Unit 3 Group Discussion Work Discuss Type I and Type II diabetes.

How are they different and how are they similar? About 1 in every 400 children and adolescents has diabetes (American Diabetes Association [ADA1], n.d.) type I (formerly called juvenile onset diabetes) with onset typically before the age of 20 years old and is caused by an autoimmune disease that attacks and destroys the insulin-producing beta cells in the pancreas. This is a chronic catabolic disease due to limited or no production of insulin by the pancreas with those individuals having to take insulin regularly injected either subcutaneously or through an insulin pump in order to stay alive. Moreover, they are usually skinny, look health and young children with type 1 diabetes can learn to manage their condition and live long, healthy, and happy lives. (ADA2, n.d; medscape1, 2012) Khardori (2012) reported that type I diabetes is most common among non-Hispanic whites, comparatively uncommon among Asians, and most predominant in males with the male-to-female ratio being approximately greater than 1.5:1 in populations of European origin. (Khardori, 2012) Type II (formerly called adult onset) diabetes is the most common form of diabetes with 1.9 million new cases diagnosed in individual aged 20 years and older in 2010 (ADA1, n.d.). The majorities of individuals diagnosed are over the age 40 years old and it is a chronic disease cause by an array of dysfunctions resulting from the combination of resistance to insulin action and inadequate insulin secretion (Khardori1, 2012). Type II diabetes if recognized in early stage (prediabetes) may be preventable with life style changes. It requires long-term medical attention both to limit the development of its devastating complications and to manage them when they do occur. (Medscape, 2012) Individuals with diabetes type II can manage their diabetes with diet

and exercise, oral antihyperglycemic medications, and or insulin injections (Medscape, 2012). Moreover, this chronic disease has a direct association with many comorbid as retinopathy, nephropathy, peripheral disease, and many others (Khardori1, 2012) Type 2 diabetes runs very strongly from generation to generation and most prevalent in non-Hispanic blacks (12.6%) followed by Latinos (11.8%). Furthermore, the National Diabetes Information Clearinghouse - NDDIC (2011), reported that type I and II diabetes is the leading cause of kidney failure, nontraumatic lower-limb amputations, new cases of blindness among adults, major cause of heart disease and stroke, and the seventh leading cause of death in the United States. Diabetes had an estimated total costs (direct and indirect) of $174 billion for 2007 and is expected to rise to $366 billion by 2030 (MB BCHIR, ROGLIC, GREEN, SICREE, KING, 2004) In conclusion, type I and II are chronic diseases that can lead to innumerous secondary comorbidities if lead untreated, and required a significant life style comportment or change. Individuals with Type I can manager much better the disease and live a long and productive life, when individual with type II may encounter more significant challenges with disease management and treatment. Type I is caused by an autoimmune disease and type II by the insulin cell residence or diminished insulin production by the pancreas. Type I must be managed with Insulin injections and Type II can be managed with life style changes and or oral medications, in severe cases may need insulin injections. One thing about type 1 and type 2 diabetes is that you can get either one at any age, being this the reason why the American diabetes Association has change the name from 'juvenile onset' to 'type 1,' and 'adult onset' to 'type 2.'

M.M. is a 36 yr old female who is one day post small bowel resection due to an obstruction. Her GI tract needs at least two weeks to recover from the surgery. In the two weeks before her surgery MM prior to surgery MM lost 10% of her weight and she was NPO five days prior to surgery, Considering her depleted nutritional state, what type of nutritional support is likely to be considered? Peripheral Parental Nutrition (PPN) Total Parental Nutrition (TPN)

Discuss important nursing considerations for this patient? monitors recovery ensures that bandages are kept clean and dry administer pain medications as prescript monitoring of blood pressure, pulse, respiration, and temperature encourage deep breath and coughing instruct on how to support the operative site during deep breathing and coughing. record I & O assess operative site for color and amount of drainage nasogastric tube management and care assess intravenous site for s/s of infiltration and or infection manage intravenous fluids, electrolytes, PPN/TPN as order until diet can be advance to po. encourage and assist patient to be OOB as order by prescriber assess for orthostatic blood pressure each time patient is getting OOB until ambulation is resumed if applicable referral to RD, PT, and SW if applicable schedule for a follow-up examination as order by surgeon

Discuss important patient education points to discuss with MM regarding her nutritional support. Will not to be able to eat anything by mouth during bowel rest period During bowel rest period all nutritional needs will be provide through the veins (parenteral) When ready to start eating and there is no present bowel sounds a sip water trial will be start to encourage bowel movement

When bowel sounds are present, diet will start with a clear liquid diet as chicken broth, tea, gelatin, and to stay away from liquids reddish in color If clear liquid diet is tolerated for 24 hours, diet will be advanced to a full liquid diet If full liquid diet is tolerated to a low fiber or regular diet

What are the two major categories of IV fluids? Discuss the indications for each type. Provide an example for both types. Crystalloids have small parts in them that are absorbed through the vascular bed and into the surrounding tissue. o commonly used for rehydration, and electrolyte replacement o example: 0.9% saline, Lactated Ringers, and D5W (dextrose). Colloids have large particles in them so they are not as easily absorbed into the vascular bed o commonly used to replace lost blood, maintain healthy blood pressure, and volume expansion o example: intravenous immunoglobulin and propofol

R. is a 54 yr old male who has been taking an NSAID for a shoulder injury for three months. He describes himself as a one pack per day smoker and drinks 3 beers each evening after work. He presents to the ER with severe abdominal pain.

What risk factors for Peptic Ulcer disease does R have? Drinking too much alcohol Regular use of NSAIDs Cigarettes smoking (NDDIC, 2010)

What changes can he make to control his pain? Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. Eating meals at regular intervals with a small snack before bedtime Not over eating Avoid or manage stressful conditions Avoid smoking

Maintain proper diet and avoid food or beverages which upset the gastric mucosa like coffee, tea, colas and alcohol. (NDDIC, 2010)

What ypes of medications is his physician likely to prescribe? Peptic ulcer with an H. pylori infection - combinations of the following medications for 5 - 14 days: o Two different antibiotics to kill H. pylori, such as clarithromycin (Biaxin), amoxicillin, tetracycline, or metronidazole (Flagyl) o Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium) o Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria

Peptic ulcer without an H. pylori infection, or caused by aspirin or NSAIDs: o Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium) for 8 weeks.

Peptic ulcer to manage symptoms or disease if must continue taking aspirin or NSAIDs for other health conditions o Misoprostol on a regular basis o Medications that protect the tissue lining (such as sucralfate) (NDDIC, 2010)

References ADA1. (n.d.). Diabetes statistics. http://www.diabetes.org/diabetes-basics/diabetes-statistics/ ADA2. (n.d.) Diabetes type I, http://www.diabetes.org/diabetes-basics/type-1/ Khardori, R. (2012). Type 1 diabetes mellitus. Medscape Reference. Retrieved from http://emedicine.medscape.com/article/117739-overview#a0104

Khardori1, R. (2012). Type 2 diabetes mellitus. Medscape Reference. Retrieved from http://emedicine.medscape.com/article/117853-overview MB BCHIR, S. W., ROGLIC, G., GREEN, A., SICREE, R. & KING, H. (2004). Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care (5)IABETES CARE, VOLUME 27, NUMBER 5, retrieved from http://www.who.int/diabetes/facts/en/diabcare0504.pdf National Diabetes Information Clearinghouse NDDIC1. (2010). H. pylori and Peptic Ulcers. Retrieved from http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/index.aspx National Diabetes Information Clearinghouse NDDIC. (2011). National diabetes statistics, 2011. Retrieved from http://diabetes.niddk.nih.gov/dm/pubs/statistics/#Deaths Hemorrhoid information center. A sample guide to manage peptic ulcer. Retrieved on 04/16/2012 from http://www.hemorrhoidinformationcenter.com/peptic-ulcer-diseaseasimple-guide-for-managing-and-treating-ulcers/