Ebook Care of people with diabetes (4/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Care of people with diabetes (4/E): Part 2
Ebook Care of people with diabetes (4/E): Part 2
Chapter 9Management During Surgical and Investigative ProceduresSURGICAL PROCEDURESKey points•Surgery induces the counter-regulatory response that can Ebook Care of people with diabetes (4/E): Part 2n increase the blood glucose 6-8 times higher than normal in people with and without diabetes. Optimal control before, during, and after surgery reduces morbidity and mortality and length of stay.•Preventing hyperglycaemia reduces the risk of adverse outcomes in people with diabetes.•Morning procedu Ebook Care of people with diabetes (4/E): Part 2res are desirable.•Insulin should never be omitted in people with Type I diabetes.•Complications should be stabilised before, during, and after surgerEbook Care of people with diabetes (4/E): Part 2
y.•Cease oral glucose lowering medicines 24-36 hours before the procedure depending on rhe particular medicine and their duration of action; but note Chapter 9Management During Surgical and Investigative ProceduresSURGICAL PROCEDURESKey points•Surgery induces the counter-regulatory response that can Ebook Care of people with diabetes (4/E): Part 2entary therapies especially herbal medicines with a high risk of interacting with conventional medicines and/or causing bleeding.•An insulin-glucosc infusion is the most effective way to manage hyperglycae-inia in the operative period.RationaleDiabetes is associated with an increased need for surgic Ebook Care of people with diabetes (4/E): Part 2al procedures and invasive investigations and higher morbidity than non-diabetics. Anaesthesia and surgery are associated with a complex metabolic andEbook Care of people with diabetes (4/E): Part 2
neuroendocrine response that involves theof People with Diabetes: 4 Manual of Nursing Practice. Fourth Edition. Trisha Dunning.<0 2014 John Wiley &: Chapter 9Management During Surgical and Investigative ProceduresSURGICAL PROCEDURESKey points•Surgery induces the counter-regulatory response that can Ebook Care of people with diabetes (4/E): Part 2nsulin resistance, gluconeogenesis, hypcrglycacmia and neutrophil dysfunction, which impairs wound healing. The stress response also occurs in people without diabetes but is more pronounced and difficult to manage in people with diabetes due to the underlying metabolic abnormalities. Advances in dia Ebook Care of people with diabetes (4/E): Part 2betes management, surgical techniques, anaesthetic medicines and intensive care medicine have significantly improved surgical outcomes for people withEbook Care of people with diabetes (4/E): Part 2
diabetes.IntroductionPeople with diabetes undergo surgery for similar reasons to those without diabetes; however, because of rhe long-term complicatiChapter 9Management During Surgical and Investigative ProceduresSURGICAL PROCEDURESKey points•Surgery induces the counter-regulatory response that can Ebook Care of people with diabetes (4/E): Part 2es, feet);•eye surgery such as cataract removal, repair retinal detachment, vitrectory;•carpal runnel decompression.Surgical-induced stress results in endocrine, metabolic and long-term effects that have implications for the management of people with diabetes undergoing surgery (see Table 9.11. Stre Ebook Care of people with diabetes (4/E): Part 2ss induces hyperglycaemia, which causes osmotic diuresis, increasedTable 9.1 Hormonal, metabolic, and long-term effects of surgery.HormonalMetabolkLooEbook Care of people with diabetes (4/E): Part 2
p-term effects if optimal blood glafOie (ontfol is not achievedE Secretion of* epinephrine, norepinephrine, ACTH, cortisol and growth hormone E secretChapter 9Management During Surgical and Investigative ProceduresSURGICAL PROCEDURESKey points•Surgery induces the counter-regulatory response that can Ebook Care of people with diabetes (4/E): Part 2cose utilisation and glycogen storage g Gluconeogenesis E Protein catabolism and reduced amino acid and protein synthesis in skeletal muscle E Lipolysis and formation of ketone bodies E Storage of fatty acids in the liver Osmotic diuresis with electrolyte loss and compromised circulating volume E Ri Ebook Care of people with diabetes (4/E): Part 2sk of cerebrovascular accident, myocardial arrhythmias infarction electrolyte disorders E Blood pressure and heart rate g PeristalsisLoss of lean bodyEbook Care of people with diabetes (4/E): Part 2
mass - impaired wound healing, s resistance to infection Loss of adipose tissue Deficiency of essential amino acids, vitamins, minerals, and essentiaChapter 9Management During Surgical and Investigative ProceduresSURGICAL PROCEDURESKey points•Surgery induces the counter-regulatory response that can Ebook Care of people with diabetes (4/E): Part 2stimulates glucagon secretion from the pancreatic alpha cells and together with growth hormone and cortisol, potentiates the effects of norepinephnne and epinephrine. Cortisol increases gluconeogenesis.Management During Surgical and Investigative Procedures 279hepatic glucose output, lipolysis and i Ebook Care of people with diabetes (4/E): Part 2nsulin resistance. Unless these metabolic abnormalities arc controlled, surgical stress increases the risk of DKA, Hyperosmolar states HHS, and lacticEbook Care of people with diabetes (4/E): Part 2
acidosis (see Chapter 7), infection, impaired wound healing, and cerebral ischaemia. The risk of HHS is high in procedures such as cardiac bypass surChapter 9Management During Surgical and Investigative ProceduresSURGICAL PROCEDURESKey points•Surgery induces the counter-regulatory response that can Ebook Care of people with diabetes (4/E): Part 2tinal instability that can compound gastric autonomic neuropathy and lead to nausea, vomiting and predispose the individual to dehydration and exacerbate fluid loss via osmotic diuresis and blood loss during surgery. As a result, electrolyte changes, particularly in potassium and magnesium, increase Ebook Care of people with diabetes (4/E): Part 2 the risk of cardiac arrhythmias, ischaemic events, and acute renal failure (Dagogo-Jack & Alberti 2002). The risk is particularly high in people withEbook Care of people with diabetes (4/E): Part 2
chronic hyperglycaemia (HbAk>8%), existing diabetes complications, older people, and those who arc obese, all of which arc associated with increased Chapter 9Management During Surgical and Investigative ProceduresSURGICAL PROCEDURESKey points•Surgery induces the counter-regulatory response that can Ebook Care of people with diabetes (4/E): Part 2quences of surgery that need to be considered when positioning the patient. The respiratory system is affected and functional residual capacity and expiratory reserve volume maybe reduced possibly due to excess weight on the chest wall and/or displacement of the diaphragm. Severe obesity can lead to Ebook Care of people with diabetes (4/E): Part 2 hypoventilation and obstructive sleep apnoea. These factors predispose the individual to aspiration pneumonia. Various cardiac changes increase the rEbook Care of people with diabetes (4/E): Part 2
isk of heart failure and inadequate tissue oxygenation. In addition. the risk of pressure ulcers is increased due to the weight, and activity level isChapter 9Management During Surgical and Investigative ProceduresSURGICAL PROCEDURESKey points•Surgery induces the counter-regulatory response that can Ebook Care of people with diabetes (4/E): Part 2 deprivation can develop because protein and carbohydrate are used as the main energysources during surgery rather than far. In addition, energy expenditure is higher, which impacts on wound healing (Mirtallo 2008). Ebook Care of people with diabetes (4/E): Part 2Chapter 9Management During Surgical and Investigative ProceduresSURGICAL PROCEDURESKey points•Surgery induces the counter-regulatory response that canGọi ngay
Chat zalo
Facebook