Pathophysiology Of Clinical Manifestations-Myassignmenthelp.Com

Question: Discuss About The Pathophysiology Of Clinical Manifestations? Answer: Introducation In patients with diabetes type 1, the ability of the pancreas to synthesize insulin is lost. This happens when the immune system attacks and kills the -cells of the islets of Langerhans by mistakenly attacking these insulin producing cells of the pancreas. Genetic susceptibility plays a role in type 1 diabetes, but the fact that that not all susceptible people progress to the disease indicates that some environmental factors are involved. These environmental factors could include viral and bacterial infections and provide an exogenous antigen that triggers the autoimmune attack of immune cells on the beta-cells(Knip Simell, 2012). Researchers have found evidence that A1beta-casein from cow's milk causes the primary trigger in some cases of type 1 diabetes (Chia, et al., 2017). In the absence of insulin, the ability of the body to utilize the blood glucose for production of energy in the cells is lost. As a result the blood glucose begins to rise and hyperglycemia occurs. Hyperglycem ia is said to have occurred when the blood glucose levels reach 180 mg/dl or more. It is possible for patients of type 1 diabetes to control hyperglycemia by taking insulin injections in the required dosage (diabetes.co.uk, polyuria.html). Glucose in the urine was checked to diagnose diabetes before blood glucose tests became common. The presence of glucose in urine is termed glucosuria. The glucose in urine shows up when blood glucose levels are high. This happens because the renal tubules are unable to reabsorb the glucose due to its high levels. Glucosuria may be accompanied by symptoms, such as infections, prolonged time for wound healing, issues with vision, excessive thirst, increased frequency of urination, unexplained weight loss, and tingling sensation in hands and feet. Usually glucose appears in the urine when diabetes is poorly managed. Increased urination occurs in patients of type 1 diabetes if the diabetes is undiagnosed or if the blood sugar levels have risen high. It is one of the main symptoms of diabetes. Typically, passage of more than three liters of urine in a day is termed polyuria. Too much water lost in this way could cause dehydration and if polyuria remains prolonged, it can affect kidney function. Due to high blood sugar, the kidneys are not able to reabsorb all the sugar. The presence of sugar in the urine draws out more water and so polyuria occurs (diabetes.co.uk). Increased thirst is a consequence of loss of excess water through increased urine output, it is another important symptom of high blood sugar that occurs due to high blood sugar or hyperglycemia and is termed polydipsia. Since diabetes type 1 occurs in children, the most common symptoms that help in diagnosis are polyuria, polydipsia and weightloss. Increased appetite or polyphagia occurs in type 1 diabetes patients due to low energy. The inability of glucose to enter cells due to lack of insulin results in a demand for energy and the body responds with a signal of increased appetite. This leads to hunger and increased intake of food and a higher blood sugar level. The insulin injections lower the blood glucose levels due to transport of glucose into cells for energy production and the symptom of polyphagia does not appear in patients after levels of blood glucose are controlled. Ketones in the blood and urine may occur in patients suffering from type 1 diabetes because of elevated blood glucose levels for a prolonged period. Ketones are the alternative fuel that the body uses when glucose cannot be used as a source of energy. The lack of insulin prevents cells from utilizing blood glucose as a source of energy. The body responds by breaking down fats and muscle for generation of energy. This occurs during periods of fasting when insulin levels are low but glucagon and epinephrine are there in normal levels. This causes release of fats from fat cells which reach the liver through the circulating blood. In the liver the fats are metabolized which results in the formation of ketones. The ketones, through the blood stream travel to different tissues and cells and can be used as an alternative source of energy (Ucsf). Unexplained weight loss often occurs in individuals who are diagnosed with type 1 diabetes which is often unintentional and the patient has not been on an exercise or diet regime to lose weight. The high blood glucose is a consequence of the inability of the body to utilize the glucose as a source of energy because it cannot be transported to the cells in the absence of insulin. In order to meet the energy demands of the body, the body responds by oxidising the fats and muscles of the body. Muscle loss is usually accompanied by weight loss and is observed more often in patients with type 1 diabetes. Some patients of type 2 diabetes may also experience unexplained weight loss (diabetes.co.uk, /symptoms/unexplained-weight-loss.html). Nursing considerations related to the administration of NovoRapid Before administration It is important to check several times whether the correct type of insulin is being administered. A correct dosage should be prepared and it is better to ask a colleague to double check for the type of insulin being administered. The correct syringe calibrated with units should be used. The site of previous injections should be checked and a different site should be prepared for subcutaneous administration of the insulin. Repeated injections on the same site can cause necrosis (brooksidepress.org). The prefilled insulin should be rolled between the hands in order to mix the contents so that a uniform mixture is visible. It is important to ensure that each patient is given the right dose of insulin. The nurse should remain watchful and observe the patient carefully for any sign of hypoglycemia or hyperglycemia. Since fast acting insulin begins to act and lowers blood glucose level soon after the subcutaneous injection is given it is important to check blood glucose before the administ ration and the patient should be given a reminder about having a meal soon after (nhslanarkshire) Just before the injection the nurse should check whether the patient has not been administered the dose by another nurse. During administration the nurse should ensure that the site of subcutaneous injection is cleaned thoroughly, however an alcohol swab may not be used because the astringent action of the alcohol can make the subcutaneous injection painful. Nurse's hands should be washed with soap and water and gloves should be worn. Complete dosage of the insulin should be injected subcutaneously by raising the skin and rotating the needle. The injection should be held at the site up to a count of ten to ensure that the insulin disperses from the site of the injection. After administration of insulin the sharps should be discarded in the sharp box. The time, dosage and date of the administration should be recorded on the chart right after the administration and the entry should be initialled. In the instance that the site of injection bleeds or there is a visible spot of insulin or if the patient complains of pain, it should be reported to a senior colleague. It should be ensured that the insulin is stored at the recommended temperature in the refrigerator between 20C to 80C. Patient's blood glucose level should be checked every hour until two consecutive readings are within the normal range, two hour testing should be done until two consecutive readings are in the normal range and then a four hourly schedule should be maintained. Parents of a child who has been recently diagnosed with type 1 diabetes may experience a significant amount of stress. It is a life-threatening disorder and the constant challenge of having to deal with episodes of hypoglycemia or hyperglycemia can be emotionally exhausting for the parents. In Briana's case, she is a young child and dealing with giving the child insulin injections everyday could prove to be a daunting task. The parents may perceive it as harming the child with her getting upset at the prospect of feeling the pain. Parents of children have been assessed to be suffering from post traumatic stress disorder (Landolt, et al., 2002). Until the family gets used to the routine of frequent blood glucose checks, watching out for symptoms of hypoglycemia, making a schedule for food intake and sticking to it are difficult additions to an already busy life. That the disease, though manageable, will trouble Briana throughout her life is an added cause of worry. The child may prote st and may have behvioural issues the because the constant restrictions on diet can make the child irritable. In case of Briana's parents, they have the responsibility of her two year old sibling. The parents work full time and juggling the responsibilities of work, home and the kids can be physically exhausting. Managing the child's needs of medication, care, diet and physical exercise within their routines can prove to be physically exhausting. So many pressures can make them struggle with time and their own energy levels. Keeping up with emotional, physical and financial demands causes considerable distress to the parents. Ensuring that Briana's father is able to understand the illness of his daughter and the complex requirements of care-giving is important for achieving good health outcomes. As a nurse it is important to play a proactive role in helping her intellectually disabled father to understand the illness. With the help of educational tools, it is possible to make the father understand the requirements of monitoring the child's blood glucose levels, giving her insulin injections, training in how to recognize hypo- or hyper-glycemia, the importance of adherence to diet and exercise and the risk of long-term complications. Since the father was overwhelmed at the time of diagnosis, it is important to keep him calm and understand how he can help the child's mother in giving care to the child. It is possible to engage social workers who deal in training intellectually disabled parents(Getz, 2011). In Briana's case her father is concerned and most likely to understand the care needs in dealing with his child's illness. References brooksidepress.org. (n.d.). /1-72-nursing-implications-for-administration-of-insulin/. Retrieved from https://brooksidepress.org/: https://brooksidepress.org/giu/lessons/lesson-1-nursing-care-related-to-the-gastrointestinal-system/section-viii-diabetes/1-72-nursing-implications-for-administration-of-insulin/ Chia, J. S., McRae, J. L., Kukuljan, S., Woodford, K., Elliott, R. B., Swinburn, B., Dwyer, K. M. (2017). A1 beta-casein milk protein and other environmental pre-disposing factors for type 1 diabetes. Nutrition Diabetes, 7(5), e274. diabetes.co.uk. (n.d.). /polyuria.html. Retrieved from https://www.diabetes.co.uk: https://www.diabetes.co.uk/symptoms/polyuria.html diabetes.co.uk. (n.d.). /symptoms/unexplained-weight-loss.html. Retrieved from https://www.diabetes.co.uk: https://www.diabetes.co.uk/symptoms/unexplained-weight-loss.html diabetes.co.uk. (n.d.). polyuria.html. Retrieved from https://www.diabetes.co.uk: https://www.diabetes.co.uk/symptoms/polyuria.html diaTribe. (n.d.). type-1-diabetes. Retrieved from https://diatribe.org: https://diatribe.org/type-1-diabetes Getz, L. (2011, December). 111511p14.shtml. Retrieved from https://www.socialworktoday.com: https://www.socialworktoday.com/archive/111511p14.shtml Knip, M., Simell, O. (2012). Environmental Triggers of Type 1 Diabetes. Cold Spring Harbor Perspectives in Medicine , 2(7), a007690. https://doi.org/10.1101/cshperspect.a007690. Landolt, M., Ribi, K., Laimbacher, J., Vollrath, M., Gnehm, H., Sennhauser, F. (2002). Brief Report: Posttraumatic Stress Disorder in Parents of Children With Newly Diagnosed Type 1 Diabetes . Journal of Pediatric Psychology, 27(7):647-652. nhslanarkshire. (n.d.). Guideline%20for%20the%20Administration%20of%20Insulin%20by%20Nursing%20Staff%20final%20May14.pdf. Retrieved from https://www.nhslanarkshire.org.uk: https://www.nhslanarkshire.org.uk/Services/Diabetes/Diabetes%20Clinical%20Guidelines/Documents/fGuideline%20for%20the%20Administration%20of%20Insulin%20by%20Nursing%20Staff%20final%20May14.pdf Ucsf. (n.d.). /ketones/. Retrieved from https://dtc.ucsf.edu: https://dtc.ucsf.edu/types-of-diabetes/type1/understanding-type-1-diabetes/how-the-body-processes-sugar/ketones/ webmd.com. (n.d.). /diabetic-ketoacidosis-dka-topic-overview#1. Retrieved from https://www.webmd.com: https://www.webmd.com/diabetes/tc/diabetic-ketoacidosis-dka-topic-overview#1