Writing Assignment #4 Define Disorder Type 2 Diabetes Mellitus: A progressive disorder in which the person has a combination of insulin resistance and decreased secretion of insulin by pancreatic beta cells. (Ignatavicius,Workman 2013 pg 1417) Risk Factors (related to the older adult) Age related changes that affect the incidence of diabetes mellitus in the older adult include but are not limited to changes in: adiposity, sarcopenia and physically activity. The older adult client is at risk for decreased glucose tolerance, increased insulin resistance in the peripheral tissues and impaired pancreatic function. Persons with pre-existing complications with controlling blood pressure or those with a history of cardiac problems are also at an increased risk for developing type 2DM. Cognitive decline can also prove to be a risk factor due to the older adults inability to maintain a suitable diet. Nursing Management Assessment o Signs and Symptoms: the older adult may have and/or complain of atypical signs and symptoms Excessive thirst, hunger and urination The older adult may complain of fatigue, changes in vision, changes in weight gain (may experience gain or loss) and complications of infection. Some patients may also experience frequent urinary tract infections, impotence, numbess in the extremities or vaginitis. Diagnosis o The ADA recommends that adults age 45 years and older be screened every 1-3 years using the FPG (fasting plasma glucose), A1C or an oral glucose tolerance test. o Nursing Diagnosis Possible nursing diagnoses for the older adult include but are not limited to: Risk for impaired skin integrity related to impaired circulation Knowledge deficit: diabetes management and skills related to lack of exposure Altered tissue perfusion related to decreased or interrupted arterial flow Altered nutrition :more that body requirements related to overeating habits or lack of regular exercise Planning, Expected Outcomes and Goals of therapy o Goals and planning of care should be focused on maintaining consistent desired glucose levels, management of self-care, and prevention of associated symptoms and complications. o Possible patient outcomes may include but are not limited to: The patient will follow the plan of care based on recommendations of their healthcare providers The client will show evidence of successful coping Client will show knowledge of the recommended diet for persons with type 2 Diabetes The patient will maintain adequate circulation The client will maintain a proper foot care regimen Interventions and Implementation of Nursing Care o Interventions for Diabetes management in the older adult should be specific to the patient and may include but are not limited to: Glucose control and monitoring Blood Pressure control Management of Cognitive and Physical functioning Management of co-existing conditions and co-morbidities Preventing falls and fractures Lowering the incidence of polypharmacy Monitoring vision and hearing complications Management of diet and exercise Assessment for and/or management of depression o Medication Metformin- often considered the first line of drug therapy. It has a low risk for increased hypoglycemia however it may cause gastrointestinal discomfort and weight loss which may cause further complications in the older client. Due to a high risk of hypoglycemia, Glyburide should not be used in the older client. Insulin therapy may also be used to control glucose levels in the older client. Insulin therapy should be monitored carefully in the older adult because of age related changes in the metabolic system of older adults as well as due to possible decline in fine motor skills and physical frailty in relation to self-administration of insulin. o Surgical Treatment Whole pancreas transplantation-successful transplantation can eliminate the need for insulin injections, glucose monitoring and numerous dietary restrictions. Islet Cell transplantation-*considered an experimental procedure* this procedure eliminates the need for insulin therapy and protects against complications of diabetes. Surgical treatment in the older adult should be used with caution, due to decreased healing time of diabetic patients and older adults; there is an increased risk for post-surgical complications such as delayed healing and increased chance of infection. o Non-Pharmacologic Management Maintaining a balanced diet is essential however due to possible lack of financial resources and unwillingness of the older adult to make lifestyle changes, it may be difficult to implement this change. The nurse should keep in mind that the older patient is at an increased risk for malnutrition and dehydration as well as lack of knowledge of adequate meal planning and preparation. Exercise or increasing physical activity has beneficial effects on carbohydrate metabolism and insulin activity in the body. Appropriate exercise activity can aide in the control of blood glucose levels by reducing body weight, insulin resistance and glucose intolerance. Evaluation including Patient/Family teaching o Patient and family education should be focused on areas that include but are not limited to: Diet and exercise management specific to the patients cognitive function and physical capabilities Teaching on self-administration of medications and insulin if applicable Establishing and maintaining a proper foot-care regimen The nurse should assess and document the older adults self-care management skills as well as the familys ability to assist the patient in their care. The older adult client should receive positive reinforcement when self-care management goals are met and regular evaluations and adjustments in goals should be made as needed.