Diabetes, An Issue of Critical Care Nursing Clinics , livre ebook

Critical Care Nursing Clinics of NA
Diabetes
Celia M. Levesque, RN, MSN, NP-C
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
ISSN  0899-5885
Volume 25 • Number 1 • March 2013
Table of Contents
Cover image
Title page
Contributors
Forthcoming Issues
Preface
Guidelines for Care of the Hospitalized Patient with Hyperglycemia and Diabetes
Hyperglycemia and diabetes in the hospital
Identification of hyperglycemia and diabetes in the hospital
Assessing for hyperglycemia
Glycemic targets
Treatment of hyperglycemia
Treatment of hypoglycemia
Transition to outpatient care
Summary
Management of Hyperglycemia in the Intensive Care Unit
Introduction
Hyperglycemia defined
Causes of hyperglycemia among critically ill patients
Management of hyperglycemia in critically ill patients
Glycemic control in the critically ill patient
Novel approaches to glucose management
Summary
Intravenous Insulin Infusions
Introduction
Insulin infusion basics
Perioperative Care of Patients with Diabetes
Introduction
Effects of surgery on blood glucose
Assessment before surgery
Blood glucose target in the perioperative period
Adjustment of noninsulin diabetes medications
Insulin therapy in surgery patients with diabetes
Insulin therapy in long or complex surgical procedures
Sliding-scale short-acting or rapid-acting insulin
Day of surgery
Postoperative care
Summary
Hyperglycemic Management After Solid Organ Transplantation
Introduction
Current literature
Pathology
Diagnosis and treatment
Summary
Use of Noninsulin Antidiabetic Medications in Hospitalized Patients
Introduction
Classes of oral diabetes medications
Summary
Appendix A Oral and injectable noninsulin antidiabetic medications
Use of Insulin in the Noncritically Ill-hospitalized Patients with Hyperglycemia and Diabetes
Introduction
Physiology and types of diabetes
Glycemic targets in the noncritical care setting
Factors contributing to hyperglycemia in hospitalized patients
Types of insulin
Common insulin regimens in the hospital
Implications for nursing care of hospitalized patients with hyperglycemia and diabetes
Summary
Appendix Sample insulin use guideline
Management of Hypertension in Patients with Diabetes
Introduction
Incidence of hypertension in diabetes
The impact of hypertension on the development of long-term diabetes complications
Diagnosing hypertension in patients with diabetes
Blood pressure goal
Treatment of hypertension in patients with diabetes
Hypertension drug classes
Summary
Diabetes and Heart Failure
Heart failure facts
Diagnostic tools
Assessment
Treatment
Inpatient management
Case study
Summary
Diabetes Education in Hospitalized Children
Educational needs of the family and child with newly diagnosed diabetes
Safety
Simple pathophysiology
Skills
School
Support
Comprehensive diabetes self-management education
How much diabetes self-management education should occur in the hospital?
Supporting diabetes education: the critical care nurse’s role
Educating and supporting the child with repeated admissions
Summary
Management of the Hospitalized Diabetes Patient with an Insulin Pump
Introduction
Benefits of intensive insulin management
Description of the insulin pump
Modes of operation of the insulin pump
Initial dosage calculation for basal and bolus rates
Patient selection
Advantages of insulin-pump therapy
Disadvantages of insulin-pump therapy
Use of the insulin pump in hospitalized patients
Summary
Critical Care Diabetes Education
Introduction
Who should be targeted?
What to teach?
When: time, resources, and opportunity
Where… can you make a difference?
Why?
Summary
Limb Salvage for Veterans with Diabetes
Introduction
The impact of diabetes on lower limb amputation
Cost of lower limb amputations in patients with diabetes
Prevention of lower limb amputations at Michael E Debakey at VA in Houston, Texas
Index
Contributors
CONSULTING EDITOR

JAN FOSTER, PhD, RN, CNS
College of Nursing, Texas Woman’s University, Houston, Texas
EDITOR

CELIA M. LEVESQUE, RN, MSN, NP-C, CNS-BC, BC-ADM, CDE
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
AUTHORS

ASHRAF ABBAS, RN, MSN, ACNP-BC
Vascular Surgery Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas

VERONICA BRADY, MSN, FNP-BC, BC-ADM, CDE
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas

BECKY CHILDERS, RN, MSNspEd, CDE
Director of Joslin Diabetes Center Affiliate at St. Joseph Medical Center and Advanced Wound Care, St. Joseph Medical Center, Houston, Texas

KATE CRAWFORD, RN, MSN, ANP-C, BC-ADM
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas

ESPERANZA GALVAN, MS, RN, CVRN, CDE
Manager, CardioPulmonary Management Program, Harris Health System, Houston, Texas

LINDA WILLS GIBSON, RN, MSN, CRRN, ANP-C
Director of PAVE Clinic (Prevention of Amputation for Veterans Everywhere), Rehabilitation Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas

TALAR L. GLOVER, MS, RN, CNS, CDE
Director, Diabetes Service Line and Patient Education, Harris Health System, Houston, Texas

JUDY KEAVENY, RN, MSN, CNS M-S, CDE
Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas

CORI KOPECKY, MSN, RN, OCN
Clinical Nurse, The University of Texas MD Anderson Cancer Center, Houston, Texas

CELIA M. LEVESQUE, RN, MSN, NP-C, CNS-BC, BC-ADM, CDE
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas

ASHLEY MARTIN, MSN, RN, ANP-BC
Department of Endocrine Neoplasia and Hormonal Disorders, MD Anderson Cancer Center, Houston, Texas

DEBORAH MCCREA, RN, MSN, CNS, CEN, CFRN, EMT-P
Professor, Department of Emergency Medical Services, Houston Community College, Houston, Texas

JOHNNY L. ROLLINS, RN, MSN, ANP-C
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas

BARB SCHREINER, PhD, RN, CDE, BC-ADM, CPLP
Core Faculty Professor, Department of Nursing, Capella University, Minneapolis, Minnesota
Forthcoming Issues
June 2013 Summer Trauma Stephen D. Krau, PhD, RN, CNE, Editor
September 2013 Infectious Disease Cynthia Bautista, PhD, RN, CNRN, Editor
December 2013 Critical Illness in the Older Adult Sonya R. Hardin, RN, PhD, CCRN, ACNS-BC, NP-C, Editor
RECENT ISSUES
December 2012 Winter Trauma Margaret M. Ecklund, MS, RN, CCRN, ACNP-BC, Editor
September 2012 The Lungs in a Mechanical Ventilator Environment Meredith Mealer, RN, MS, CCRN and Suzanne C. Lareau, RN, MS, FAAN, Editors
June 2012 Management of ComplexWounds Janet Foster, PhD, APRN, CNS, CCRN, Editor

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Preface

Celia M. Levesque, RN, MSN, NP-C, CNS-BC, BC-ADM, CDE
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, PO Box 301402-Unit 1461, Houston, TX 77230-1402, USA
E-mail address: clevesqu@mdanderson.org


Celia M. Levesque, RN, MSN, NP-C, CNS-BC, BC-ADM, CDE, Editor
Diabetes mellitus affects 8.3% of the US population. People with diabetes are twice as likely to be hospitalized, and their length of stay is approximately 30% longer compared to patients without diabetes. The management of blood glucose and the complications of hyperglycemia in the hospitalized patient with and without diabetes are the subject of many research studies. This issue covers the current guidelines for management of diabetes and hyperglycemia in the hospitalized patient. The issue begins with a review of the general recommendations for hospitalized patients with diabetes and hyperglycemia by Crawford. Brady then discusses the management of hyperglycemia and diabetes for patients in the intensive care unit. Martin discusses indications and adjustment of an insulin drip as well as commonly used drips. Perioperative management of diabetes and hyperglycemia, discussed by Levesque, can be complicated and is crucial for the prevention of acute complications and the reduction of the risk for morbidity and mortality. The use of steroids in transplant patients commonly causes hyperglycemia in those without diabetes and uncontrolled diabetes in those with diabetes. Rollins discusses the management in patients after solid organ transplantation. The use of noninsulin diabetes medications in hospitalized patients is discussed by Kopecky. The use of insulin and commonly used insulin regimens in patients who are not critically ill are discussed by Levesque and Childers. Management of complications of diabetes is discussed in several of the articles. Gibson and Abbas discuss limb salvage; Levesque discusses hypertension management, and Glover and Galvan discuss heart failure. Diabetes education of children by Schreiner and of adults by Keaveny is important so that the patient and family can learn to self-manage their diabetes after discharge. Insulin pumps are not commonly seen in hospitalized patients and McCrea discusses the basics of insulin pump therapy as well as troubleshooting and nursing care while the patient is using the pump.
Guidelines for Care of the Hospitalized Patient with Hyperglycemia and Diabetes

Kate Crawford, RN, MSN, ANP-C, BC-ADM
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1461, Houston, TX 77030, USA
E-mail address: kcrawford@mdanderson.org

Abstract
Hyperglycemia and diabetes place hospitaliz