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(BQ) Part 1 book “Care of people with diabetes” has contens: Diagnosing and classifying diabetes, holistic assessment, nursing diagnosis, and documentation, monitoring diabetes mellitus, medicines management, … and other contents.
Fourth Edition “This comprehensive work represents a kaleidoscope of excellence, and all professionals involved in the provision and delivery of diabetes care will find it invaluable in their practice.” – From the Foreword, by Anne-Marie Felton, President and co-founder of Foundation of European Nurses in Diabetes (FEND), Vice President Diabetes UK Care of People with Diabetes is an essential guide to the care and management of people with diabetes mellitus, with particular emphasis on the acute care setting Written by an experienced clinical nurse specialist with extensive knowledge of evidence-based diabetes care, this fully updated fourth edition serves as an essential companion to clinical practice for nurses and health care professionals People with diabetes experience a high symptom and self-care burden associated with managing their condition, and require appropriate support, advice and regular monitoring Similarly, health professionals need to maintain and keep up-to-date with an ever-increasing body of knowledge in order to help people with diabetes incorporate new research into their self-care Care of People with Diabetes provides an extensive overview of the knowledge base all health professionals require to work effectively with people with diabetes • Comprehensive clinical manual on an ever-more prevalent condition, written to meet the needs of nurses and health care professionals • Provides key evidence for best practice • Includes protocols for consistent care and improving patient outcomes A Ma n ua l o f Nu r s in g P c ti ce Trisha Dunning Dunning • Includes new material on evaluating education programmes, cystic fibrosis-related diabetes, diabetes and sleep apnoea, and end-of-life care Care of People with Diabetes Fourth Edition Special features: Care of People with Diabetes A M anual o f N u r s i n g P r ac t i ce A Manual of Nursing Practice Care of People with Diabetes About the author Professor Trisha Dunning is Inaugural Chair in Nursing at Deakin University and Barwon Health, Australia She is an Honorary Life Member of the Australian Diabetes Educators Association, a Vice President of the International Diabetes Federation and a Distinguished Life Fellow of the Australian College of Nursing ISBN 978-0-470-65919-9 www.wileynursing.com 780470 659199 Fourth Edition Care of People with Diabetes This book is dedicated to all people with diabetes who taught me so much of what I know about life with diabetes, people with diabetes who need health care and to all the health professionals who care for them Care of People with Diabetes A Manual of Nursing Practice Fourth Edition Professor Trisha Dunning AM RN, MEd, PhD, CDE, FACN (DLF) Inaugural Chair in Nursing and Director Centre for Nursing and Allied Health Research, Deakin University and Barwon Health Geelong, Victoria, Australia This edition first published 2014, © 2014 by John Wiley & Sons, Ltd Third edition first published 2009 © Trisha Dunning Second edition first published 2003 © Blackwell Publishing Ltd First edition first published 1994 © Blackwell Publishing Ltd Registered Office John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Offices 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030–5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book It is sold on the understanding that the publisher is not engaged in rendering professional services If professional advice or other expert assistance is required, the services of a competent professional should be sought The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom Library of Congress Cataloging-in-Publication Data Dunning, Trisha Care of people with diabetes : a manual of nursing practice / Trisha Dunning – 4th ed p ; cm Includes bibliographical references and index ISBN 978-0-470-65919-9 (pbk.) I. Title [DNLM: 1. Diabetes Mellitus–nursing–Handbooks WY 49] RC660 616.4′620231–dc23 2013014725 A catalogue record for this book is available from the British Library Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books Cover image: iStock © Chris Fertnig Cover design by Grounded Design Set in 9.5/11.5pt Sabon by SPi Publisher Services, Pondicherry, India 1 2014 Contents Foreword Preface Acknowledgements List of Abbreviations and Symbols xv xvi xviii xix 1 Diagnosing and Classifying Diabetes Key points What is diabetes mellitus? Prevalence of diabetes Classification of diabetes Overview of normal glucose homeostasis The metabolic syndrome in children and adolescents Type and Type diabetes Type diabetes in Indigenous children and adolescents 15 Gestational diabetes 15 Example Information Sheet: Preparation for an oral glucose tolerance test 20 Screening for diabetes 21 Preventing Type diabetes 22 Preventing Type diabetes 25 Managing diabetes mellitus 25 Key points 25 Aims of management 27 Exercise/activity29 Diabetes education 32 Complications of diabetes 33 Aim and objectives of nursing care of people with diabetes 34 Technology and diabetes management 36 A sobering final comment 38 References38 2 Holistic Assessment, Nursing Diagnosis, and Documentation 44 Key points 44 Rationale44 Holistic nursing 45 Care models 45 Characteristics of an holistic nursing history 47 Nursing history 49 Example Health Assessment Chart 50 Instruments to measure health status 54 Documenting and charting patient care 54 Care plans 55 vi Contents Nursing responsibilities 56 Documentation by people with diabetes 57 References58 3 Monitoring Diabetes Mellitus 60 Key points 60 Rationale60 Introduction61 Monitoring 1: Blood glucose 61 Key points 61 Blood glucose testing checklist 71 Monitoring 2: Urine glucose 73 Key points 73 Monitoring 3: Additional assessment 76 Self-care80 The annual review 81 References81 4 Nutrition, Obesity and Exercise 84 Key points 84 Rationale84 The importance of good nutrition 85 Obesity85 Overview of the pathogenesis of obesity 86 The significance of abdominal obesity 87 Nutrition, obesity and stress 88 Methods of measuring weight 88 Managing obesity and diabetes 90 Malnutrition and under-nutrition 90 Method of screening for dietary characteristics and problems 93 Principles of dietary management for people with diabetes 94 Goals of Dietary Management 97 Dietary management: obesity 98 Bariatric surgery 99 Complementary weight loss programmes 101 Factors associated with making dietary changes 101 Nursing responsibilities 102 References107 5 Medicines Management 111 Key points 111 Introduction112 Quality Use of Medicines (QUM) 112 Quality Use of Medicines and Diabetes 113 Oral Glucose-Lowering Medicines (GLM) 114 The incretin hormones 124 New medicines for type diabetes 125 Medicine interactions 126 When should insulin be initiated in Type diabetes? 128 Barriers to insulin therapy 132 Some strategies to overcome the barriers 132 Insulin therapy 133 Contents vii Types of insulin available 134 Injection sites and administration 137 Mixing short- and intermediate-acting insulins 138 Commonly used insulin regimens 139 Interpreting morning hyperglycaemia 140 Continuous subcutaneous insulin infusion (CSII) 141 Continuous blood glucose sensors 142 Subcutaneous insulin sliding scales and top-up regimes 143 Uses of insulin infusions 145 Insulin allergy 147 Transplants148 Stabilising diabetes 148 Stabilising diabetes in hospital 149 Community and outpatient stabilisation 150 Lipid-lowering agents 152 Monitoring lipid medicines 157 Antihypertensive agents 157 Antiplatelet agents 160 Medication safety, adherence and medication self-management 161 Enhancing medication self-care 163 Example protocol for outpatient stabilisation onto insulin 166 References167 6 Hypoglycaemia 174 Key points 174 Rationale174 Introduction175 The counter-regulatory response 176 Definition of hypoglycaemia 178 Recognising hypoglycaemia 180 Counter-regulatory hormonal response to hypoglycaemia 181 Causes of hypoglycaemia 181 Preventing and managing hypoglycaemia 182 Hypoglycaemic unawareness 183 Prevalence of hypoglycaemic unawareness 183 Nocturnal hypoglycaemia 184 Relative hypoglycaemia 187 Medicine interactions 187 Objectives of care 188 Treatment188 Prolonged hypoglycaemia 189 Patients most at risk of hypoglycaemia 190 Psychological effects of hypoglycaemia 191 Consequences of hypoglycaemia 192 Guidelines for administering glucagon 193 Adverse reactions 194 References194 7 Hyperglycaemia, Acute Illness, Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycaemic States (HHS), and Lactic Acidosis 198 Key points 198 Rationale199 viii Contents Prevention: proactively managing intercurrent illness 199 Self-care during illness 201 Hyperglycaemia201 Diabetic ketoacidosis (DKA) 203 Brittle diabetes and hyperglycaemia 210 Euglycaemic DKA 210 Hyperosmolar Hyperglycaemic States 211 Presenting signs and symptoms 212 Lactic acidosis 213 Lactic acidosis associated with Metformin 215 References216 8 Long-Term Complications of Diabetes 218 Key points 218 Introduction219 Pathophysiology of diabetes complications 219 Cardiovascular disease and diabetes221 Key points 221 Rationale222 Medicines and cardiovascular disease 223 Complementary medicines (CAM) 226 Other management considerations 227 Mental health and cardiovascular disease 228 Nursing responsibilities 229 Telephone coaching 233 Cerebrovascular disease 233 Signs and symptoms 234 Diabetes and eye disease235 Key points 235 Rationale235 Introduction235 Risk factors for retinopathy 236 Diabetes and renal disease241 Key points 241 Introduction241 Stages of chronic kidney disease 241 Risk factors for renal disease 242 Renal failure 243 Renal disease and anaemia 245 Diet and renal disease 245 Renal disease and older people 247 Kidney biopsy 247 Renal dialysis 247 Objectives of care 249 Nursing responsibilities 250 Commencing CAPD in patients on insulin 250 Educating the patient about CAPD 251 Supportive care 252 Renal disease and herbal medicine (see also Chapter 19) 252 Peripheral and autonomic neuropathy253 Key points 253 Introduction253 ... programmes 10 1 Factors associated with making dietary changes 10 1 Nursing responsibilities 10 2 References 10 7 5 Medicines Management 11 1 Key points 11 1 Introduction 11 2 Quality Use of Medicines... Care of People with Diabetes This book is dedicated to all people with diabetes who taught me so much of what I know about life with diabetes, people with diabetes who need health care and... (QUM) 11 2 Quality Use of Medicines and Diabetes 11 3 Oral Glucose-Lowering Medicines (GLM) 11 4 The incretin hormones 12 4 New medicines for type diabetes 12 5 Medicine interactions 12 6 When