Diabetes Mellitus Pathophysiology & Nursing | Diabetes Nursing Lecture NCLEX | Type 1 & Type 2

hey everyone it's sarah thread sister nurse RN calm and in this video i'm going to be going over diabetes mellitus this is part of a in CLECs review series on diabetes and what i want to be doing in this video is I'm going to be hitting the pathophysiology and diabetes the complications the different types and the nursing assessment in the next video I'm going to be going over the nursing interventions and I'm going to hit really hard on the forma logical aspects of taking care of a diabetic patients the education and the teaching and I'm gonna give you some clever mnemonics on how to remember that stuff because it's a lot of stuff that you need to know for the NCLEX and your nursing lecture exams and then I'll be having some more videos coming out about DKA hhns syndrome and all those things you need to know about diabetes so make sure you access the playlist enric and playlist so you can get access to those videos now after this lecture be sure to go to my website register nurse RN calm and take the free quiz a card should be popping up to test your knowledge on diabetes okay so let's get started okay first let's talk about the key players in diabetes because if you understand what's going on normally in the body you're going to understand why the diabetic patient is having all of these issues so the big key players in diabetes is glucose insulin glucagon and the liver and all of these work together to help your body use glucose because the big issue with diabetes is an issue with insulin and I'm here to say you'll see why that's an issue okay so first let's talk about blue COEs what is glucose glucose is sugar and your body loves sugar because your body needs it to survive and what sugar does is it enters into the cell or the glucose enters into the cell and fuels those cells so they can work but the catch is is that glucose cannot enter into your cell without the help of insulin so in order you eat all this sugar you take it in and enters your bloodstream but for glucose to actually go into yourself or your to use it has to have the help of in Flint and if you don't have any insulin at all then you're not going to have the ability to use the glucose and the glucose is just going to hang out in your bloodstream and cause high blood sugars which wreaks have it on havoc on the body now glucose is mainly stored in the liver in the form of glycogen which we'll go over in depth here in a second okay insulin what is insulin insulin is a hormone and it plays a huge role in helping us bring those blood sugar levels down because like I said it regulates the amount of glucose in your body it attaches let's glucose attached to it and it takes it inside that cell so you can use it and the big thing that you want to remember is that insulin is secreted by your pancreas by the beta cells of the pancreas in the inlets of the Langerhans cells so if this area of the body the beta cells in the pancreas get damaged then you're in trouble you're not going to have any insulin production now let's talk about glucagon what is glucagon it works in the opposite of insulin insulin helps us bring our sugars down glucagon helps us increase our blood sugar so it helps with low blood sugar levels and what it does is it causes the liver because your liver will store this glucose and if you have extra glucose in the body the liver will take it and store it and turn it into glycogen and whenever glucagon is released it will cause that liver to release that glycogen that it's stored up and turn it into glucose so you can get that glucose in your body and increase your blood sugar levels now the liver that's our last key player the liver is very sensitive to insulin levels in your body it's whenever it senses that you have too high of insulin levels and you have high blood sugar levels it starts doing its job but if you have low insulin levels you have low blood sugar it also helps with that so it's very vital in helping us keep those levels nice and normal so whenever you have high blood sugar and high insulin level the liver will cause the body to absorb that extra glucose and will turn it into glycogen so you can use it later on but didn't say all of a sudden your glucose drops and your insulin levels will drop as well the liver will sense that and this will cause the liver to release those stores of the glycogen which will turn into glucose and increase your blood sugar so it helps with that now let's recap about the feedback loop what happens normally in the body and someone who doesn't have diabetes and then let's talk about what's happening in someone with diabetes okay so you have a high blood sugar you a and drank a bunch of sugary stuff so what does your body do the pancreas says hey there's a lot of blood there's a lot of glucose in our body so we need to use that so the pancreas releases insulin and the insulin causes the glucose to enter into the cells and there may be some left over and the leftover will go into the liver and the liver will store it for later and turn it into glycogen and then use it whenever you need it now say you have low blood sugar you've been working all day as a nurse and you have an eight so your blood Sugar's level low is a level is low so what will your body do because it wants he'll protect you the pancreas will release glucagon now remember glucan works in the opposite of insulin and this will cause the liver to release glycogen remember all those stores that stored up from all that extra glucose and this will turn into glucose which will increase your blood sugar so that is what's happening in someone who doesn't have diabetes who has a normal healthy pancreas and they don't have insulin issues but what is happening to someone with diabetes okay what's happening is that the bought you're eating all your sugar eating your food but the body cannot get to that sugar that glucose that you're eating and this is either due to there's no insulin present either of those beta cells in the pancreas were damaged or the body is resist to insulin you and your secreting insulin perfectly but those cells are like we don't want that and they're not receptive to that insulin so you can't use it and in type one there's no insulin present in type two the body is resistant to insulin which will go end up here in a second and whatever that happens because your body's not using glucose you get hyperglycemia where you have an elevated blood sugar in the body and it just hangs out now when glucose hangs out in your body this is not good it's not meant to do that so it starts to affect major organs of the body and the body says hey we need some energy these cells need to be able to work since we can't get the glucose we've got to burn energy some other way so it will start to burn fats ketones which are acids and this happens in your type 1 diabetics and whenever you're burning those fats and those assets it's thrown the whole body out of whack it's going to cause some major acid and base and balances which we talked about in depth and metabolic acidosis and alkalosis or with the type 2 diabetics what's happening is that there is enough insulin there's just enough where your body is we're not receptive to it so it doesn't burn those fats but instead it doesn't use the card so they're having issues with carbohydrate metabolism now what causes diabetes mellitus the causes are separated into three different types you have type 1 type 2 and gestational so let's talk about type 1 ok type 1 remember this is where the patient does not have any insulin and what's happened is that those beta cells in the insolate of the llegaron which is in your pancreas have been destroyed they're not working properly at all so there is no insulin for this for this patient so in order for treatment they have to take insulin now this is not related to lifestyle like with your type 2 diabetics this is either genetic autoimmune for instance and they got a virus that went in route havoc on the body and the body attacked itself specifically those beta cells in the pancreas and it just doesn't work anymore now how do these patients present I would remember this this is important and these patients are going to be thin because they're burning all that fat off because the body needs energy so they're burning all those fats and ketones they're going to be young normally this happens in children and it's going to happen all of a sudden and there's going to be ketones present in the urine where the body is breaking down those fats now type 2 diabetics what's happening here the cells have quit responding to insulin so it's insulin resistant they don't care about the insulin and you can secrete insulin all day and they're not going to have anything to do with it and so what happens the glucose just hangs out in the body but it's like a catch-22 all this insulin is it's being produced it's nice and fine but the cells just don't want anything to do with it but you still have all this glucose and the pancreas thinks you need more insulin because it senses that you have all this glucose still in the body so it starts to over secrete insulin and you start getting the condition called hyperinsulinemia which will lead to metabolic syndrome so not good and treatment for this is normally the patient and they will the doctor will order diet and exercise that normally helps with that but if that's not successful they will start them on oral medications which we will cover in the next video in depth and and these patients normally don't take insulin but they may need insulin injections in there having lost stress on the body like with surgery or with infections so that's something just to keep in mind and this is generally type 2 diabetes is related to lifestyle either due to be nobies having a sedentary lifestyle poor diet lots of colas things like that and genetic now how do these patients for example what do they typically look like they're typically overweight and it happens over time there are usually adult age teenage age and it's very rare for them to have ketones in the because remember back to this they don't have an issue with metabolizing the fats because there's just enough insulin but they have issues with metabolizing those carbohydrates now gestational just wanted to throw that in that is a dip that's another type and it's similar to your type-2 diabetes and this is where the cells are not receptive and it happens in pregnant women and it will usually go away after birth now let's look at the complications of diabetes and the nursing assessment first let's talk about complications okay complications with diabetes you can have hypoglycemia organ problems diabetic ketoacidosis also called DKA or hyperglycemic hyperosmolar nonketotic syndrome which we will refer to as h h ns so let me go over these in detail okay hypoglycemia this is the opposite of hyperglycemia hypo means low gly means glucose and emia means blood so we have low blood glucose in the blood usually it's around less than 60 milligrams per deciliter now whenever patients have this this is usually a side effect from too much insulin or too much oral diabetic medication which we'll go over in the next video but they're going to present as being sweaty and clammy confused lightheaded dizzy and double vision now to help you remember how to treat someone with hypoglycemia because you want to treat it fast and remember the same I'm sweaty cold and clammy give me some candy so these patients who are having hypoglycemia need a simple carb remember that and I remember a test question from nursing school and it gave us the glucose and it said what would be a treatment and what the option was simple carb complex carb and listed all these things but it's a simple carb of what they need and simple carbs are like your hard candies like lifesavers and fruit juice graham crackers honey things like that that can hit the body body can absorb and take in and use now if the patients unconscious they can't eat and normally in the hospital setting whatever the doctor orders you will of them IV d50 okay now let's look at organ problems okay glucose think about it in our real life sugar if you get sugar on your hands it's really sticky the same concept can apply to whenever it gets you get way too much in the blood what it does is it causes atherosclerosis I'm hardly of the vessels now what this does is this glucose enters into the blood glucose is naturally sticky so it's going to start to stick to those proteins of the vessels and they become hard and they form plaques and normally your vessels are nice and pliable and they're not hard and when they're hard they don't work properly so let's think of all the systems in the body that are affected by hard vessels your heart you can get heart disease gonna stick on those coronary arteries make them hard blood flow is going to be narrow and there's also some plaques that can form can cause an mi myocardial infarction strokes and a lot of strokes happen without weakening of those vessels of hypertension again you have stiff hard vessels that's going to increase um resistance on your vessels causing hypertension neuropathy decreased wound healing again that is because and your you have decreased compromised circulation from those hardening of those vessels you can't get all that and all those cells there to work to help heal that wound so they will have slow wounds on their feet especially on their feet I trouble and infections okay let's look at diabetic ketoacidosis dk8 now and the other videos coming up in this series we're going to go in depth about DKA treatments and all that we're going to actually compare it with hhns because people get these two conditions confused but let me help break it down for you so you can understand it a little bit okay DKA this happens in your type 1 diabetics it's super rare to happen and type 2 it's type 1 so keep that in mind and another issue with this is they are burning ketones let the name help you out diabetic ketoacidosis okay remember what we were talking about diabetes type 1 they don't have any insulin insulin helps glucose go into the cell for energy so the body's like hey we don't have anything for energy so we've got to start burning fats ketones so what happens is that the body is burning those ketones like crazy and this is causing acids to enter into the blood one of those ketones break down and then you're getting some acid-base and balances this is life-threatening they need to be treated and how your patients going to present they're going to have extremely high blood sugars and they're going to be very thirsty and they're going to have the cosmos breathing remember that that's because all that acid build up in the body and respiratory system is trying to blow off that acid by those deep long and breaths rapid breaths and they can also have the acetone breath which is like that fruity smell in their breath and that's just because of all those ketones breaking out now let's let's look at hhns okay this happens typically in your type two diabetics and part of HHS the N stands for non-ketotic so there is no breakdown of ketones in this because remember with type 2 diabetes they have just enough insulin where they don't have to break me on the fats and said they have carbohydrate issues so I'm where you're going to have is no burning of the ketones you're just going to have a dehydration the patient's going to be very dehydrated they're going to be thirsty and they're gonna have mental status changes and their blood sugars are going to be crazy high but there's going to be no ketone tissues now how is the patient going to present to you and whenever you're assessing them what signs and symptoms are they going to have okay you'll want to remember this these are typically test questions okay the three P's for hyperglycemia because the issue with diabetes is they have high blood sugars so the three peas which are polyuria polydipsia and polyuria polyuria is where poly means many and urea means urine so they're having frequent urination they are peeing a lot they're going to want a urine output why is this happening okay this happens because of the rule of all's mices remember in our high tonic isotonic hypotonic video and we talked about osmosis this is where water likes to be where there's a higher concentration so it's going to move to a higher concentration lower concentration higher concentration and what's happened is there's all this glucose in your blood and this cells inside the cells there's water and the waters like hey all the glucose is in the blood let's move out of the cell and go into the bloodstream so you have all this water shifting into the blood that causes a lot of fluids so what system of the body gets rid of extra fluid the kidneys so the kidneys start putting out all this extra fluid you have but also whenever the kidneys is doing that one of the roles is that it reabsorbs glucose but there's way too much glucose in the blood so the kidneys can't cope with this so they start linking glucose so you're going to see glycosuria that means you're going to see glucose in their urine next they're going to have polydipsia and this plays into the poly area all these play off of each other so polydipsia poly means many dips here means thirst drinking so they're going to be very thirsty and this is because of the polyuria because they're putting out all this fluid the body's like hey we got to keep drinking to keep hydrating ourselves because we're putting all this water and then the polyphagia that means they're very hungry they're just constantly craving food and this ties back to burning all those fats all those ketones and the body needs the energy because it can't get to the glucose so the boys like hey we've got to eat keep eating food so we can keep burning this energy and these three peas are mainly seen in your type one diabetics okay now let's look at another mnemonic remember the word sugar this is what you're going to see and both the type one and the type two okay s4 slow wound-healing again that's because of that glucose being sticky harden in those vessels so you have decreased perfusion to help heal those wounds they you blurry blurry vision again that's because the damage to the eyes with all that glucose Glasco urea that's where the kidneys can't cope with all that extra glucose so it leaked into the under in a for acetone breath that is mainly seen in your type ones and that's because of the burning that the ketones it gives off that fruity smell of the breath our four rashes on the skin and repeated yeast infections in women because yeast love glucose if you have too much glucose yeast is going to build up and they have repeated vaginal infections of geese okay so that is about diabetes mellitus now don't forget to take that free quiz I you should get the card or it's down in the description below and be sure to check out that other video where I'm going over the nursing interventions where I'm coming covering the pharma logical aspects of treatment of diabetes and thank you so much for watching and please consider subscribing to this YouTube channel

Channel: RegisteredNurseRN

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Keywords: diabetes mellitus, diabetes made simple, diabetes mellitus pathophysiology, diabetes mellitus nursing, diabetes medications, diabetes mellitus type 1, diabetes mellitus type 2, diabetes mellitus crash course, diabetes nursing, diabetes nursing lecture, diabetes nclex, diabetes nursing care, diabetes nursing school, nclex diabetes mellitus, nclex diabetes

Id: Ek6hnu1zaog

Length: 20min 29sec (1229 seconds)

Published: Wed May 18 2016