, and self-help opportunities.

The source of information is:

• - conversation with the patient and his relatives;
• - medical history;
• - survey data. Next, you need to ask the patient and his relatives about risk factors:
• - Alcohol abuse;
• - Smoking;
• - Inadequate nutrition;
• - Nervous-emotional tension;

Continuing the conversation with the patient, you should ask about the onset of the disease, its causes, and the examination methods used: Blood and urine tests. Moving on to an objective examination of patients with diabetes mellitus, it is necessary to pay attention to:

Skin color and dryness;

Losing weight or being overweight. 1. In nutrition (it is necessary to find out what kind of appetite the patient has, whether he can eat on his own or not; a specialist nutritionist is required regarding dietary nutrition; also find out whether he drinks alcohol and in what quantity);

• 2. In physiological functions (stool regularity);
• 3. In sleep and rest (dependence of falling asleep on sleeping pills);
• 4. In work and rest. All results of the initial nursing assessment are recorded by the nurse on the “Nursing Assessment Sheet”. The next stage in the nurse’s activity is the synthesis and analysis of the information received, on the basis of which she draws conclusions. The latter becomes the patient's problems and the subject of nursing care. Thus, the patient's problems arise when there are difficulties in meeting needs. Carrying out the nursing process, the nurse identifies the patient's priority problems: Pain in the lower extremities;

Decreased ability to work;

Dry skin;

Nursing care plan. When drawing up a care plan together with the patient and relatives, the nurse must be able to identify priority problems in each individual case, set specific goals and draw up a realistic care plan with motivation for each step.

• 4. Implementation of the nursing intervention plan. The nurse implements the planned plan of care.
• 5. When moving on to assessing the effectiveness of nursing intervention, it is necessary to take into account the opinion of the patient and his family.

Manipulations performed by a nurse. conducts thermometry, checks water balance, distributes medications, writes them out in the prescription register, cares for seriously ill patients, prepares patients for various research methods, accompanies patients for examinations, and performs manipulations.

Emergency care for diabetes:

Emergency care for hyperglycemic coma: Accompanied by thirst, weakness, headache.

If your blood sugar rises, you should inject insulin. You can take no more than 2 units of insulin at a time. After 2-3 hours, measure the sugar; if it has not changed or decreased slightly, then you can inject more. This rule protects against a sharp drop in sugar, which is very harmful to the body.

Emergency care for hypoglycemic coma: caused by a violation of the diet, increased physical activity or an overdose of insulin in patients with diabetes.

Mild hypoglycemia is relieved by taking sugar-containing products (honey, jam). In severe cases, 20-40 ml of 40% glucose is immediately administered intravenously. If the patient regains consciousness after the administration of glucose, there is no need for urgent hospitalization.

The patient must be fed the next day (in connection with feeding, the insulin dose should be reduced by 8-10 units). Recommend mandatory examination by an endocrinologist or therapist to correct the daily regimen and insulin dose.

Foot care for diabetic feet:

Diabetic foot is a lesion of the skin, large and small vessels, nerves, bones and muscles of the foot. This pathology is caused by the toxic effects of elevated blood sugar levels. All these changes occur in connection with diabetes mellitus, a disease in which the level of glucose in the blood increases. Glucose levels rise due to disruption of its regulation by the hormone insulin, which is produced by the pancreas.

Causes of diabetic foot syndrome:

The syndrome occurs as a late complication of diabetes mellitus, when a prolonged increase in the amount of glucose in the blood has a detrimental effect on large (macroangiopathy) and small (microangiopathy) vessels, nervous, and musculoskeletal tissue. Thus, diabetes mellitus affects many organs and systems. In addition, the lower extremities, and especially the feet and ankles, have poorer blood supply due to their distance from the heart. With prolonged exposure to elevated sugar levels on the nerve endings of the lower extremities, diabetic neuropathy occurs. Neuropathy leads to a decrease in pain sensitivity - while minor damage to the skin of the feet is not felt by the patient and heals very slowly. In addition, the legs bear a lot of stress when walking, which interferes with rapid healing.

Types of diabetic feet

There are three forms of the syndrome:

• 1. Neuropathic form
• 2. Ischemic form
• 3. Mixed form

In the neuropathic form, damage to the nervous tissue predominates; in the ischemic form, blood flow is impaired. In the mixed form, there are manifestations of both neuropathic and ischemic forms.

First of all, patients are concerned about pain in the final parts of the feet, which can intensify at rest and weaken with movement. Other manifestations of damage to nervous tissue are also characteristic - numbness, burning or cooling of the feet, paresthesia (pins and needles, tingling). Deep tissue damage that develops as a result of deterioration in blood supply is represented by poorly healing ulcers, infectious lesions, and gangrene.

Treatment of diabetic foot:

During treatment, antimicrobial agents that do not have tanning properties are used, such as chlorhexidine, dioxidine, etc. Alcohol, iodine, brilliant green and potassium permanganate are contraindicated, as they can slow down healing due to their tanning properties. It is important to use modern dressings that do not stick to the wound, unlike the widespread gauze. It is necessary to treat wounds and remove non-viable tissue regularly; this should be done by a doctor or nurse, most often once every 3-15 days. Protecting the ulcer from the stress of walking also plays an important role. For this purpose, special unloading devices are used (half shoe, unloading boot).

Foot care for diabetes:

• 1. Consult a doctor if even minor inflammation occurs. Even minor inflammation can lead to serious consequences.
• 2. You need to wash your feet daily, dry them carefully, without rubbing. We must not forget about the spaces between the fingers - they also need to be thoroughly washed and dried.
• 3. Examine your feet every day to identify cuts, scrapes, blisters, cracks and other damage through which infection can enter. The soles can be inspected using a mirror. In case of poor vision, it is better to ask a family member to do this.
• 4. Do not expose your feet to very low or very high temperatures. If your feet are cold, it is better to wear socks; you should not use heating pads. You must first test the water in the bathroom with your hand and make sure that it is not too hot.
• 5. Inspect shoes daily to prevent calluses and other damage that can be caused by foreign objects in shoes, wrinkled insoles, torn lining, etc.
• 6. Change socks or stockings every day, wear only those that fit, avoid tight elastic bands and mended socks.
• 7. Shoes should be as comfortable as possible, fit well on the foot, you should not buy shoes that need to be worn in. If there is significant deformation of the feet, specially made orthopedic shoes will be required. Outdoor shoes should not be worn on bare feet; sandals or sandals with a strap that goes between the toes are contraindicated. You should not walk barefoot, especially on hot surfaces.
• 8. In case of injuries, iodine, alcohol, potassium permanganate, and brilliant green are contraindicated - they have tanning properties. It is better to treat abrasions and cuts with special agents - miramistin, chlorhexidine, dioxidine, or, in extreme cases, a 3% solution of hydrogen peroxide and apply a sterile bandage.
• 9. Do not injure the skin of your feet. Do not use drugs and chemicals that soften calluses, or remove calluses with a razor, scalpel or other cutting instruments. It is better to use pumice stones or foot files.
• 10. Trim your nails straight, without rounding the corners. Thickened nails should not be cut, but filed. If your vision is poor, it is better to take help from family members.
• 11. If your skin is dry, your feet should be lubricated daily with a rich cream (containing sea buckthorn and peach oil), but the spaces between the toes should not be lubricated. You can also use creams containing urea (Balzamed, Calluzan, etc.)
• 12. Stop smoking; smoking can increase the risk of amputation by 2.5 times.

In order to monitor blood sugar levels, patients keep self-monitoring diaries. A diabetic self-monitoring diary is necessary for type 1 and type 2 diabetes, as it allows you to control your sugar levels during the day, the dosage of insulin or tablets, as well as the number of bread units eaten. In addition, if you download, fill out, and provide a diabetic self-monitoring diary to your doctor, you will be able to more accurately adjust your diabetes treatment methods. The diary is a table designed to track data for one week. To analyze and correct the treatment of diabetes mellitus, you need to download several sheets and staple them together. (Appendix 6. Table 2)

Preparing the patient for research:

Taking urine for sugar from the daily amount

Target. Determination of the average amount of sugar in the daily volume of urine.

Indications. Suspicion of diabetes mellitus; dysfunction of the liver, pancreas, thyroid gland, metabolism.

Equipment. A jar with a capacity in the wrong direction; pot with direction; a 200 ml jar with a direction to a biochemical laboratory; glass or plastic rod; fluid intake record sheet; volumetric flask.

Technique for taking urine for sugar from the daily amount:

• 1. The night before, the patient is warned about the upcoming study. He is informed that tomorrow morning at 6.00 he must urinate in the toilet, then go to the nurse’s post to be weighed. During the day, the patient, after urinating in a signed pot, needs to pour the urine into a three-liter jar. The last urination into the jar must be done at 6.00 the next day and again go to the nurse for weighing. In addition to collecting urine, the patient must keep a record of the liquid he drinks, as well as liquid food, fruits and vegetables.
• 2. In the morning of the next day after the patient’s last urination in a jar, the nurse must mix all the urine in a three-liter jar, measure its amount, pour 200 ml into a prepared jar with a direction, and send it to the laboratory.
• 3. Data on the amount of urine excreted (daily diuresis), fluid consumed and the patient’s body weight are noted on the temperature sheet.
• 4. The result of the study is pasted into the medical history.

Notes The level of sugar in the urine (glucosuria) largely depends on the correct collection of the daily amount of urine. Knowledge of daily diuresis is necessary to determine the daily loss of sugar in urine. If the patient is elderly or weakened, a nurse records the fluid consumed.

Preparing for a glucose tolerance test:

A glucose tolerance test is a laboratory test that is used to detect diabetes mellitus and pre-diabetic conditions.

General rules when preparing for research:

When donating blood for glucose (in addition to the basic requirements for preparing for tests), you should not brush your teeth, chew gum, or drink tea/coffee (even unsweetened). A morning cup of coffee will dramatically change your glucose levels. Contraceptives, diuretics and other medications also have an effect.

• 1. For most studies, it is recommended to donate blood in the morning, from 8 to 11 o’clock, on an empty stomach (at least 8 hours must pass between the last meal and blood collection, you can drink water as usual), on the eve of the study, a light dinner with a restriction eating fatty foods. For tests for infections and emergency studies, it is acceptable to donate blood 4-6 hours after the last meal.
• 3. On the eve of the study (within 24 hours), avoid alcohol, intense physical activity, and taking medications (in consultation with your doctor).
• 4. 1-2 hours before donating blood, refrain from smoking, do not drink juice, tea, coffee, you can drink still water. Avoid physical stress (running, quickly climbing stairs), emotional excitement. It is recommended to rest and calm down 15 minutes before donating blood.
• 5. You should not donate blood for laboratory testing immediately after physiotherapeutic procedures, instrumental examination, X-ray and ultrasound examinations, massage and other medical procedures.
• 6. When monitoring laboratory parameters over time, it is recommended to conduct repeated tests under the same conditions - in the same laboratory, donate blood at the same time of day, etc.
• 7. Blood for research must be donated before starting to take medications or no earlier than 10-14 days after they are discontinued. To assess the control of the effectiveness of treatment with any drugs, a study should be conducted 7-14 days after the last dose of the drug.

If you are taking medications, be sure to notify your doctor.

ATTENTION! Special preparation rules for a number of tests: strictly on an empty stomach, after a 12-14 hour fast, you should donate blood for gastrin-17, lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol, VLDL cholesterol, triglycerides, lipoprotein (a), apolipo-protene A1, apolipoprotein B) glucose tolerance test is performed in the morning on an empty stomach after 12-16 hours of fasting.

Insulin storage:

Insulin preparations, when properly stored, fully retain their properties until the expiration date indicated on the bottle. An unopened bottle is best stored in the dark at a temperature from +2 to +8 C, preferably in the refrigerator on the door or in its lower compartment, but not in the freezer. Frozen insulin cannot be used!

If there is no refrigerator, for example in a village, it is proposed to store insulin in a cool cellar or even in a well, hanging it in a plastic bag above the water itself. But you should not worry if insulin is not in the refrigerator, cellar or well, since at room temperature (+18 - +20 C) it can be stored for a long time without losing activity - until the expiration date, and in an open bottle - up to 1 month. On the other hand, when traveling in summer in hot climates, it is advisable to store insulin in a thermos with a wide hole, which should be cooled with cold water 1-2 times a day. You can simply wrap the insulin bottle with a damp cloth, periodically moistened with water.

Of course, you should not leave insulin near heating radiators or stoves. Insulin should never be stored in direct sunlight, otherwise its activity will decrease tenfold.

• · it was accidentally frozen;
• · it has changed its color (exposure to sunlight gives insulin a yellow-brown tint);
• · flakes and suspended particles have appeared in short-acting insulin, the solution is cloudy or has sediment;
• · when stirred, the insulin suspension does not form a homogeneous (white or whitish) mixture; lumps or fibers remain in it.

Note that only fast-acting, ultra-short-acting and short-acting insulins, as well as the new long-acting insulin glargine, should be transparent.

The patient should always remember that an unexplained increase in blood glucose levels may be associated with a possible decrease in the activity of the insulin used.

Nursing process in diabetes mellitus. Diabetes mellitus is a chronic disease characterized by impaired production or action of insulin and leading to disruption of all types of metabolism and, first of all, carbohydrate metabolism. Classification of diabetes mellitus adopted by WHO in 1980:
1. Insulin-dependent type - type 1.
2. Insulin-independent type - type 2.
Type 1 diabetes mellitus is more common in young people, type 2 diabetes mellitus - in middle-aged and elderly people.
In diabetes, the causes and risk factors are so closely intertwined that it is sometimes difficult to distinguish between them. One of the main risk factors is hereditary predisposition (type 2 diabetes mellitus is hereditarily more unfavorable); obesity, unbalanced nutrition, stress, pancreatic diseases, and toxic substances also play an important role. in particular alcohol, diseases of other endocrine organs.
Stages of diabetes:
Stage 1 - prediabetes - a state of predisposition to diabetes mellitus.
Risk group:
- Persons with a family history.
- Women who gave birth to a live or stillborn child weighing more than 4.5 kg.
- Persons suffering from obesity and atherosclerosis.
Stage 2 - latent diabetes - is asymptomatic, the fasting glucose level is normal - 3.3-5.5 mmol/l (according to some authors - up to 6.6 mmol/l). Latent diabetes can be detected by a glucose tolerance test, when the patient, after taking 50 g of glucose dissolved in 200 ml of water, experiences an increase in blood sugar levels: after 1 hour it is above 9.99 mmol/l. and after 2 hours - more than 7.15 mmol/l.
Stage 3 - overt diabetes - the following symptoms are characteristic: thirst, polyuria, increased appetite, weight loss, itching (especially in the perineal area), weakness, fatigue. The blood test shows an increased glucose level, and glucose may also be excreted in the urine.
With the development of complications associated with damage to the blood vessels of the central nervous system. fundus. kidneys, heart, lower extremities, symptoms of damage to the corresponding organs and systems are added.

Nursing process in diabetes mellitus:
Patient problems:
A. Existing (present):
- thirst;
- polyuria:
- skin itching. dry skin:
- increased appetite;
- weight loss;
- weakness, fatigue; decreased visual acuity;
- pain in the heart;
- pain in the lower extremities;
- the need to constantly follow a diet;
- the need for constant administration of insulin or taking antidiabetic drugs (Maninil, Diabeton, Amaryl, etc.);
Lack of knowledge about:
- the essence of the disease and its causes;
- diet therapy;
- self-help for hypoglycemia;
- foot care;
- calculating bread units and creating menus;
- using a glucometer;
- complications of diabetes mellitus (comas and diabetic angiopathy) and self-help for comas.
B. Potential:
Risk of development:
- precomatose and comatose states:
- gangrene of the lower extremities;
- acute myocardial infarction;
- chronic renal failure;
- cataracts and diabetic retinopathy with blurred vision;
- secondary infections, pustular skin diseases;
- complications due to insulin therapy;
- slow healing of wounds, including postoperative wounds.
Collection of information during the initial examination:
Asking the patient about:
- following a diet (physiological or diet No. 9), about the diet;
- physical activity during the day;
- ongoing treatment:
- insulin therapy (name of insulin, dose, duration of action, treatment regimen);
- antidiabetic tablet drugs (name, dose, features of their administration, tolerability);
- recent studies of blood and urine tests for glucose levels and examinations by an endocrinologist;
- the patient has a glucometer and the ability to use it;
- the ability to use a table of bread units and create a menu based on bread units;
- ability to use an insulin syringe and pen;
- knowledge of places and techniques for insulin administration, prevention of complications (hypoglycemia and lipodystrophy at injection sites);
- keeping a diary of observations of a patient with diabetes mellitus:
- past and present visits to the “Diabetes School”;
- development in the past of hypoglycemic and hyperglycemic coma, their causes and symptoms;
- ability to provide self-help;
- the patient has a “Diabetic Passport” or a “Diabetic Business Card”;
- hereditary predisposition to diabetes mellitus);
- concomitant diseases (diseases of the pancreas, other endocrine organs, obesity);
- patient complaints at the time of examination.
Patient examination:
- color, moisture of the skin, presence of scratching:
- determination of body weight:
- blood pressure measurement;
- determination of the pulse on the radial artery and on the artery of the dorsum of the foot.
Nursing interventions, including working with the patient's family:
1. Conduct a conversation with the patient and his relatives about dietary habits depending on the type of diabetes mellitus and diet. For a patient with type 2 diabetes, give several sample menus for the day.
2. Convince the patient of the need to strictly follow the diet prescribed by the doctor.
3. Convince the patient of the need for physical activity recommended by the doctor.
4. Conduct a conversation about the causes, essence of the disease and its complications.
5. Inform the patient about insulin therapy (types of insulin, the beginning and duration of its action, connection with food intake, storage features, side effects, types of insulin syringes and syringe pens).
6. Ensure timely administration of insulin and taking antidiabetic medications.
7. Control:
- condition of the skin;
- body weight:
- pulse and blood pressure;
- pulse on the artery of the dorsum of the foot;
- adherence to diet and nutrition; transmission to the patient from his relatives;
- recommend constant monitoring of glucose levels in the blood and urine.
8. Convince the patient of the need for constant monitoring by an endocrinologist, keeping an observation diary, which indicates the levels of glucose in the blood, urine, blood pressure levels, foods eaten per day, therapy received, changes in well-being.
9. Recommend periodic examinations by an ophthalmologist, surgeon, cardiologist, nephrologist.
10. Recommend classes at the Diabetes School.
11. Inform the patient about the causes and symptoms of hypoglycemia and coma.
12. Convince the patient of the need to immediately contact an endocrinologist if there is a slight deterioration in health and blood counts.
13. Teach the patient and his relatives:
- calculation of grain units;
- creating a menu based on the number of bread units per day; collection and subcutaneous administration of insulin with an insulin syringe;
- foot care rules;
- provide self-help for hypoglycemia;
- measuring blood pressure.
Emergency conditions for diabetes mellitus:
A. Hypoglycemic state. Hypoglycemic coma.
Reasons:
- Overdose of insulin or antidiabetic tablets.
- Lack of carbohydrates in the diet.
- Insufficient food intake or skipping meals after insulin administration.
- Significant physical activity.
Hypoglycemic states are manifested by a feeling of severe hunger, sweating, trembling of the limbs, and severe weakness. If this condition is not stopped, then the symptoms of hypoglycemia will increase: trembling will intensify, confusion in thoughts, headache, dizziness, double vision, general anxiety, fear, aggressive behavior will appear, and the patient will fall into a coma with loss of consciousness and convulsions.
Symptoms of hypoglycemic coma: the patient is unconscious, pale, and there is no smell of acetone from the mouth. the skin is moist, profuse cold sweat, muscle tone is increased, breathing is free. blood pressure and pulse are not changed, the tone of the eyeballs is not changed. In the blood test, the sugar level is below 3.3 mmol/l. there is no sugar in urine.
Self-help for hypoglycemic conditions:
It is recommended that at the first symptoms of hypoglycemia, eat 4-5 pieces of sugar, or drink warm sweet tea, or take 10 glucose tablets of 0.1 g, or drink from 2-3 ampoules of 40% glucose, or eat a few candies (preferably caramel ).
First aid for hypoglycemic conditions:
- Call a doctor.
- Call a laboratory assistant.
- Place the patient in a stable lateral position.
- Place 2 pieces of sugar behind the cheek on which the patient is lying.
Prepare medications:
40 and 5% glucose solution. 0.9% sodium chloride solution, prednisolone (amp.), hydrocortisone (amp.), glucagon (amp.).
B. Hyperglycemic (diabetic, ketoacidotic) coma.
Reasons:
- Insufficient dose of insulin.
- Diet violation (high carbohydrate content in food).
- Infectious diseases.
- Stress.
- Pregnancy.
- Injuries.
- Surgical intervention.
Precursors: increased thirst, polyuria. possible vomiting, loss of appetite, blurred vision, unusually strong drowsiness, irritability.
Symptoms of coma: absence of consciousness, smell of acetone from the breath, hyperemia and dry skin, noisy deep breathing, decreased muscle tone - “soft” eyeballs. The pulse is threadlike, blood pressure is reduced. In the blood test - hyperglycemia, in the urine test - glucosuria, ketone bodies and acetone.
If warning signs of coma appear, immediately contact an endocrinologist or call him at home. If there are signs of hyperglycemic coma, urgently call the emergency room.
First aid:
- Call a doctor.
- Give the patient a stable lateral position (prevention of tongue retraction, aspiration, asphyxia).
- Take urine with a catheter for rapid diagnostics of sugar and acetone.
- Provide intravenous access.
Prepare medications:
- short-acting insulin - actropid (fl.);
- 0.9% sodium chloride solution (vial); 5% glucose solution (vial);
- cardiac glycosides, vascular agents.

State educational institution

Secondary vocational education

Vladimir region

"Murom Medical College"

Refresher courses

Abstract

on the topic:“Nursing process in diabetes mellitus:

reasons, priority problems, implementation plan.”

Completed by the listener

Advanced training courses

Lazareva Alexandra Valentinovna

m/s MUZ "Kulebak Central District Hospital"

Moore

PLAN:

I. Introduction. 3

II. Nursing process for diabetes mellitus:

reasons, priority problems, implementation plan. 4

1. Causes of diabetes mellitus. 4

2. Problems of patients with diabetes. 6

3. Implementation plan (practical part). 10

III. Conclusion. 11

IV. List of used literature. 12

.

Diabetes mellitus is an urgent medical and social problem of our time, which, in terms of prevalence and incidence, has all the features of an epidemic covering most economically developed countries of the world. Currently, according to WHO, there are already more than 175 million patients in the world, their number is growing steadily and will reach 300 million by 2025. Russia is no exception in this regard. Over the past 15 years alone, the total number of people with diabetes has doubled.

The problem of combating diabetes mellitus is given due attention by the Ministries of Health of all countries. In many countries of the world, including Russia, appropriate programs have been developed that provide for early detection of diabetes mellitus, treatment and prevention of vascular complications, which are the cause of early disability and high mortality observed in this disease.

The fight against diabetes mellitus and its complications depends not only on the coordinated work of all parts of the specialized medical service, but also on the patients themselves, without whose participation the targets for compensating carbohydrate metabolism in diabetes mellitus cannot be achieved, and its violation causes the development of vascular complications .

It is well known that the problem can be successfully solved only when everything is known about the causes, stages and mechanisms of its appearance and development.

Nursing process for diabetes mellitus:

reasons, priority problems, implementation plan

1. Causes of diabetes mellitus.

In diabetes mellitus, the pancreas is not able to secrete the required amount of insulin or produce insulin of the required quality. Why is this happening? What is the cause of diabetes? Unfortunately, there are no clear answers to these questions. There are individual hypotheses with varying degrees of reliability; a number of risk factors can be pointed out. There is an assumption that this disease is viral in nature. It is often suggested that diabetes is caused by genetic defects. Only one thing is firmly established:You cannot catch diabetes like you can catch the flu or tuberculosis.

There are definitely a number of factors that predispose to diabetes. In the first place you should indicate hereditary predisposition.

The main thing is clear: hereditary predisposition exists, and it must be taken into account in many life situations, for example, when getting married and when planning a family. If heredity is associated with diabetes, then children need to be prepared for the fact that they can also get sick. It must be explained that they constitute a “risk group”, and therefore, through their lifestyle, they must nullify all other factors influencing the development of diabetes.

Second leading cause of diabetes - obesity. This factor, fortunately, can be neutralized if a person, aware of the full extent of the danger, vigorously fights excess weight and wins this fight.

Third reason - these are some diseases as a result of which beta cells are damaged. These are diseases of the pancreas - pancreatitis, pancreatic cancer, diseases of other endocrine glands. The provoking factor in this case may be injury.

The fourth reason is a variety of viral infections (rubella, chickenpox, epidemic hepatitis and some other diseases, including influenza). These infections play the role of a trigger mechanism, as if launching the disease. It is clear that for most people, the flu will not be the onset of diabetes. But if this is an obese person with aggravated heredity, then the flu poses a threat to him. A person who has no family members with diabetes can suffer from influenza and other infectious diseases many times - and at the same time, the likelihood of developing diabetes is much less than for a person with a hereditary predisposition to diabetes.

In fifth place should be called nervous stress as a predisposing factor. People with aggravated heredity and those who are overweight should especially avoid nervous and emotional stress.

In sixth place among the risk factors - age. The older a person is, the more reason there is to fear diabetes. It is believed that with every ten year increase in age, the likelihood of developing diabetes doubles. A significant proportion of people permanently residing in nursing homes suffer from various forms of diabetes,

So, most likely, diabetes has several causes, in each specific case it may be one of them. In rare cases, certain hormonal disorders lead to diabetes; sometimes diabetes is caused by damage to the pancreas that occurs after the use of certain medications or due to prolonged alcohol abuse.

Even those reasons that are precisely defined are not absolute. So all people at risk should be vigilant. You should be especially careful about your condition between November and March, because most cases of diabetes occur during this period. The situation is complicated by the fact that during this period your condition may be mistaken for a viral infection. An accurate diagnosis can be made based on a blood glucose test.

2. Problems of patients with diabetes mellitus.

The main problems of patients with diabetes mellitus:

2. Smell of acetone from the mouth.

3. Nausea, vomiting

The goal of the nursing process is to maintain and restore the patient's independence and meet the basic needs of the body.

The nursing process requires from the nurse not only good technical training, but also a creative attitude towards patient care, the ability to work with the patient as an individual, and not as an object of manipulation. The constant presence of the nurse and her contact with the patient make the nurse the main link between the patient and the outside world.

The nursing process consists of five main stages.

1. Nursing examination. Collection of information about the patient’s health status, which can be subjective and objective.

The subjective method is physiological, psychological, social data about the patient; relevant environmental data. The source of information is a survey of the patient, his physical examination, study of medical documentation data, conversation with the doctor, and the patient’s relatives.

The objective method is a physical examination of the patient, including assessment and description of various parameters (appearance, state of consciousness, position in bed, degree of dependence on external factors, color and moisture of the skin and mucous membranes, presence of edema). The examination also includes measuring the patient's height, determining his body weight, measuring temperature, counting and assessing the number of respiratory movements, pulse, and measuring and assessing blood pressure.

The end result of this stage of the nursing process is the documentation of the information received and the creation of a nursing medical history, which is a legal protocol - a document of the independent professional activity of the nurse.

2. Identifying the patient's problems and formulating a nursing diagnosis. The patient's problems are divided into existing and potential. Existing problems are those problems that are currently bothering the patient. Potential - those that do not yet exist, but may arise over time. Having established both types of problems, the nurse determines the factors that contribute to or cause the development of these problems, and also identifies the patient’s strengths that he can counteract the problems.

Since a patient always has several problems, the nurse must establish a system of priorities. Priorities are classified as primary and secondary. Primary priority is given to problems that are likely to have a detrimental effect on the patient in the first place.

The second stage ends with the establishment of a nursing diagnosis. There is a difference between medical and nursing diagnosis. Medical diagnosis focuses on recognizing pathological conditions, while nursing diagnosis is based on describing patients' reactions to health problems. The American Nurses Association, for example, identifies the following as the main health problems: limited self-care, disruption of the normal functioning of the body, psychological and communication disorders, problems associated with life cycles. As nursing diagnoses, they use, for example, phrases such as “lack of hygiene skills and sanitary conditions”, “decreased individual ability to overcome stressful situations”, “anxiety”, etc.

Purpose of the work: learn how to organize the nursing process for this disease. To consolidate theoretical knowledge on this topic and learn to apply it in practical work, i.e. carry out correct diagnosis, provide emergency assistance, treatment and care. Continue to improve manipulation techniques. Develop in yourself the moral and ethical qualities necessary for a medical worker.

Task No. 1. List the main symptoms and syndromes found in this disease.

Increased levels of glucose in the blood and urine, the appearance of ketone bodies, polyuria, polyphagia, dyspeptic disorders, weight loss, changes in the skin, the formation of a diabetic foot, micro- and macroangiopathy, nephropathy, polyneuropathy, arthropathy.

Task No. 2. List the patient's problems encountered with this disease and fill out the table:

Task No. 3. How will you implement problems with this disease? Fill out the table.

Task No. 4. List the main directions in treating a patient with this disease:

adherence to a diet, regimen, administration of insulin or tableted hypoglycemic drugs, training in disease control, emergency measures in case of complications, hygiene measures. Training at the "school for diabetics."

Task No. 5. Fill out the table using the recipe guide. Write down the main medications prescribed for this disease.

Task No. 6. Solve a situational problem on the topic of the lesson and fill out the table:

A 34-year-old patient is admitted for inpatient treatment to the endocrinology department with a diagnosis of diabetes mellitus, insulin-dependent form, newly diagnosed.

During a nursing examination, the nurse received data such as: complaints of dry mouth, thirst (drinks up to 10 liters per day), frequent urination, general weakness, concern about the outcome of the disease.

OBJECTIVELY: consciousness is clear. The skin is pale, dry, pulse 88 beats per minute, satisfactory quality, blood pressure 140/90 mm Hg. Art. Respiratory rate 18 per minute, height 168 cm, weight 99 kg.

Nurse work plan

Satisfaction of needs is impaired: to be healthy, to eat, to sleep, to excrete, to rest, to work, to communicate, to avoid danger.

Patient problems	Observation	Care plan	Motivation	The role of the patient and relatives	Grade
Real: dry mouth, thirst (up to 10 liters per day), frequent urination, general weakness, anxiety about the outcome of the disease. Potential: development of hyperglycemic coma. Priority: Thirst	M.s will observe the appearance and condition of the patient. MS will provide monitoring of pulse, blood pressure, respiratory rate, and physiological changes in body weight.	1. M.s will ensure strict adherence to diet No. 9, excluding irritating spicy, sweet and salty foods. 2. M.s will take care of the skin, oral cavity, and perineum. 3. M. will have a conversation with relatives about the nature of the programs. 4. M.s will provide access to fresh air by ventilating the room for 30 minutes. 5. M.s will provide monitoring of the patient: general condition, pulse, blood pressure, respiratory rate, physiological functions, body weight. 6. M.s will carry out the doctor’s orders. 7. M.s will provide psychological support to the patient and his leisure time.	1. To normalize metabolic processes in the body, primarily carbohydrate and fat. 2. Prevention of infection. 3. To normalize metabolic processes and increase defenses. 4. Enrichment of air with oxygen, improving cleansing processes in the body. 5. For early diagnosis and emergency care in case of complications. 6. To improve the general condition of the patient. 7. To overcome psychological problems.	M.s will have a conversation with relatives about providing additional nutrition.	The patient notes an improvement in health, demonstrates knowledge of preventing complications of the disease, and creating a diet.

Goals: short-term – thirst will decrease by the end of the week;

long-term – thirst will not bother you, the patient will demonstrate knowledge about the disease and master the technique of administering insulin before discharge.

Task No. 7. Remember what manipulations are necessary when implementing the nursing process for a patient with this disease. Fill out the table.

Manipulation	Patient preparation	The main stages of the manipulation.
Urine test for sugar	Explain the procedure.	During the day, all urine is collected in one container without a preservative, which must be stored in a cold place. At the end of the collection, the urine in the container is thoroughly shaken, the total amount is noted, 200 ml is poured out and sent to the laboratory. The label says “Urine for sugar.” When it is necessary to determine the amount of sugar in individual portions, the urine is collected in three different containers (from 6.00 to 14.00, from 14.00 to 22.00, from 22.00 to 6.00) and accordingly the urine is sent in three jars indicating the amount of urine.
CALCULATION OF INSULIN DOSE	Explain the procedure and teach the patient how to perform it.	Insulin is administered subcutaneously 30 minutes before meals. Domestic insulin is produced in 5 ml bottles. 1 ml contains 40 units of insulin. To administer insulin, use an insulin syringe that has a scale of divisions in units of action. Combination syringes are often used, on which, in addition to the insulin scale, there is also a regular one (in ml) - 1.5 ml and 2 ml. It is necessary to frequently change injection sites to avoid complications such as lipodystrophy. Action algorithm 1. Before dialing insulin, determine the “division price” of the insulin scale. A small division on the insulin scale corresponds to 2 units. 2. Calculate to what division you should dial up the dose of insulin, using the proportion: 1 division - 2 units of insulin, X divisions - (required dose) units of insulin. 3. If you use a combination syringe, you can make the calculation in another way: remembering that 1 ml contains 40 units. 0.1 ml - 4 units of insulin X ml - (required dose) units of insulin 4. Fill the syringe with air in a volume equal to the prescribed dose of insulin. Introduce it into the bottle, having previously treated its stopper. 5. Fill the syringe with a little more than the calculated amount. Excess insulin will be removed by expelling air from the syringe and checking the needle for patency. 6. Prepare everything for subcutaneous insulin injection. SAFETY RULES Attention! If the patient does not eat 30 minutes after the insulin injection, hypoglycemia may develop, leading to loss of consciousness. The nurse must strictly monitor food intake in connection with insulin injections! Help with the development of hypoglycemia: 1) give the patient sweet tea, white bread, sugar, candy 2) in case of loss of consciousness, administer 40% glucose intravenously - 50 ml

Evaluation (teacher comments)------------------

Physiological needs:

Yes (stomatitis, dietary restrictions).

Drink (thirst, fluid deficiency).

Breathe (ketoacidotic coma).

Eliminate (kidney damage).

Sexual desires (impotence).

Be clean (pustular diseases, skin trophic disorders).

Maintain the condition (complications, decompensation).

Dressing, undressing (coma).

Maintain temperature (infectious complications).

Sleep, rest (decompensation).

Move (diabetic foot, other complications).

Psycho-social:

Communicate (hospitalization, visual impairment, etc.).

Achieving success and harmony.

Have life values ​​(depression, fear, lack of adaptation to the disease due to the severity of the disease and the development of complications).

Play, study, work (disability, lifestyle changes).

Possible patient problems.

1) Physiological:

• Polyuria.

  Itchy skin.

  Violation of skin trophism.

  Visual impairment.

  Weakness.

  Weight loss.

  Excess body weight.

  Violation of water balance.

  Loss of motor activity.

2) Psychological:

Lack of adaptation to the disease.

Fear of losing vision.

Fear of losing a child.

Anxiety.

Depression.

Lack of knowledge about the disease.

Inappropriate attitude towards the disease.

Self-control deficit.

Changing the nature of nutrition.

The need for constant injections.

Decreased performance.

Lack of communication.

Changing the family process.

Social:

Loss of social and industrial connections.

Loss of ability to work.

Isolation during hospitalization.

Difficulties in self-sufficiency (self-control means, medications, products).

Lack of self-realization.

Lack of life values.

Spiritual:

Lack of spiritual participation (harmony, success).

5) Potential problems:

Risk of loss of consciousness due to hyperglycemia.

Risk of hypoglycemia.

Risk of vision loss.

Risk of developing lipodystrophies.

Risk of disruption of skin trophism.

Risk of developing infectious complications.

Patient problem : Thirst

Goals: Short term: The patient will not be thirsty in a week.

Long-term: The patient will demonstrate knowledge of the causes of thirst and how to combat it

The nurse will explain to the patient the essence and causes of this phenomenon.

The nurse will explain to the patient the need to monitor fluid intake and excretion.

The nurse will warn the patient and explain to him how to properly prepare for a blood sugar test.

The nurse will monitor your urine sugar as directed by your doctor.

If necessary, the nurse will carry out the doctor's orders - administering insulin or giving sulfa drugs with a hypoglycemic effect.

Patient problem: Polyuria.

Goals: Short term: The patient's urine output will decrease within a week of starting treatment.

Long-term: By the time of discharge, diuresis has normalized.

Nursing intervention plan:

The nurse will explain the cause and essence of this phenomenon to the patient.

The nurse will monitor daily urine output and record it on the temperature sheet.

The nurse will talk about nutrition for diabetes.

The nurse, as directed by the doctor, will monitor urine sugar from the daily amount.

The nurse will administer insulin as directed by the physician.

Problem : High risk of loss of consciousness due to hyperglycemia.

Goal of intervention: The patient will be aware of the causes of hyperglycemia.

Nursing intervention plan:

The nurse will monitor the condition of breathing, skin, and eyeballs.

The nurse will teach the patient self-monitoring techniques.

The nurse will tell the patient about the need to follow a diet.

The nurse will teach the patient and family how to administer insulin.

The nurse will administer insulin as directed by the physician.

The nurse will talk to the family about the importance of taking insulin regularly.

Problem: Anxiety about vision deterioration.

Goal of intervention: The patient will demonstrate knowledge of the causes of visual impairment.

Nursing intervention plan:

The nurse will try to calm the patient.

The nurse will talk with the patient about the causes of this complication.

The nurse will provide the patient with sufficient information and include him in the collaborative process.

The nurse will send the patient to the ophthalmologist as prescribed by the doctor.

5. The nurse will introduce the patient to a person with diabetes mellitus who has adapted to their disease.

The nurse will talk with the patient's family about the need for psychological support and assistance with vision loss.