IDDM
Blood Glucose
Normal range:
4-8 mmol/L
Laboratory Test
B-type Natriuretic Peptide (BNP)
Arrythmia
Pulse: irregular, fast, weak
Oral Hypoglycemics
Metformin: reduces available sugar for absorption
Glyburide: increases pancreas insulin release
Hypoglycemia Protocol
PO/dysphagia/NPO
Conscious vs. Unconscious
Blood Tests
Acute: blood glucose level
Chronic: Hemoglobin A1C
Right-Sided HF
Peripheral Edema
Weight Gain
Health Risk
Decreased cardiac output.
Blood stasis & clot formation.
Insulins
Rapid-acting (Lispro)
Fast-acting (Humulin R)
Long-acting (Lantus/glargine)
Diabetic Diet
Complex carbohydrates
Low-fat proteins
Long-Term Complications
Neuropathy (peripheral nerves)
Nephropathy (kidney damage)
Retinopathy (vision changes)
Left-Sided HF
Pulmonary Edema
Dyspnea/SOB
Cardiac Tests
ECG
Holter Monitor
Echocardiogram
Diuretics
Furosemide: hypokalemia
Spironolactone: hyperkalemia
Sliding Scale
Type of insulin
Frequency/timing
CBG Parameters
Foot Care
Protect feet, inspect skin, treat wounds, remove necrosis, amputation surgery.
Blood Pressure
Early: hypertension
Advanced: hypotension
Laboratory Tests
Coagulation: INR, PTT
Electrolytes: Na+, K+, Ca+
Anticoagulants
Warfarin: po, frequent INR, monitor bleeding
Apixaban: po, monitor bleeding
SBAR
Reportable findings: new, urgent, unsafe, significant
Hypoglycemia
Day/night fluctuations
Medication effect
Nutrition changes
Lifestyle
Low exertion activities
Low sodium diet
Oxygen therapy
Bradycardia
Medication effect
Worsening heart function
Disease progression
Antiarrhythmics
Digoxin: narrow therapeutic index, toxicity, bradycardia, visual changes
Discharge Planning
Patient education effective
Rx covered by health benefits