221 Nursing Assessment, Management and Treatment of Autoimmune Diseases
● Diabetic retinopathy : If the blood vessels of the retina are damaged, the patient may go blind. Other conditions linked to diabetic retinopathy include cataracts and glaucoma. ● Damage to the feet : Nerve damage or reduced blood flow to the lower extremities increases the risk of complications to the feet. Without treatment, even minor cuts and blisters can become quite serious, leading to infections that may eventually require the amputation of toes, feet, or leg(s). ● Skin and mouth issues : Patients may be more vulnerable to skin and mouth infections including those caused by bacteria and fungi. Disease of the gums and dry mouth are also likely. ● Pregnancy issues : If the T1D is poorly controlled in pregnant females, the risk of miscarriage, stillbirth, and birth defects increases. The risk of diabetic ketoacidosis, retinopathy, pregnancy induced hypertension, and preeclampsia may also increase. Diabetic ketoacidosis (DKA) is a serious, acute metabolic complication character- ized by hyperglycemia, hyperketonemia, and metabolic acidosis. DKA is most common in patients with T1D and oc- curs when insulin levels are inadequate to meet the body’s basic metabolic require- ments. Hyperglycemia causes osmotic diuresis with severe fluid and electrolyte loss (Merck Manual, 2020b). Signs and symptoms of DKA include nausea, vomiting, and (especially in chil- dren) abdominal pain. If untreated, signif- icant decompensation can occur. Patients may display hypotension and tachycardia because of dehydration and acidosis. To compensate for acidemia, respirations in-
crease in rate and depth (Kussmaul res- pirations). The patient’s breath may have a fruity odor because of exhaled acetone (Merck Manual, 2020b). Treatment consists of rapid intravas- cular volume repletion with 0.9% saline given IV, correction of hyperglycemia and acidosis, and prevention of hypokalemia. Treatment should take place in critical care settings because of the need for hourly clinical and laboratory assessments with necessary adjustments indicated by as- sessment results (Merck Manual, 2020b). Assessment and diagnosis Patients are assessed for common symp- toms of T1D. These include the following (Mayo Clinic, 2021c; Rebar et al., 2019): ● Increased thirst. ● Extreme hunger. ● Frequent urination. ● Unintended weight loss ● Fatigue. ● Weakness. ● Blurred vision. ● Irritability. ● Mood changes. ● In children, bed-wetting in those who did not previously wet the bed at night. A thorough history and physical are con- ducted to help rule out other conditions. In addition to history, physical, and a re- view of signs and symptoms, several di- agnostic tests are performed. These in- clude the following (Mayo Clinic, 2021c; Rebar et al., 2019): ● Glycated hemoglobin (A1C) test : The A1C is a blood test that reports average blood glucose levels for the past 2 to 3 months. The test measures the percentage of blood glucose that is attached to the body’s hemoglobin. The higher the glucose levels, the higher the percentage of hemoglobin
Powered by FlippingBook