Documents.tips Plan de Ingrijirea a Pacientului Cu Diabet Zaharat

7/26/2019 Documents.tips Plan de Ingrijirea a Pacientului Cu Diabet Zaharat

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Plan de ngrijirea a pacientului cu diabet zaharat

DIAGNOSTICNURSING SAUPOTENIAL

OBIECTIVEINTERVENIILE ASISTENTEI: PROPRII l DELEGATE EVALUARE

Alimenta ie inadec -vat:

Cauza:- dezechilibrul e!ab"#li$ului %lucidel"r&'a(i)e$!*ri:- +"li)a%ie,- +"lidi+$ie&

S* $e "b-i(*echilibrule!ab"li$ului%lucidic .( &&&zilePacie(!ul $* $ealie(!eze .( ra+"r!cu (e/"ile $aleca(!i!a!i/e 0icali!a!i/e123 "re&

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- +e(!ru +acie(!ul abula!"r:- i(/i!* +eri"dic +acie(!ul la c"(!r"ale cli(ice 0i de lab"ra!"r .( cadruldi$+e($arului edical 4%lic"zurie5 %liceie6,- +e(!ru +acie(!ul dezechilibra!5 i(!er(a! .( $+i!al:- a$i%ur* alie(!a-ia +acie(!ului:- e/alueaz* (e/"ile ca(!i!a!i/e 0i cali!a!i/e .( )u(c-ie de /7r$!* 4c"+il5

ad"le$ce(!5 adul!65 $e85 $!are )izi"l"%ic* 4$arci(*5 al*+!are65 ac!i/i!a!ea+acie(!ului5 )"ra b"lii: +r"!ei(e 9#9;


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- +re+ararea alie(!el"r: $e /a )"l"$i +e(!ru .(dulcirea ceaiuril"r5c"+"!ului5 ciclaa! de $"diu $au zahari(a 4care $e +u( du+* )ierberea+r"du$el"r6, $"$urile (u $e .(%r"a0* cu )*i(*5 ci cu le%ue +a$a!e,+a$!ele )*i("a$e $e c7(!*re$c .(ai(!e de )ierbere, +7i(ea $e c7(!*re0!e .(ai(!ede a )i +r*@i!* 4+ri( de$hidra!are $e c"(ce(!reaz* .( %lucide6, $e )"l"$e0!e

)ierberea 0i c"acerea ca !eh(ici de +re+arare a alie(!el"r- rec"l!eaz* +r"du$ele +e(!ru e8ae(ul de lab"ra!"r 4$7(%e5 uri(*6,- adi(i$!reaz* edica-ia +re$cri$* de e dic la "rele i(dica!e,- i($uli(a "rdi(ar*: S&C& .( d"za rec"a(da!*5 adi(i$!ra!* cu 9;#= i(.(ai(!ea e$ei 4)"l"$e0!e $eri(%* $+ecial* %rada!* .( u(i!*-i de i($uli(*5 -i(e$eaa c* alc""lul i(ac!i/eaz* +r"du$ul6, ri!ul de adi(i$!rare: 2# "ri +e zi5.(ai(!ea e$el"r +ri(ci+ale, adi(i$!rarea T&V& (uai .( cazul c"eidiabe!ice,- i($uli(a "("c"+"(e(!*5 $eile(!*5 le(!* " da!* $au de d"u* "ri +e zila "re )i8e i(@ec-ii S&C&,- re$+ec!* cu $!ric!e-e *$urile de a$e+$ie,- al!er(eaz* l"cul de i(@ec!are +e(!ru a +re/e(i li+"di$!r")iile

l"c de i(@ec!are:- )a-a e8!er(* a bra-ului5 91 i@l"cie, )a-a a(!er" e8!er(* a c"a+$ei5 91

i@l"cie,- re%iu(ea $ubcla/icular*5- )la(curile +ere!elui abd"i(al5- re%iu(ea )e$ier*, $u+er"e8!er(*,- adi(i$!reaz* edica-ia "ral* hi+"#%liceia(!*, $ul)aide

hi+"%liceia(!e $au bi%ua(ide 0i ur*re0!e e)ec!ele $ecu(dare ale ace$!"ra4%re-uri5 /*r$*!uri5 e+i%a$!ral%ii5 i(a+e!e(-*6,- adi(i$!reaz* edica-ia ad@u/a(!* # /i!a# i("!era+ia5 CL&

rec"a(da!*

Pacie(!ul .0i adi(i$!reaz*c"rec! !ra!ae(# !uledicae(!"$&


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Risc de complicaii

acute

Cauze:- dezechilibrule!ab"li$ului%lucidel"r 0ili+idel"r'a(i)e$!*ri:- c"*hi+er%liceic*,

- "b"$eal*5$"("le(-*5i(a+e!e(-*,- %re-uri5 /*r$*!uri5diaree- !ahicardie- +ierderea le(!* ac"(0!ie(!ei- +iele u$ca!*

- re$+ira-ieu$aul5 # hale(*de ace!"(*- c"*hi+"%liceic*:- ae-eli5 a$!e(ie

Pacie(!ul $* (u

+rezi(!ec"+lica-ii acu!eale b"lii&

- $e$izeaz* u(ele "di)ic*ri5 care $e da!"reaz* u("r c"+lica-ii:

"di)ic*ri ale c"+"r!ae(!ului 4"b(ubilarea65 !ra($+ira-ii5 re$+ira-ieu$aul,- ac"rd* .(%ri@iri $+eciale:- a6 .( c"a hi+er%liceic*:- adi(i$!reaz* d"za de i($uli(* "rdi(ar* rec"a(da!* de edic +e cale$ubcu!a(a!* 0i i(!ra/e("a$*5 la i(!er/alul $!abili!,- rec"l!eaz*5 +eri"dic5 $7(%e +e(!ru d"zarea %luc"zei5 a rezer/ei alcali(e0i uri(* +e(!ru %lic"zurie,- $u+ra/e%heaz* +ul$ul5 !e($iu(ea ar!erial*5 re$+ira-ia5 re/e(irea

c"(0!ie(-ei,- reechilibreaz* hidr"elec!r"li!ic 0i acid"# bazic +acie(!ul +ri( +er)uzii cu$er )izi"l"%ic $"lu-ie Ri(%er5 $"lu-ie i$cher 0i $"lu-ie bicarb"(a! de $"diu93 %


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- !ra($+ira-ii- T&A& cre$cu!*- +ierderea bru$c*a c"(0!ie(-ei- +iele ued*-

re$+ira-ie ("ral*

- .(/a-* +acie(!ul i($uli("de+e(de(! cu $*#0i d"zeze edicae(!ul5cu $*#0i )ac* i(@ec-ia cu i($uli(*5 cu $* re$+ec!e re%ulile dea$e+$ie5 cu $* al!er(eze l"cul de i(@ec!are5 cu $* +*$!reze +r"du$ul4l"c u$ca!5 T35 %rade65 $* *(7(ce la 9;#= i(u!e du+*adi(i$!rare

Risc de complicaii

cronice:

- $c*derea acui!*-ii/izuale,- dureri .( ebrelei()eri"are

# .(/a-* +acie(!ul $* recu("a$c* $e(ele I c"+lica-iil"r acu!e 0i cu $*i(!er/i(* .( cazul ace$!"ra 4.( caz de hi+"%liceie $*#0i adi(i$!reze +u-i(*a+* .(dulci!*6# .(/a* +acie(!ul $* )"l"$ea$c* !e$!e ra+ide de de!eri(are a %liceiei i%lic"zuriei la d"iciliu# i+lic* )ailia .( .(%ri@irea +acie(!ului +e(!ru a cereea clia!ul de li(i!ei $ecuri!a!e, .( cazul c"+iil"r5 +*ri(ii $u(! i+licai .( !"!ala .(%ri@ire a

c"+ilului diabe!ic&

Coma diabetic

E$!e c"+lica-ia cea ai %ra/* a diabe!ului zahara! P"a!e )i decla(0a!* de:er"are die!e!ic* 4+"$! +relu(%i! 0i (u e8ce$ul alie(!ar65"+rirea $au dii(uarea (e@u$!i)ica!* a !ra!ae(!ului cu i($uli(*5er"ri .( d"zarea i($uli(ei5$ure(a@5 )ac!"ri +$ihici5i()ec-ii5 i(!"8ica-ii5

c"r!ic"!era+ie e!c&


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Tabl"u cli(ic- .( +rec"*

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- .( c"*

A!i!udi(e de

ur%e(*

l&a& C"a diabe!ic* e$!e !"!deau(a +receda!* de " )az* +r"dr"al* +rec"a e8!eri"riza!* cli(ic +ri(:# a("re8ie !"!al* 4e$!e u( a/er!i$e(! la u( diabe!ic care de "bicei e$!e +"li)a%65 .($"-i!* de %re-uri5 /*r$*!uri5 %reu!a!e e+i%a$!ric*5# +"lidi+$ie5 +"liurie5# +"li+(ee cu hale(* ace!"(ic* 4elee(!e /al"r"a$e +e(!ru a i(!er/e(i .(ai(!e de a+ari-ia c"ei6&

I( cF( c"a diabe!ic* acid"#ce!"(ic* e8i$!* $e(e a@"re:

re:l&b&1.Di$+(ee

# re$+ira-ia u$$aul 4.( 3 !i+i: i($+ira-ie5 +auz*5 e8+ira-ie # +auz*6 a+l*5 z%""!"a$*2&Tulbur*ri de cu("0!i(-* 4c"* cal*63.De$hidra!are %l"bal*:- !e%ue(! u$ca!5- e8!rei!*-i reci5 de a$+ec! /i"laceu5- +liu cu!a(a! +er$i$!e(!5- u$c*ciu(ea libii 4r"0ie +r*@i!*65 a uc"a$el"r5

- )acie$ $u+!5 (a$ a$cu-i!5- hi+"!"(ia %l"bil"r "culari5 .()u(da-i .( "rbi!e5- hi+"!e($iu(e ar!erial*5 c"la+$&

4.al!e $e(e: hi+"!erie5 /*r$*!uri5 dureri abd"i(ale5 idriaz*5 hale(* ace!"(ic*- Pe(!ru c"()irarea dia%("$!icului +"! )i de!eri(a!e 4acce$ibile "ric*rui cabi(e! edical6 %lic"zuria 4reac!i/: ehli(% $au

Nla(der65 ace!"(uria 4reac-ia Le%al 6 $au +ri( !e$!e ra+ide&- Ca !ra!ae(! de ur%e(-* $e adi(i$!reaz* i($uli(a 2= U i&/& 4chiar la d"iciliu6&- Se !ra($+"r!* de ur%e(-* la $+i!al u(de !ra!ae(!ul e$!e e!a+iza! +e "re 0i $!ric! i(di/idualiza! +e(!ru c"ba!erea acid"zei 0i

hidra!are&Se rec"l!eaz* +r"be de lab"ra!"r +e(!ru de!eri(area %liceiei5 %lic"zuriei ca(!i!a!i/e5 ace!"(uriei5 hea!"cri!ului5 az"!eiei5

i"("%raei5 rezer/ei alcali(e&

Coma hipoglicemic


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Tabl"ul

cli(ic

U(e"ri e$!e +receda!* de )"ae i+eri"a$*5 $e( za-ie de "b"$eal*5 !ahicardie5 a(8ie!a!e5 !ra($+ira-ii5 a%i!a-ie +$ih"#

"!"rie 4l"%"ree5 delir5 )a$cicula-ii u$culare65

De cele ai ul!e "ri $e i($!aleaz* bru$c

Are !abl"u carac!eri$!ic de c"* Hued*H 0i hi+er!"(*:

- !ra($+ira-ii +r")uze5

- a%i!a-ie +$ihic*5- c"(!rac!uri u$culare5- c"(/ul$ii5- hi+er)le8ia "$!e"#!e(di("a$*5- hi+er!"(ia %l"bil"r "culari5- $e(ul Babi($>i bila!eral&

C"(dui!adeur%e(*

C"a hi+"%liceic* 4la u( b"l(a/ diabe!ic6 !rebuie di)ere(-ia!* de c"a diabe!ic* 4/ezi a(!eri"r65 de care $e de"$ebe0!e +ri(:ab$e(-a re$+ira-iei de !i+ u$$aul 0i a hale(ei ace!"(ice5 a )e("e(el"r de de$hidra!are 4+ielea e$!e u$ca!* .( c"a diabe!ic*0i ued* .( cea hi+"%liceic*6 0i ab$e(-a !ulbur*ril"r (eur"l"%ice C7(d di)ere(-ierea e$!e %reu de )*cu!5 $e adi(i$!reaz* 2=#= l %luc"z* hi+er!"(ic* 42= #3=


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Evoluia simptomelor

- +"liurie- +"lidi+$ie- u$c*ciu(ea %urii- %reuri5 /*r$*!uri

- a$!e(ie5 $"("le(-*#c"*- re$+ira-ie u$$aul

Evoluia simptomelor

- a(8ie!a!e5 (eli(i0!e- !ra($+ira-ii5 +al+i!a-ii- $e(za-ie de )"ae- ce)alee5 di+l"+ie

- dez"rie(!are +$ihic*- a%i!a-ie +$ih""!"rie- c"(/ul$ii !"(ic#cl"(ice- +ierderea cu("0!i(-ei

Starea clinic

- !e%ue(! u$ca!5 hi+ereic- lib* u$ca!*5 cr*+a!*- hi+"!e($iu(e ar!erial*- hi+"# 0i are)le8ie

Starea clinic

!e%ue(! +alid5 ued T&A& ("ral* $au cre$cu!*+u+ile dila!a!e re)le8ele "$!e"!e(di("a$e acce(!ua!e 4hi+erre)le8ie6 Babi($>i +"zi!i/ bil!eral&

Documents.tips Plan de Ingrijirea a Pacientului Cu Diabet Zaharat

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Transcript of Documents.tips Plan de Ingrijirea a Pacientului Cu Diabet Zaharat