Diabetes Care Paper 1: Diabetes Care Analysis Abstract: Diabetes is a common endocrine and metabolic, chronic lifelong disease, which is caused by the absolute or relative deficiency of insulin secretion, and the sensitivity of target cells to insulin is reduced, resulting in abnormal metabolism of sugar, protein and fat. Clinically, 95% of diabetes belongs to type II diabetes, and the incidence rate is increasing year by year and younger. Our hospital has treated dozens of patients with diabetes since July 2009. The nursing experience is summarized as follows.
Keywords: diabetes care
Diabetes mellitus is a common endocrine metabolic and chronic lifelong disease, which is caused by the absolute or relative deficiency of insulin secretion and the decrease of the sensitivity of target cells to insulin, resulting in abnormal metabolism of sugar, protein and fat. Clinically, 95% of diabetes belongs to type II diabetes, and the incidence rate is increasing year by year and younger. Since July 2009, our hospital has treated dozens of diabetic patients. Nursing experience is summarized as follows:
1 do a good job in psychological care
Diabetes is a lifelong disease with a long course and many complications. Patients have a heavy ideological burden and are prone to negative emotions such as irritability, pessimism and disappointment. Studies have shown that excessive depression, anxiety and stress lead to excessive secretion of catecholamine, adrenocortical hormone, especially glucocorticoid in the body, which can affect the utilization of glucose by tissues and cause blood sugar to rise. In a negative emotional state, cortisol secretion in the body increases. After the concentration of the latter increases, it can hinder the utilization of blood sugar by antagonizing insulin, which leads to the increase of blood sugar. Therefore, medical staff should be considerate of patients and do a good job in ideological interpretation. Tell the patients the knowledge about diabetes, with a kind attitude and kind language, not only listen to the patients' complaints, but also gain their trust, encourage them, try their best to help them overcome their difficulties, so that they can establish their determination to fight the disease for a long time, so that patients can maintain a good mood and actively cooperate with treatment and nursing.
2 dietotherapy nursing
Dietotherapy is one of the basic methods to treat diabetes, and it is also an important basic treatment measure throughout the whole treatment process, which should be strictly and persistently adhered to. (1) Make a diet plan and eat reasonably: three meals should be quantified regularly. Usually, the daily calories are distributed to three meals in the morning, noon and evening according to 1/5, 2/5, 2/5 or 1/3, 1/3. If you eat less, you will eat more. ② Balanced diet and reasonable distribution: The daily diet should ensure normal physiological needs. Eat the following basic foods every day: cereals, meat and eggs, vegetables and fruits, dairy products and oils. Daily calorie distribution should meet the following standards: carbohydrate accounts for 50%-60%, protein.
3 Exercise therapy nursing
Reasonable exercise can enhance the utilization of glucose in muscle tissue, improve insulin sensitivity, lower blood sugar, eliminate excess fat in the body, control weight, improve blood lipid metabolism, enhance myocardial contractility, promote blood circulation, increase vital capacity, improve lung ventilation function, and reduce and delay the occurrence and development of diabetic complications. Exercise time1-65438+0.5 hour after meals is the best time to lower blood sugar. Pay attention to the principle of individualization in exercise methods. Elderly patients with diabetes should choose low-intensity and short-term exercise, such as walking, brisk walking, Tai Ji Chuan and Qigong. Young and middle-aged diabetics can choose moderate-intensity exercise that should not last too long, such as jogging, brisk walking and aerobics. Patients with severe diabetes must stay in bed and gradually increase their activity when their condition improves. Before exercising, patients must make effective exercise plans under the guidance of doctors.
4 drug treatment and nursing
① Oral hypoglycemic agents should strictly control the action, side effects, common dosage and the purpose of medication. For example, sulfonylurea drugs mainly promote insulin secretion, so they need to be taken 30 minutes before meals. ② Attention should be paid to the adverse reactions of drugs when taking drugs, so as to determine the time of taking drugs. If biguanides have gastrointestinal reactions, we can guide patients to take drugs during or after meals, which can reduce the adverse reactions. Glucosidase inhibitor: The main adverse reactions are abdominal distension, abdominal pain, diarrhea or constipation, which should be chewed with the first meal. ③ The medication time and interval should be fixed to reduce the occurrence of hypoglycemia. ④ Regularly monitor and record blood sugar: usually, fasting, before meals, 2 hours after meals, before going to bed and in the early hours of the morning are selected for blood sugar monitoring. ⑤ During taking medicine, in order to control blood sugar, we should continue to follow the diet plan.
5 basic nursing
Keep the bed clean and dry. Keep the mouth and skin clean, especially the vulva. Female patients should take good care of urethral orifice and vaginal orifice to prevent urinary tract infection. Bedridden elderly people bathe in warm water every night, observe the bony process and massage, and turn over every 2 hours/kloc-0 times to prevent the formation of pressure ulcers. Special emphasis is placed on foot care, and patients are advised to wash their feet every day. It is generally required to soak your feet with warm water of about 40 degrees Celsius, and the time should not be too long. Choose appropriate shoes and socks to avoid ulcers, infections and even gangrene caused by minor injuries. Feet are easy to dry in autumn and winter, so you can apply moisturizing cream evenly on the surface of your feet and sprinkle some talcum powder on your sweaty feet. Don't leave long nails, and cutting toenails can't hurt your skin, so as not to hurt your feet and cause irreparable consequences.
6 Nursing care of complications
Acute complications: ① ketoacidosis: strictly follow the doctor's advice, quickly establish venous access to ensure the input of liquid and insulin, so as to correct the imbalance of water, electrolyte and acid-base balance and control blood sugar. ② Hypoglycemia: People who are conscious can take sugar water, candy, biscuits, bread, steamed bread and other foods orally to relieve it. Coma patients can be injected with 30 ~ 40ml of 50% glucose intravenously. Coma people can't take food orally to avoid suffocation.
Chronic complications: ① diabetic eye disease: If the patient's vision is blurred, he should reduce his activities on weekdays to keep his stool unobstructed and avoid retinal detachment caused by forced defecation; When the patient's vision drops, attention should be paid to strengthening the rescue and safety care in daily life to prevent accidents; ② Diabetic nephropathy: actively and effectively control hypertension and limit protein intake. In addition to diet control, oral lipid-lowering drugs and anticoagulants can be taken to improve glomerular circulation.
7 discharge guidance
Because diabetes is a chronic lifelong disease, treatment is a long-term process. Give guidance to discharged patients and their families on insulin injection skills, the use of blood glucose meters, aseptic technique operation, and matters needing attention in oral hypoglycemic drugs. In particular, regular examination is helpful to monitor the development of the disease, actively prevent complications and improve the quality of life.
8 abstract
Through the nursing analysis of all clinical cases, the author thinks that diet nursing and drug nursing play a key role in diabetic patients, but other nursing items can not be ignored, and their roles are becoming more and more important. As there are more and more diabetic patients, how to carry out scientific and effective nursing is a subject worthy of in-depth discussion in nursing specialty.
refer to
[1] Yu Cuifeng. Nursing care of diabetic patients. China applied medicine, 20 10 may.
[2] You Liming, Wu Ying. Medical nursing. Fourth edition
Diabetes Care Paper Model 2: Diabetes Care Abstract: With the improvement of people's living standards, the prevalence of diabetes is increasing. At present, the number of diabetic patients in China is 3-4 times that of 10 years ago. Diabetes is a chronic lifelong disease, and patients need to be treated in complicated social life and family life. Therefore, it is very important to do a good job in nursing patients with diabetes.
Keywords: etiology, clinical manifestations, laboratory examination, diabetes care
Summary of clinical practice:
1 Etiology of diabetes
1. 1 genetic factor. 1 type or type 2 diabetes mellitus has obvious genetic heterogeneity. Diabetes has a tendency of family onset. 1/4 ~ 1/2 patients have a family history of diabetes. At least 60 genetic syndromes can be associated with diabetes.
1.2 environmental factors. Obesity caused by overeating and decreased physical activity are the most important environmental factors of type 2 diabetes, which makes individuals with genetic susceptibility to type 2 diabetes prone to illness. 1 The immune system of diabetic patients is abnormal. After being infected by some viruses such as Coxsackie virus, rubella virus and parotid virus, it leads to autoimmune reaction and destroys insulin. Cells.
2 Clinical manifestations of diabetes mellitus
2. 1 Drink more, urinate more, eat more and lose weight.
2.2 Fatigue, weakness and obesity.
3 check
3. 1 Blood sugar is the only criterion for diagnosing diabetes. Is it obvious? Three more and one less? Symptoms can be diagnosed as long as the blood sugar level is abnormal. Asymptomatic people need two abnormal blood sugar levels to diagnose diabetes. Suspicious people need to do a 75g glucose tolerance test.
3.2 urine sugar. Often positive. When the blood glucose concentration exceeds the renal glucose threshold (160 ~ 180 mg/dl), urine glucose is positive. When the renal glucose threshold rises, the diagnosis can be negative even if the blood glucose reaches the level of diabetes. Therefore, urine glucose determination is not used as a diagnostic standard.
3.3 urine ketone body. When ketosis or ketoacidosis occurs, urine ketone body is positive.
3.4 glycosylated hemoglobin (HbA 1c). It is the product of non-enzymatic reaction between glucose and hemoglobin, and the reaction is irreversible. HbA 1c level is stable, which can reflect the average blood sugar level two months before blood collection. It is the most valuable index to judge the state of blood sugar control.
3.5 glycosylated serum protein. It is the product of non-enzymatic reaction between blood glucose and serum albumin, and reflects the average blood glucose level 1 ~ 3 weeks before blood collection.
3.6 Serum insulin and C-peptide levels. Reflect the island? The reserve function of cells. In the early stage of type 2 diabetes or obesity, serum insulin is normal or elevated. With the development of the disease, the function of islet gradually decreased and the ability of insulin secretion decreased.
3.7 blood lipids. Dyslipidemia is very common in diabetic patients, especially when blood sugar is poorly controlled. It is characterized by the increase of triglyceride, total cholesterol and low density lipoprotein cholesterol. The level of high density lipoprotein cholesterol decreased.
3.8 Immune indicators. Islet cell antibody, insulin autoantibody and glutamic acid decarboxylase antibody are three important indexes of humoral immune abnormality in 1 type diabetes mellitus, among which GAD antibody has high positive rate and long duration, which has important diagnostic value for 1 type diabetes mellitus. The positive rate of 1 diabetic first-degree relatives is also certain, which is significant for predicting 1 diabetes.
3.9 Urinary albumin excretion, radioimmunoassay or enzyme-linked method. Urinary albumin excretion can be sensitively detected, and urinary albumin is slightly increased in early diabetic nephropathy.
4 Nursing care of diabetes
4. 1 diet care. The nursing of diet therapy is the most basic nursing measure for diabetic patients. The purpose of effective diet control is to reduce islets. The burden of cells, correct metabolic disorders and eliminate symptoms. Diet should be based on the principle of controlling total calories, low in sugar, low in fat, moderate in protein, high in vitamins and high in cellulose. At the same time, it should be quantified regularly.
4.2 Psychological nursing. It is necessary to educate diabetic patients to understand the basic knowledge of diabetes, establish confidence in overcoming the disease, how to control diabetes, and control the benefits of diabetes to health. According to the characteristics of each diabetic patient's condition, formulate appropriate treatment plans.
Cognitive therapy is the theoretical basis for us to educate patients. For some patients who have no clinical symptoms or mild clinical symptoms but are only found in physical examination, let them know about chronic hyperglycemia and chronic diabetes, and take supportive psychotherapy, such as explanation, comfort, encouragement, guarantee, etc., and give different explanations to patients to help them get out of confusion and adjust their psychological state. Help patients adapt to life problems. After hospitalization, the role and living environment of diabetic patients have changed. At the same time, they must also receive diabetes treatment, which means that patients need to change their living habits formed over the years. Diet therapy is the basic treatment for diabetes. Regardless of the patient's age and severity, and whether or not to use drugs, patients must strictly implement a long-term adherence to the diet plan.
4.3 Self-monitoring blood sugar. With the gradual popularization of small rapid blood glucose meters, patients can adjust the dosage of hypoglycemic agents at any time according to their blood glucose levels. 1 type diabetes mellitus's blood sugar is monitored at least 4 times a day (before meals), and 8 times when blood sugar is unstable (before meals, after meals, before going to bed at night and at 3 am). During intensive treatment, fasting blood glucose should be controlled below 7.2 mmol/L, 2 hours after meal blood glucose should be less than 10mmol/L, and HbA 1c should be less than 7%. The frequency of self-monitoring blood sugar in patients with type 2 diabetes can be reduced appropriately.
4.4 medication care. Oral hypoglycemic agents include sulfonylureas and biguanides. Educate patients to take medicine according to dosage on time, and don't increase or decrease it at will. Observe the changes of blood sugar, GHB, FA, urine sugar, urine volume and weight, and observe the curative effect, dosage and adverse reactions of the drug. When using insulin, we should closely observe and prevent the adverse reactions of insulin. The common hypoglycemia reaction is related to excessive insulin dosage, eating disorder or excessive exercise, which is more common in patients with type I diabetes. It is characterized by fatigue, dizziness, palpitation, hyperhidrosis and hunger, which can cause coma in severe cases. Those who respond to hypoglycemia should immediately lie down and rest to test their blood sugar in time, and eat sugary foods such as candy, biscuits and sugary drinks according to their condition to relieve symptoms. Coma should immediately draw blood to check blood sugar, and then inject 20 ~ 30 ml of 50% glucose intravenously. The key to prevent hypoglycemia is to adjust the effective dose and time of insulin according to the situation, eat regularly and quantitatively, and exercise moderately. If the meal time is postponed, you can eat some biscuits first. Note that the main manifestations of insulin allergic reaction are local itching and urticaria after injection, and systemic rash is rare.
4.5 Foot care of diabetes. Choose the right shoes and socks, wash and protect your feet correctly, insist on foot examination and go to the hospital for treatment in time.
In addition, patients and their families should be given guidance on diabetes, so that they can understand the importance of diet therapy, and teach patients how to test their blood sugar and urine sugar, so as to keep abreast of the development of the disease and achieve the purpose of control.
5 conclusion
Through the simple analysis of the causes of diabetes and practical life nursing, patients can actively receive diabetes education, improve their knowledge and skills about diabetes, actively participate in disease control, improve their quality of life, effectively promote blood sugar control, reduce complications and improve their quality of life.
Application of humanized nursing intervention in diabetes care Objective To explore the application effect of humanized nursing intervention in diabetes care. Methods Thirty-eight patients with diabetes who received humanized nursing intervention during the hospitalization period of 20 15 ~ 16 were selected as the intervention group, and 30 patients who received routine nursing measures in endocrinology department were selected as the routine group. The clinical treatment effect, blood sugar changes before and after nursing and nursing service satisfaction of the two groups were compared. Results The clinical efficacy of the intervention group was significantly higher than that of the routine group (P
Because diabetes takes a long time to treat, it is difficult to effectively control the disease and the treatment cost is high, so it is very important to take effective nursing services for patients [1]. 38 diabetic patients hospitalized from 20 15 to 1-20 16 to 1 were given humanized nursing intervention, and the nursing effect was compared with that of conventional nursing patients. The report is as follows.
1 data and methods
1. 1 general information
Thirty-eight patients with diabetes who received humanized nursing intervention during hospitalization from 2015 to 2016 were selected as the intervention group, and 30 patients who received routine nursing measures in endocrinology department were selected as the routine group. The average blood sugar level of all patients at onset was >: 7.8 mmol/L. There were 30 patients in the routine group, including male 19 and female 1 1. The youngest is 50 years old and the oldest is 85 years old, with an average age (66.2? 10.3) years old, the treatment method was 1 1 cases using hypoglycemic drugs alone, 19 cases using hypoglycemic drugs in combination. The average fasting blood glucose level was (7.6? 1.5)mmol/L； There were 38 patients in the intervention group, including 23 males and 65438 05 females. The youngest is 52 years old, the oldest is 865,438+0 years old, and the average age is 65.7? 9.9) years old, 16 cases were treated with hypoglycemic drugs alone, and 22 cases were treated with hypoglycemic drugs in combination. The average blood sugar level is (8.0? 1.8) mmol/L. There is no significant difference in the above indexes between the two groups, which is comparable.
1.2 method
The routine group was given routine care of endocrinology department, such as intravenous injection. The intervention group was given humanized nursing intervention on the basis of the routine group, and the specific contents included:
① Implementation of comprehensive nursing: Nurses implement comprehensive nursing according to patients' specific conditions to improve the quality of nursing service and reduce the incidence of nursing defects; After the patient is hospitalized, the nursing staff will evaluate the patient's hospitalization, establish a personal file for the diabetic patient and make preparations; During the period of hospitalization, medical staff should strengthen communication with patients, provide effective psychological care for patients, and do a good job in disease health education; According to the situation and related nursing procedures, the patients were given targeted care.
(2) Humanistic care: nurses effectively penetrate humanistic care in the nursing process, such as effectively protecting patients' privacy, caring for patients' mental and physical pain, and providing targeted psychological counseling to patients on different occasions; Before taking treatment for the patient, keep the patient's hands warm, ensure that the intravenous infusion position is full, and explain the related methods and precautions of vascular protection to the patient [2].
③ Individualized nursing: Nurses carry out effective nursing according to patients' individualization, such as introducing the types, specifications, usage, drugs, clinical efficacy and adverse reactions of hypoglycemic agents to patients in detail, and telling patients to pay special attention to dosage, injection site and injection time when using insulin.
(4) Dietary care: the diet should be balanced between dosage and diet, and dietary care plays a key role in controlling blood sugar in diabetic patients; Nurses should make a reasonable and healthy diet plan for patients according to their specific conditions and eating habits, and at the same time guide patients to eat a reasonable diet, eat more foods rich in fiber, vitamins and high protein, low blood sugar, low fat and low calorie, eat less spicy and irritating foods, and prohibit drinking sugary drinks, smoking and drinking.
⑤ Exercise instruction: Reasonable exercise can improve the sensitivity of insulin receptor, which is of great significance to reduce the dosage of hypoglycemic drugs and the weight of patients. Nurses can instruct patients to exercise properly, such as yoga, Tai Ji Chuan, walking and so on. The daily exercise time and amount should be moderate to avoid strenuous exercise, and the exercise time should be 1 h after meals as far as possible, which is not suitable for patients with retinopathy, infection and serious cardiovascular and cerebrovascular diseases.
⑥ Health education: Medical staff should closely observe hypoglycemia during the treatment of diabetes, and inform them that their clinical symptoms are drowsiness, palpitation, pallor, sweating, disturbance of consciousness, etc. If hypoglycemia occurs, biscuits and fruit candy can be used appropriately; Anyone with conscious disturbance or drowsiness as clinical symptoms should immediately check the blood sugar level and inform the doctor to deal with it immediately to prevent hypoglycemia [3].
1.3 observation index
Observe and compare the clinical treatment effect, blood sugar level before and after nursing and patients' satisfaction with nursing service between the two groups. According to the fasting blood glucose and 2 h postprandial blood glucose level of patients, the clinical treatment effect was evaluated, and the evaluation criteria included obvious effect, effectiveness and ineffectiveness; The significant effect means that the fasting blood glucose of patients is lower than 7.2 mmol/L or the degree of blood glucose level decline is >: 30%, the postprandial blood glucose level is lower than 8.3 mmol/L or the blood glucose level drops10% ~ 30%; Effective means that the fasting blood glucose of patients is in the range of 7.2 ~ 8.3 mmol/L or the degree of blood glucose decrease is >: 30%, and the postprandial blood glucose level is in the range of 8.3 ~ 10 mmol/L or the blood glucose level decreases10% ~ 30%. Ineffective means that the patient's blood sugar level has not improved significantly. Self-made satisfaction questionnaire was used to investigate the satisfaction of nursing service. Total score 100, with a score above 90 being satisfactory, 80-90 being relatively satisfactory, and below 80 being unsatisfactory.
1.4 statistical method
SPSS 18.0 statistical software was used for data processing, and (X? S) means, line t test, p
Two results
2. 1 Comparison of clinical efficacy between the routine group and the intervention group.
The total effective rate of clinical treatment in the intervention group was 94.7% (65,438+06 cases, 20 cases effective and 2 cases ineffective), while that in the routine group was 76.7% (9 cases effective, 65,438+04 cases effective and 7 cases ineffective). The difference between the two groups was statistically significant (? 2=4.7670，P=0.0290)
2.2 Comparison of blood sugar changes between the routine group and the intervention group before and after nursing.
There was no significant difference in blood sugar between the two groups before nursing. After nursing, the levels of fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin in the intervention group were significantly better than those in the routine group (P
2.3 Comparison of patients' satisfaction with nursing service between routine group and intervention group
The patients' satisfaction with nursing service in the intervention group was 100% (20 cases were satisfied, 8 cases were satisfied, and 0 cases were dissatisfied), while that in the routine group was 90.0% (satisfied 15 cases, satisfied 12 cases, and dissatisfied 3 cases). The difference between the two groups was statistically significant (? 2=3.9754，P=0.0462)。
3 discussion
Diabetes is a disease caused by many factors, mainly refers to the relative or absolute deficiency of patients' own insulin function, which leads to the increase of blood sugar. What are the common clinical symptoms of the disease? Three more and one less? That is, eat more, drink more and urinate more to lose weight [4]. Diabetes is a long-term chronic disease. There is a lack of good treatment at present. Patients often need to take hypoglycemic drugs for life, and the cost of clinical treatment is high, which has a great impact on patients' psychology and physiology, so it is very important to take effective nursing intervention for diabetic patients [5].
The results showed that the clinical treatment effect, blood sugar level after nursing and patients' satisfaction with nursing service of humanized nursing service were significantly better than those of conventional nursing group (P