IMPLEMENT & MONITOR NURSING CARE FOR CLIENTS WITH CHRONIC HEALTH PROBLEMS

INTRODUCTION:
Chronic definition: This describes a disease of long duration involving very slow changes. Such disease is often of gradual onset. (Oxford Nursing dictionary).
The chronic health problem that I am going to talk about is Diabetes Mellitus which is endocrine system disorder. It involve the pancreatic islets that produce two hormones, insulin and glucagon, which both helps to regulate blood glucose level. (funnel, Koutoukidis, et al(2005) Tabbners nursing Care, “Endocrine System” (see chapter 41, pp 698-702).

AETIOLOGY:
Diabetes Mellitus results from an insulin deficiency a hormone (or chemical messenger) produced in the pancreas, or from the production of substances antigonistic to insulin, which causes it to be ineffective. Insulin is needed to turn sugar and other food into energy. In diabetes, the body either doesn't make enough insulin or can’t use its own insulin as well as it should, or both. This causes sugar to accumulate in the blood, often leading to complications. This disorder may be caused byl;

Hereditary Factors,
Pancreatic Disorder,
By disorder of endocrine glands, such as the pituitary or adrenal glands,
Autoimmune attack, ie; Beta and T-cell immune.

This disorder is classified into two types:

Type 1-Insulin Dependent Diabetes Mellitus (IDDM);
This type of diabetes mellitus results from the body's failure to produce insulin. It can occur at age from infancy up to about age 40. There is a sudden onset of signs and symptoms, which include weight loss, polyuria, polydipsia, fatigue, and the presence of glucose and ketonies in the urine. Hyperglycaemia and dehydration accelerate the development of metabolic acidosis and, if untreated, can lead to coma and death.
Type 2-Non insulin Dependent Diabetes Mellitus (NIDDM);
This type of diabetes mellitus result from a condition in which the body fails to use insulin properly, combined with relative insulin deficiency. It is more likely to occur after the age of 40. The signs and symptoms develop slowly and the individual is generally obese. This type of diabetes mellitus can go undetected, as the sign and symptoms of fatigue, polyuria and polydipsia can be quite insignificant. Diagnosis occur when the individual presents with another disease, which is a common complication of diabetes mellitus, such as, a monilial infection, cataracts, degenerative changes in the blood vessels, or peripheral neuritis.
SIGNS AND SYMPTOMS OF DIABETES MELLITUS INCLUDE: Thirst, frequent urination,
Tiredness or lack of energy,
Blurred vision,
Infection (eg. Thrush),
Weight loss (in type 1-diabetes).

The symptoms of diabetes may not appear until blood glucose levels are above approximately 15mmol/1 or higher. So, it is common to have diabetes without knowing about it.
In Australia, one adult in twelve has diabetes and the prevalence is increasing. Research has shown that for every person with known diabetes, there is another who has it but has not yet been diagnosed.

Diabetes mellitus is prone to range of complications, especially if the blood glucose level is uncontrolled. Complications include:

Hyperglycaemia - Blood sugar level higher than normal,
Diabetic ketoacidosis,
Hyperosmolar non-ketotic hyperglycaemia,
Retinopathy – Disease of retina.
Neuropathy – Disease of nervous tissue,
Cardiavascular and peripheral vascular disease,
Nephropathy- Disease of the kidney,
Hypoglycaemia (imbalance of food, exercise and medication).

DIAGNOSIC TESTS:
Blood test measure the body's use of glucose and include:
Glucose tolerance test. This test the individual fasts overnight before the administration of glucose. The test evaluates glucose absorption after its oral or intravenous administration and then the level is measured at intervals to diagnose diabetes mellitus.
Fasting serum glucose test (or fasting blood sugar). This test the