2型糖尿病的护理查房.ppt

,NursingRoundsof,Type2diabetesmellitus2型糖尿病的护理查房,EndocrinologyDepartment内分泌科,.,Goodafternooneveryone:Welcometoournursingrounds，IamWenXiaHe,theheadnurseofendocrinologydepartment.,Today,thepeopletakepartinourNursingroundsareseniornurseLiLiYu,primarynurseQiTang,LuFenZhang,XiaZhao,PingHe,andBeddoctorHuiJieYang.今天,参加这次护理查房的有护师余莉利，护士唐琦、张芦芬、赵霞、何萍以及床位医生杨慧杰.,Ournursingroundsisseparatedintofourparts：thefirst,Specializedknowledge,thesecond,Casepresentation,thethird,Situationconversation,thefourth,Nursingplan.,Now，letsbegin.,Letsbeginfromthefirstpart:Specializedknowledge.PleaseletLiLiintroducethebasicknowledgeaboutdiabetes.,DoYouknowaboutdiabetes你了解糖尿病吗,什么是糖尿病？糖尿病是身体不能分泌足够的胰岛素或者细胞对体内胰岛素产生抵抗的一种代谢性疾病.,Whatisdiabetes?Diabetesisagroupofmetabolicdiseasesresultingfromthatthebodydoesnotproduceenoughinsulin,thebodydoesnotrespondtotheinsulin,orboth.,Diabetesmellitusischaracterizedbychronichyperglycemia糖尿病以慢性高血糖为特征,Theclassicalsymptomsofdiabetes糖尿病的典型症状：Polyuria多尿Drink多饮Polyphagia多食Weightloss体重减轻,糖尿病的分型：1型糖尿病2型糖尿病妊娠糖尿病特殊类型糖尿病,TheTypeofDiabetesType1diabetesmellitusType2diabetesmellitusGestationaldiabetesmellitusSpecifictypesofdiabetes,糖尿病的诊断标准诊断标准静脉血浆葡萄糖水平（mmol/L）1.糖尿病症状加随机血糖11.1或2.空腹血糖（FPG）7.0或3.葡萄糖负荷后2h血糖11.1无糖尿病症状者，需改日重复检查,ThediagnosticcriteriafordiabetesHavethesymptomsofdiabetesandcomplywithanyofthefollowingpoints:Anytimetheplasmaglucoselevelhigherthanequalto11.1mmol/LFastingplasmaglucoselevelshigherthanorequalto7.0mmol/LInOGTTtest,2hPGlevelhigherthanorequalto11.1mmol/L,急性并发症：糖尿病酮症酸中毒高渗性非酮症糖尿病昏迷感染,Themajorcomplicationsofdiabetes,Acutecomplications：DiabeticketoacidosisHyperosmolarnonketoticdiabeticcomaInfection,慢性并发症：血管病变神经病变糖尿病足,Chroniccomplications：VascularlesionsNeuropathyDiabeticfoot,什么人易患糖尿病,糖调节受损者年龄40岁超重、肥胖人群有糖尿病家属史有高血压、高血脂、心脑血管疾病的患者,WhotendstosufferfromthediabetesImpairedglucoseregulation.Age40yearsold.Theoverweightpeople,Theobesepeople.Familyhistoryofdiabetes.Peoplewithhighbloodpressure,highcholesterolandcardiac-cerebralvasculardiseases.,Allright,letsbeginthesecondpart:Casepresentation.PleaseletbeddoctorHuiJieYangintroducethepatientsmedicalhistory第一部分内容结束，请欣赏第二部分：请床位医生杨慧杰介绍该病人的病史,Name：ZhouHongliangSex:maleAge:43yearsoldAdmissionnumber：641202Admissiontime：2014-08-2810:30ChiefComplaint:thirst,polydipsiaandpolyuriaforthreeyears.,GeneralInformation,PresentIllness,DiagnosedasT2DM3yearsago,prescribedwith“MetforminOnglyzaandPioglitazone”tocontrolthebloodglucose.患者3年前诊断为2型糖尿病，一直服用二甲双胍、安立泽和吡格列酮对其控制血糖.,Twomonthsago,thepatientwithdrawledthe“OnglyzaandPioglitazone”,onlyoral“Metformin”treatment.NomonitoringtheBG.2月前，患者自行停止服用安立泽和瑞彤，只服用泰白，同时未监测血糖.,2014-08-28,toourout-patientdepartment,testedFPGis12.8mmol/L,soadmitted.2014年8月28日，我院门诊将其收住入院，当时空腹血糖12.8mmol/L.,PastHistory,Hypertensionforfouryears.高血压史4年Denyingdrugallergyhistory,nohistoryofsurgery、traumaandtransfusion.否认药物过敏史，否认手术、外伤及输血史.,Havingsmokinghistoryfor20years,nodrinkinghistory.有吸烟史20年，无酗酒史.Havingfamilyhistoryofdiabetes.有糖尿病家族遗传史.,PhysicalExamination,Height164cm,weight77kg.T36.6,P74times/minute,R18times/minute，BP134/85mmHg.,Thepatientwasclear.Theneckissoft.Nopalpatingthebilateralthyroidenlargement.Heart,lungandabdomenareallnegative.Theresnoedemaoflowerlimbs.Bilateraldorsalispedisarterypulseisnormal.Thepathologicalcharacterisnegative.患者神志清，颈软，双侧甲状腺无肿大，心脏，肺，腹部无异常.双侧足背动脉搏动正常.其病理征阴性.,AdmittingDiagnosis,1.Type2diabetesmellitus2型糖尿病2.Hepertension高血压病,Allright,letsbeginthethirdpart:situationconversationThepatientQiTangNurse1LuFenZhangNurse2XiaZhaoPracticalNurseTingTingZhang,?,-Goodafternoon,-Goodafternoon,今天感觉怎么样？,-howdoyoufeelnow?,我感觉好多了.,-Ifeelmuchbetter.,Doyouneedanyhelp?,需要我们的帮助吗？,我想知道什么是糖尿病饮食.,IwanttoknowwhatistheDiabetesDiet.,适量摄入碳水化合物，限制脂肪高热量食物、甜食、食盐的摄入、戒烟.,Thatincludesmoderateintakeofcarbohydrates,limitingabsorbfat,high-caloriefoods,sweetsandsalt,alsosmokingcessation.,那怎么估量呢？,Howdoesitmeasure?,Youractualheightis164cm,minus105istheidealweight,thatis59kg.Actualweight(77kg)-idealweight(59kg)is18kg,dividebytheidealweight(59kg),thenmultiplyby100%=30.5%.Thatmeansyouareobesity.Youbelongtolightmanualworker.Thedailycaloriesneededshouldbe20kcal/kg/day.So,thetotalcaloriesis59times20=1180kcal.Aftercalculating,yourmealboxbelowas:8partsofstaplefood,1categoryservingsofvegetables,2copiesofmeatandeggs,1partmilk,1partoil.,你的实际身高164cm105=理想体重59kg.（实际体重77kg理想体重59kg）/理想体重59kg100%=30.5%属于肥胖体型.你每天工作属于轻体力劳动，每天每千克体重需要热量为20千卡.总热量5920=1180千卡，经过计算你一天的膳食框如下:主食类8份蔬菜类1份肉蛋类2份乳类1份油脂1份,那我哪些食物能吃，哪些不能吃？,WhatfoodscanIeat,whatcannoteat?,Eggs,milk,meat,soyandotherfoodscanbeeaten,buttotiming,quantitative.Thehighsugarcontent,forexamples,sugarcane,bananas,datescannotbeeaten.Youcanalsoeatsomesugar-freefoods,suchassugar-freecookies.Here,Ihaveabook,itcanhelpyou.,鸡蛋、牛奶、肉、豆制品等食物都能吃，但要定时、定量，甘蔗、香蕉、红枣含糖高的不能吃.还可以吃一些无糖食品，比如无糖饼干.我这里有一本书，它能帮助你.,WhatshouldIpayattentionto?,平时我还需要注意点什么？,Inadditiontoproperdiet,youalsoneedadequateexercise,usingappropriateoralmedicationandinsulintocontrolbloodglucose.Youdbettermonitorthebloodglucoseintime.,除了合理饮食，还需要适当运动，使用合适的口服药和胰岛素来控制血糖。最好自己能按时监测血糖。,WhenshouldImonitor?Whatistherangeoftheglycemiccontrol?,什么时候监测，血糖控制范围是多少？,Usuallywemonitoritinthemorningfastingand2hoursaftermeals.Fasting:4.4-6.1mmol/Lnon-fasting:4.4-8.0mmol/LDoyouknowthesymptomsofhypoglycemia?,一般是早上空腹和三餐后2小时监测.空腹：4.46.1mmol/L非空腹：4.48.0mmol/L你了解低血糖症状吗？,Palpitations,tremor,sweating,hungry,weakness.,心悸、手抖、出汗、饥饿感、软弱无力,Whenyouhavethesesymptoms,youneedtoeatcookiesorcandyimmediately.,当你有这些症状的时候，要马上吃饼干或者糖果.,好的，谢谢！,Okay,thankyou!,Yourewelcome.Pleaseringthebellifyouhaveanyneed.,不客气，有什么需要随时按铃叫我们！,TingTingZhang，Doyouknowthatthediabeteshavefivecarriages？,张婷婷，你知道糖尿病的五驾马车？,1.Diettherapy.2.Exercisetherapy.3.Drugtherapy.4.Self-monitoring.5.Healtheducation.,1.饮食治疗2.运动治疗3.药物治疗4.自我监测5.健康教育,Letsbeginthefourthpart：Nursingplan.,PingHe,pleaseintroducesomethingaboutthepatientsnursingplan,Nursingintervention护理措施Hypoglycemia低血糖,ForNurse,1.Accuratemedication.2.Monitorbloodglucose.3.Healthguidanceforpatientsandtheirfamilies.,遵医嘱用药.合理监测血糖.对患者及家属健康宣教.,Nursingintervention护理措施Hypoglycemia低血糖,Forpatients,1.Timing,quantitativemeal.2.Carrycandy,cookiesetc.3.Avoidfastingexercise.4.Understandthesymptomsofhypoglycemiaandcountermeasures.,病人定时、定量进餐.随身携带糖果、饼干等.避免空腹锻炼.了解低血糖的症状及应对措施.,Nursingintervention护理措施Hypoglycemia低血糖,Forpatients,低血糖的症状：心慌、手抖、出冷汗、饥饿感，四肢乏力，血糖3.9mmol/L.应对措施：卧床休息，立即按呼叫器通知护士测量血糖，根据血糖值进食含糖的食物或饮料.,Thesymptomsofhypoglycemia:palpitation,trembling,coldsweats,hunger,weakness,bloodglucose3.9mmol/L.Countermeasures:torestinbed;tocallnursetomeasurebloodglucose,toeatordrinkthesugaryfoodsaccordingtothebloodglucoselevels.,Nursingintervention护理措施Theriskofinfection有