a nurse is teaching a client who has diabetes mellitus about insulin injections This is a topic that many people are looking for. star-trek-voyager.net is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, star-trek-voyager.net would like to introduce to you Diabetes Mellitus Pathophysiology & Nursing | Diabetes Nursing Lecture NCLEX | Type 1 & Type 2. Following along are instructions in the video below:
Everyone its sarah thread sister nurse rn calm and in this video. Imm going to be going over diabetes mellitus. This is part of a in clecs series on diabetes and what i want to be doing in this video is im going to be hitting the pathophysiology and diabetes.
The complications. The different types and the nursing assessment in the next video. Im going to be going over the nursing interventions and im going to hit really hard on the forma.
Logical aspects of taking care of a diabetic patients the education and the teaching and im gonna give you some clever mnemonics on how to remember that stuff because its a lot of stuff that you need to know for the nclex and your nursing lecture exams. And then ill be having some more videos coming out about dka hhns syndrome and all those things you need to know about diabetes so make sure you access the playlist enric and playlist. So you can get access to those videos now after this lecture be sure to go to my website register nurse rn calm and take the free quiz.
A card should be popping up to test your knowledge on diabetes. Okay. So lets get started.
Okay. First lets talk about the key players in diabetes. Because if you understand whats going on normally in the body youre going to understand why.
The diabetic patient is having all of these issues. So the big key players in diabetes. Is glucose insulin.
Glucagon and the liver and all of these work together to help your body use glucose because the big issue with diabetes is an issue with insulin and im here to say youll see why thats an issue okay so first lets talk about blue coes. What is glucose glucose is sugar and your body loves sugar because your body needs it to survive. And what sugar does is it enters into the cell or the glucose enters into the cell and fuels those cells.
So they can work. But the catch is is that glucose cannot enter into your cell. Without the help of insulin.
So in order you eat all this sugar you take it in and enters your bloodstream. But for glucose to actually go into yourself or your to use it has to have the help of in flint and if you dont have any insulin at all then youre not going to have the ability to use the glucose and the glucose is just going to hang out in your bloodstream and cause high blood sugars. Which wreaks have it on havoc on the body.
Now glucose is mainly stored in the liver in the form of glycogen. Which well go over in depth here in a second okay insulin. What is insulin insulin is a hormone and it plays a huge role in helping us bring those blood sugar levels down.
Because like i said it regulates the amount of glucose in your body. It attaches lets glucose attached to it and it takes it inside that cell. So you can use it and the big thing that you want to remember is that insulin is secreted by your pancreas by the beta cells of the pancreas in the inlets of the langerhans cells.
So if this area of the body the beta cells in the pancreas get damaged. Then youre in trouble youre not going to have any insulin production. Now lets talk about glucagon.
What is glucagon. It works in the opposite of insulin insulin helps us bring our sugars down. Glucagon helps us increase our blood sugar.
So it helps with low blood sugar levels. And what it does is it causes the liver. Because your liver will store this glucose and if you have extra glucose in the body the liver will take it and store.
It and turn it into glycogen and whenever glucagon is released it will cause that liver to release that glycogen that its stored up and turn it into glucose. So you can get that glucose in your body and increase your blood sugar levels now the liver. Thats our last key player.
The liver is very sensitive to insulin levels in your body. Its whenever. It senses that you have too high of insulin levels.
And you have high blood sugar levels. It starts doing its job. But if you have low insulin levels you have low blood sugar.
It also helps with that so its very vital in helping us keep those levels. Nice and normal. So whenever you have high blood sugar.
And high insulin level. The liver will cause the body to absorb that extra glucose and will turn it into glycogen so you can use it later on. But didnt say all of a sudden your glucose drops and your insulin levels will drop as well the liver will sense that and this will cause the liver to release those stores of the glycogen.
Which will turn into glucose and increase your blood sugar. So it helps with that now lets recap about the feedback loop. What happens normally in the body and someone who doesnt have diabetes and then lets talk about whats happening in someone with diabetes.
Okay. So you have a high blood sugar. You a and drank a bunch of sugary stuff.
So what does your body do the pancreas says hey. Theres a lot of blood. Theres a lot of glucose in our body.
So we need to use that so the pancreas releases insulin and the insulin causes. The glucose to enter into the cells. And there may be some left over and the leftover will go into the liver and the liver will store it for later and turn it into glycogen and then use it whenever you need it now say you have low blood sugar.
Youve been working all day as a nurse and you have an eight so your blood sugars level low is a level is low. So what will your body do because it wants hell protect you the pancreas will release glucagon now remember glucan works in the opposite of insulin. And this will cause the liver to release glycogen.
Remember all those stores that stored up from all that extra glucose and this will turn into glucose. Which will increase your blood sugar. So that is whats happening in someone who doesnt have diabetes who has a normal healthy pancreas and they dont have insulin issues.
But what is happening to someone with diabetes okay. Whats happening is that the bought youre eating all your sugar eating your food. But the body cannot get to that sugar that glucose that youre eating and this is either due to theres no insulin present either of those beta cells in the pancreas were damaged or the body is resist to insulin you and your secreting insulin perfectly.
But those cells are like we dont want that and theyre not receptive to that insulin so you cant use it and in type one theres no insulin present in type two the body is resistant to insulin. Which will go end up here in a second and whatever that happens because your bodys not using glucose you get hyperglycemia. Where you have an elevated blood sugar in the body.
And it just hangs out now when glucose hangs out in your body. This is not good. Its not meant to do that so it starts to affect major organs of the body and the body says hey we need some energy these cells need to be able to work since we cant get the glucose.
Weve got to burn energy. Some other way so it will start to burn. Fats ketones.
Which are acids and this happens in your type. 1. Diabetics.
And whenever youre burning those fats and those assets. Its thrown the whole body out of whack. Its going to cause some major acid and base and balances.
Which we talked about in depth and metabolic acidosis and alkalosis or with the type. 2 diabetics. Whats happening is that there is enough insulin.
Theres just enough where your body is were not receptive to it so it doesnt burn those fats. But instead it doesnt use the card. So theyre having issues with carbohydrate metabolism.
Now what causes diabetes mellitus. The causes are separated into three different types you have type 1 type. 2.
And gestational so lets talk about type 1. Ok type. 1.
Remember. This is where the patient does not have any insulin and whats happened is that those beta cells in the insolate of the llegaron. Which is in your pancreas have been destroyed.
Theyre not working properly at all so there is no insulin for this for this patient. So in order for treatment. They have to take insulin now.
This is not related to lifestyle like with your type. 2 diabetics. This is either genetic autoimmune for instance and they got a virus that went in route havoc on the body and the body attacked itself specifically those beta cells in the pancreas.
And it just doesnt work. Anymore. Now how do these patients present.
I would remember this this is important and these patients are going to be thin. Because theyre burning all that fat off because the body needs energy. So theyre burning all those fats and ketones.
Theyre going to be young normally this happens in children. And its going to happen all of a sudden. And theres going to be ketones present in the urine where the body is breaking down those fats now type.
2 diabetics. Whats happening here the cells have quit responding to insulin so its insulin resistant. They dont care about the insulin and you can secrete insulin.
All day and theyre not going to have anything to do with it and so what happens the glucose just hangs out in the body. But its like a catch 22. All this insulin is its being produced its nice and fine.
But the cells just dont want anything to do with it. But you still have all this glucose and the pancreas thinks you need more insulin because it senses that you have all this glucose still in the body. So it starts to over secrete insulin and you start getting the condition called hyperinsulinemia.
Which will lead to metabolic syndrome. So not good and treatment for this is normally the patient and they will the doctor will order diet and exercise that normally helps with that. But if thats not successful.
They will start them on oral medications. Which we will cover in the next video in depth. And and these patients normally dont take insulin.
But they may need insulin injections in there having lost stress on the body like with surgery or with infections. So thats something just to keep in mind. And this is generally type 2 diabetes is related to lifestyle either due to be nobies.
Having a sedentary lifestyle. Poor diet lots of colas things like that and genetic now. How do these patients for example.
What do they typically look like theyre typically overweight. And it happens over time there are usually adult age teenage age. And its very rare for them to have ketones in the because remember back to this they dont have an issue with metabolizing.
The fats because theres just enough insulin. But they have issues with metabolizing those carbohydrates now gestational. Just wanted to throw that in that is a dip thats another type and its similar to your type 2 diabetes.
And this is where the cells are not receptive and it happens in pregnant women and it will usually go away after birth now. Lets look at the complications of diabetes. And the nursing assessment first lets talk about complications.
Okay complications with diabetes. You can have hypoglycemia organ problems diabetic ketoacidosis also called dka or hyperglycemic hyperosmolar nonketotic syndrome. Which we will refer to as h h ns so let me go over these in detail.
Okay hypoglycemia. This is the opposite of hyperglycemia hypo means low gly means glucose and emia means blood. So we have low blood glucose in the blood.
Usually its around less than 60 milligrams per. Deciliter. Now whenever patients have this this is usually a side effect from too.
Much insulin or too much oral diabetic medication which well go over in the next video. But theyre going to present as being sweaty and clammy confused lightheaded dizzy and double vision. Now to help you remember how to treat someone with hypoglycemia.
Because you want to treat it fast and remember the same im sweaty cold and clammy give me some candy. So these patients who are having hypoglycemia need a simple carb. Remember that and i remember a test question from nursing school.
And it gave us the glucose and it said. What would be a treatment. And what the option was simple carb complex carb and listed all these things.
But its a simple carb of what they need and simple carbs are like your hard candies like lifesavers and fruit juice graham crackers honey. Things like that that can hit the body body can absorb and take in and use now if the patients unconscious. They cant eat and normally in the hospital setting whatever the doctor orders you will of them iv d50.
Okay. Now lets look at organ problems. Okay glucose think about it in our real life sugar.
If you get sugar on your hands. Its really sticky the same concept can apply to whenever it gets you get way too much in the blood. What it does is it causes atherosclerosis.
Im hardly of the vessels. Now what this does is this glucose enters into the blood glucose is naturally sticky. So its going to start to stick to those proteins of the vessels and they become hard and they form plaques and normally your vessels are nice and pliable and theyre not hard and when theyre hard they dont work properly.
So lets think of all the systems in the body that are affected by hard vessels your heart you can get heart disease gonna stick on those coronary arteries make them hard blood flow is going to be narrow. And theres also some plaques that can form can cause an mi myocardial infarction strokes and a lot of strokes happen without weakening of those vessels of hypertension. Again you have stiff hard vessels thats going to increase um resistance on your vessels causing hypertension neuropathy decreased wound healing again that is because and your you have decreased compromised circulation from those hardening of those vessels.
You cant get all that and all those cells. There to work to help heal that wound so they will have slow wounds on their feet especially on their feet. I trouble and infections okay.
Lets look at diabetic ketoacidosis dk8. Now and the other videos coming up in this series. Were going to go in depth about dka treatments and all that were going to actually compare it with hhns because people get these two conditions confused.
But let me help break it down for you so you can understand it a little bit okay dka this happens in your type. 1 diabetics. Its super rare to happen and type 2.
Its type 1 so keep that in mind. And another issue with this is they are burning ketones. Let the name help you out diabetic ketoacidosis.
Okay. Remember what we were talking about diabetes type. 1.
They dont have any insulin insulin. Helps glucose go into the cell for energy. So the bodys like hey.
We dont have anything for energy. So weve got to start burning fats ketones. So what happens is that the body is burning those ketones like crazy.
And this is causing acids to enter into the blood. One of those ketones break down and then youre getting some acid base and balances. This is life threatening.
They need to be treated and how your patients going to present. Theyre going to have extremely high blood sugars and theyre going to be very thirsty and theyre going to have the cosmos breathing. Remember that thats because all that acid build up in the body and respiratory system is trying to blow off that acid by those deep long and breaths.
Rapid. Breaths and they can also have the acetone breath. Which is like that fruity smell in their breath.
And thats just because of all those ketones breaking out. Now. Lets lets look at hhns.
Okay. This happens typically in your type. Two diabetics and part of hhs.
The n stands for non ketotic. So there is no breakdown of ketones in this because remember with type 2 diabetes. They have just enough insulin where they dont have to break me on the fats and said they have carbohydrate issues.
So im where youre going to have is no burning of the ketones. Youre just going to have a dehydration. The patients going to be very dehydrated.
Theyre going to be thirsty. And theyre gonna have mental status changes and their blood sugars are going to be crazy high. But theres going to be no ketone tissues.
Now how is the patient going to present to you and whenever youre assessing them what signs and symptoms are they going to have okay. Youll want to remember. This these are typically test questions.
Okay. The three ps for hyperglycemia because the issue with diabetes is they have high blood sugars. So the three peas.
Which are polyuria polydipsia and polyuria polyuria is where poly means. Many and urea means urine. So theyre having frequent urination.
They are peeing a lot theyre going to want a urine output. Why is this happening okay this happens. Because of the rule of alls mices remember in our high tonic isotonic hypotonic video and we talked about osmosis.
This is where water likes to be where theres a higher concentration. So its going to move to a higher concentration lower concentration higher concentration. And whats happened is theres all this glucose in your blood and this cells inside the cells.
Theres water and the waters. Like hey all the glucose is in the blood. Lets move out of the cell and go into the bloodstream.
So you have all this water shifting into the blood that causes a lot of fluids. So what system of the body gets rid of extra fluid. The kidneys so the kidneys start putting out all this extra fluid you have but also whenever the kidneys is doing that one of the roles is that it reabsorbs glucose.
But theres way too much glucose in the blood. So the kidneys cant cope with this so they start linking glucose. So youre going to see glycosuria that means youre going to see glucose in their urine next.
Theyre going to have polydipsia and this plays into the poly area all these play off of each other so polydipsia poly means. Many dips here means thirst drinking so theyre going to be very thirsty. And this is because of the polyuria because theyre putting out all this fluid.
The bodys like hey we got to keep drinking to keep hydrating ourselves. Because were putting all this water and then the polyphagia that means theyre very hungry. Theyre just constantly craving food and this ties back to burning all those fats.
All those ketones and the body needs the energy because it cant get to the glucose. So the boys like hey weve got to eat keep eating food. So we can keep burning this energy.
And these. Three peas are mainly seen in your type. One diabetics.
Okay. Now lets look at another mnemonic. Remember the word sugar.
This is what youre going to see. And both the type one and the type two okay s4 slow wound healing. Again thats because of that glucose being sticky harden in those vessels.
So you have decreased perfusion to help heal those wounds. They you blurry blurry vision again thats because the damage to the eyes. With all that glucose glasco urea.
Thats where the kidneys cant cope with all that extra glucose so it leaked into the under in a for acetone breath. That is mainly seen in your type ones. And thats because of the burning that the ketones.
It gives off that fruity smell of the breath our four rashes on the skin and repeated yeast infections in women because yeast love glucose. If you have too much glucose yeast is going to build up and they have repeated vaginal infections of geese. Okay.
So that is about diabetes mellitus. Now dont forget to take that free quiz. I you should get the card or its down in the description below and be sure to check out that other video.
Where im going over the nursing interventions where im coming covering the pharma. Logical aspects of treatment of diabetes and thank you so much for watching and please consider subscribing to this youtube channel. .
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