Nursing Care for Children with Diabetes Mellitus

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					Nursing Care for Children with Diabetes
                   Mellitus
‫ﻣﺮﺍﻗﺒﺖ ﻫﺎی ﻧﺮﺳﻨگ ﺩﺭﻧﺰﺩ ﺍﻃﻔﺎﻝ ﻣﺼﺎﺏ ﺑﻪ ﺩیﺎﺑﺖ ﻣﻠیﺘﻮﺱ‬




                                          AFAMS
     01/08/2012
   Nursing Care for Children with Diabetes
                     Mellitus
    ‫ﻣﺮﺍﻗﺒﺖ ﻫﺎی ﻧﺮﺳﻨگ ﺩﺭﻧﺰﺩ ﺍﻃﻔﺎﻝ ﻣﺼﺎﺏ ﺑﻪ ﺩیﺎﺑﺖ‬
                     ‫ﻣﻠیﺘﻮﺱ‬
Learning Objective: Nursing students          ‫ﻫﺪﻑ آﻤﻮﺯﺵ: ﺷﺎگﺮﺩﺍﻥ ﻧﺮﺳﻨگ ﺍﻫﻤیﺖ‬
will gain an understanding of nursing       ‫ﻣﺮﺍﻗﺒﺖ ﻫﺎی ﻧﺮﺳﻨگ ﺩﺭﻧﺰﺩ ﺍﻃﻔﺎﻝ ﻣﺼﺎﺏ ﺑﻪ‬
care for children with diabetes mellitus.     .‫ﺩیﺎﺑﺖ ﻣﻠیﺘﻮﺱ ﺭﺍ ﺩﺭیﺎﻓﺖ ﺧﻮﺍﻫﻨﺪ ﻧﻤﻮﺩ‬
Estimated Time to Complete: 210             :‫ﺯﻣﺎﻥ ﺗﻌیﻦ ﺷﺪﻩ ﺑﺮﺍی ﺗکﻤیﻞ ﺍیﻦ ﻟکچﺮ‬
minutes.                                                               .‫012 ﺩﻗیﻘﻪ‬




                                                                        AFAMS
        Terminal Learning Objective
             ‫ﺍﻫﺪﺍﻑ ﻧﻬﺎﺋی آﻤﻮﺯﺵ‬
Given a scenario of a         ‫ﻳﻚ ﺳﻨﺎﺭﻳﻮ ﻛﻪ ﻣﺮﺑﻮﻁ ﺑﻪیک‬
   pediatric patient with      ‫ﻃﻔﻞ کﻪ ﻣﺼﺎﺏ ﺑﻪ ﺩیﺎﺑﺖ‬
   diabetes mellitus,       ‫ﻣﻠیﺘﻮﺱ ﺍﺳﺖ،ﺍﺭﺍﺋﻪ گﺮﺩیﺪﻩ‬
   provide safe and           ‫ﻣﺮﺍﻗﺒﺖ ﻫﺎی ﻣﺼﺌﻮﻥ ﻭﻣﻮﺛﺮ‬
   effective care.
                              .‫ﺑﺮﺍی ﻣﺮیﺾ ﺍﺟﺮﺍ گﺮﺩﺩ‬




                                              AFAMS
       Enabling Learning Objectives
             ‫ﺍﻫﺪﺍﻑ ﺗﻮﺍﻧﺎﺋی آﻤﻮﺯﺵ‬
A: Describe the pathophysiology,
                                       ‫:پﺘﻮﻓﺰیﻮﻟﻮژی، ﺍﺳﺒﺎﺏ، ﺗﺼﻨیﻒ ﺑﻨﺪی‬A
   etiology, classification and         ‫ﻭ ﺍﺟﺮﺍ ﺗﺴﺖ ﻫﺎی ﺗﺸﺨﺼیﻪ ﺧﻮﻥ ﺭﺍ‬
   diagnostic blood test for               ‫ﺩﺭﻧﺰﺩیک ﻃﻔﻞ ﻣﺼﺎﺏ ﺑﻪ ﺩیﺎﺑﺖ‬
   diabetes mellitus in children                  .‫ﻣﻠیﺘﻮﺱ ﺗﺸﺮیﺢ ﻧﻤﺎیﺪ‬
D: Determine appropriate nursing       ‫: ﻣﺮﺍﻗﺒﺖ ﻫﺎی ﻧﺮﺳﻨگ ﺑﻪ ﻃﻮﺭ ﻣﻨﺎﺳﺐ‬D
   care for a child with type I       ‫ﺩﺭﻧﺰﺩ یک ﻃﻔﻞ کﻪ ﻣﺼﺎﺏ ﺑﻪ ﺩیﺎﺑﺖ‬
   diabetes, including diabetic                ‫ﺗﺎیپیک ﺑﻪ ﺷﻤﻮﻝ ﺩیﺎیﺒیﺘک‬
   ketoacidosis                              .‫کیﺘﻮﺍﺳیﺪﻭﺯ ﺍﻧﺪ، ﺍﺟﺮﺍ گﺮﺩﺩ‬
C: Determine the best approach to        ‫: ﺑﻬﺘﺮیﻦ ﺷیﻮﻩ ﻫﺎی ﺭﺳیﺪﻩگی ﺭﺍ‬C
   teaching a child and family               ‫ﺑﺮﺍی ﻃﻔﻞ ﻣﺼﺎﺏ ﺑﻪ ﺩیﺎﺑﺖ ﻭ‬
   about diabetes, including blood     ‫ﻓﺎﻣیﻞ ﻣﺮیﺾ آﻤﻮﺯﺵ ﺩﺍﺩﻩ ﺷﻮﺩ کﻪ‬
   glucose self-monitoring
                                      ‫ﺍیﻦ ﺷیﻮﻩ ﻫﺎ ﺷﺎﻣﻞ ﻣﺎﻧیﺘﻮﺭگﻠﻮکﻮﺯ‬
D: Describe the nurse's role in the         .‫ﺧﻮﻥ ﺗﻮﺳﻂ ﺧﻮﺩ ﺷﺨﺺ ﻣیﺒﺎﺷﺪ‬
   nutritional management of
   diabetes in children                      ‫: ﺍﺻﻮﻝ ﻧﺮﺳﻨگ ﺩﺭﺑﺎﺭﻩ ﻣﻨﺠﻤﻨﺖ‬D
                                       ‫ﺗﻐﺬیﻪ ﺍﻃﻔﺎﻝ ﻣﺼﺎﺏ ﺑﻪ ﺩیﺎﺑﺖ ﺷﺮﺡ‬
                                                                .‫ﺩﺍﺩﻩ ﺷﻮﺩ‬


                                                                AFAMS
       Enabling Learning Objectives
             ‫ﺍﻫﺪﺍﻑ ﺗﻮﺍﻧﺎﺋی آﻤﻮﺯﺵ‬
E: Examine the challenges of      ‫: چﺎﻟﺶ ﻫﺎی ﻣﻨﺠﻤﻨﺖ ﺍﻧﺴﻮﻟیﻦ ﺭﺍ‬E
    insulin management in          .‫ﺩﺭﻧﺰﺩ یک ﻃﻔﻞ ﺑﺎﺯﺭﺳی ﻧﻤﺎیﺪ‬
    children                         ‫: ﺟﻨﺒﻪ ﻫﺎی ﻣﺨﺘﻠﻒ ﻣﻨﺠﻤﻨﺖ ﺭﺍ‬F
F: Identify various aspects of           ‫ﺩﺭﺍﻃﻔﺎﻝ ﻣﺼﺎﺏ ﺑﻪ ﺩیﺎﺑﺖ‬
    home management of                     .‫ﺩﺭﺧﺎﻧﻪ ﻣﺸﺨﺺ ﻧﻤﺎیﺪ‬
    children with diabetes
    mellitus                            ‫: پﺮﻭﺳﻪ ﻧﺮﺳﻨگ کﻪ ﺷﺎﻣﻞ‬G
                                       ‫ﺗﺸﺨیﺺ، ﻣﺪﺍﺧﻼﺕ ﻭﻧﺘﺎیﺞ‬
G: Describe the nursing            ‫ﻣﺘﻮﻗﻊ ﻧﺮﺳﻨگ ﻣیﺒﺎﺷﺪ، ﺩﺭﺍﻃﻔﺎﻝ‬
    process to include nursing
    diagnosis, interventions,           ‫ﻣﺼﺎﺏ ﺑﻪ ﺩیﺎﺑﺖ ﻣﻠیﺘﻮﺱ‬
    and expected outcomes,                        .‫ﺗﺸﺮیﺢ گﺮﺩﺩ‬
    of a pediatric patient with
    diabetes mellitus




                                                          AFAMS
                     Diabetes Mellitus
                       ‫ﺩﻳﺎﺑﺖ ﻣﻠیﺘﻮﺱ‬
•   Chronic metabolic condition           ،‫• ﺩﺭﺗﺸﻮﺷﺎﺕﻣیﺘﺎﺑﻮﻟیک ﻣﺰﻣﻦ‬
    in which the body is unable to        ‫ﺑﺪﻥ ﺗﻮﺍﻧﺎﺋی آﻦ ﺭﺍ ﻧﺪﺍﺭﺩ ﺗﺎ ﺍﺯ‬
    use carbohydrates properly          ‫کﺎﺭﺑﻮﻫﺎیﺪﺭیﺖ ﺍﺳﺘﻔﺎﺩﻩ ﻧﻤﺎیﺪ‬
    because of insulin deficiency    .‫ﺯیﺮﺍ ﻓﻘﺪﺍﻥ ﺍﻧﺴﻮﻟیﻦ ﻣﻮﺟﻮﺩ ﺍﺳﺖ‬
•   Facts:                                                       ‫• ﺣﻘﺎیﻖ‬
     – Highest between 5-7 years       ‫– ﺑﻠﻨﺪﺗﺮیﻦ ﻭﻗﺎیﻊ ﺑیﻦ ﺳﻨیﻦ‬
        and 11-13 years                     ‫5- 6 ﻭ11- 31 ﻣیﺒﺎﺷﺪ‬
     – Type I most common               ‫–ﺗﺎیپ ﺍﻭﻝ آﻦ ﺑیﺸﺘﺮیﻦ ﻧﻮﻉ‬
        endocrine disorder in              ‫ﺗﺸﻮﺷﺎﺕ ﺍﻧﺪﻭکﺮﺍیﻦ ﺭﺍ‬
        children                           .‫ﺩﺭﺍﻃﻔﺎﻝ ﻧﺸﺎﻥ ﺩﺍﺩﻩ ﺍﺳﺖ‬




                                                               AFAMS
                    ‫‪Pathophysiology‬‬
                      ‫پﺘﻮﻓﺰیﻮﻟﻮژی‬
                       ‫ﺗﺮﺷﺢ ﺍﻧﺴﻮﻟیﻦ ﺩﺭ‬
                          ‫ﺟﺮیﺎﻥ ﺧﻮﻥ‬


                       ‫ﻋﺮﻭﻕ ﺷﻌﺮیﻪ ﺩﻣﻮی‬




‫ﺣﺠﺮﺍﺕ ﺗﻮﻟیﺪ کﻨﻨﺪﻩ‬                        ‫ﺗﺨﺮیﺐ ﺣﺠﺮﺍﺕ ﺗﻮﻟیﺪ کﻨﻨﺪﻩ‬
     ‫ﺍﻧﺴﻮﻟیﻦ‬                                     ‫ﺍﻧﺴﻮﻟیﻦ‬

                                                          ‫‪AFAMS‬‬
                     Pathophysiology
                        ‫پﺘﻮﻓﺰیﻮﻟﻮژی‬
•   Beta cells of pancreas             ‫• ﺣﺠﺮﺍﺕ ﺑیﺘﺎ پﺎﻧﻘﺮﺍﺱ ﺍﻧﺴﻮﻟیﻦ‬
    deficient in insulin production                     .‫ﺭﺍ ﺗﻮﻟیﺪﻧﻤیکﻨﺪ‬
•   Insulin deficiency impairs           ‫• ﻓﻘﺪﺍﻥ ﺍﻧﺴﻮﻟیﻦ ﺳﺒﺐ ﻋﺪﻡ ﺍﻧﺘﻘﺎﻝ‬
    glucose transport into all        .‫گﻠﻮکﻮﺯ ﺑﻪ ﺗﻤﺎﻡ ﺣﺠﺮﺍﺕ ﻣیﺸﻮﺩ‬
    cells of the body                         ‫• ﺑﺪﻥ ﻗﺎﺩﺭﻧیﺴﺖ ﺗﺎ ﺷﺤﻢ ﺭﺍ‬
•   Body unable to store and                  ‫ﺫﺧیﺮﻩ ﻭ ﺍﺯآﻦ ﺑﻄﻮﺭ ﻣﻨﺎﺳﺐ‬
    utilize fats properly; decrease       ‫ﺍﺳﺘﻔﺎﺩﻩ ﻧﻤﺎیﺪ ﻭﺳﻨﺘیﺰ پﺮﻭﺗیﻦ‬
    in protein synthesis
•   As blood glucose increases, it
                                                           .‫کﺎﻫﺶ ﻣیﺎﺑﺪ‬
    spills into the urine, diuresis           ‫•ﺯﻣﺎﻧیکﻪ ﺳﻮیﻪ گﻠﻮکﻮﺯ‬
    occurs, ketones accumulate             ‫ﺩﺭﺧﻮﻥ ﺍﻓﺰﺍیﺶ یﺎﺑﺪ، ﺩﺭﺍﺩﺭﺍﺭ‬
•   Untreated can lead to coma             ‫ﺍﻃﺮﺍﺡ ﺷﺪﻩ ، ﺩیﻮﺭﺱ ﺑﻪ ﻭﺟﻮﺩ‬
    and death                           .‫آﻤﺪﻩ ﻭکیﺘﻮﻥ ﻫﺎ ﺗﺠﻤﻊ ﻣیﻨﻤﺎیﺪ‬
                                            ‫• ﻫﺮگﺎﻩ ﻣﺮیﺾ ﺗﺪﺍﻭی ﻧﺸﻮﺩ‬
                                               ‫ﺳﺒﺐ کﻮﻣﺎ ﻭﻣﺮگ ﻣﺮیﺾ‬
                                                                 .‫ﻣیگﺮﺩﺩ‬

                                                              AFAMS
Pathophysiology
  ‫پﺘﻮﻓﺰیﻮﻟﻮژی‬




                  AFAMS
                              Etiology
                              ‫ﺍیﺘﻮﻟﻮژی‬
•   Autoimmune disease                                ‫• ﺍﻣﺮﺍﺽ ﺍﺗﻮ ﺍﻣیﻮﻥ‬
•   A trigger, or stressor causes      ‫• ﺍﺳﺒﺎﺏ ﻓﺸﺎﺭی ﺳﺒﺐ ﺗﺨﺮیﺐ ﺣﺠﺮﺍﺕ‬
    destruction of the beta cells in           ‫ﺑیﺘﺎ ﺩﺭ ﺟﺰﺍیﺮ ﻻﻧگﺮﻫﺎﻧﺲ‬
    the islets of Langerhans in the                   .‫پﺎﻧکﺮﺍﺱﻣیگﺮﺩﺩ‬
    pancreas                                      ‫• ﻣﻌﻤﻮﻟی ﺗﺮیﻦ ﺗﺸﻮﺷﺎﺕ‬
•   Most common endocrine                    ‫ﺍﻧﺪﻭکﺮﺍیﻨی ﺩﺭ ﻫﻨگﺎﻡ ﻃﻔﻠیﺖ‬
    disorder of childhood                                       .‫ﻣیﺒﺎﺷﺪ‬
•   Physical, emotional, and           ‫ﻓﺰیکی، ﺍﺣﺴﺎﺳﺎﺗی ﻭ ﺭﺷﺪپی آﻤﺪ ﻫﺎ‬ •
    developmental consequences                    ‫• ﺍﺧﺘﻼﻃﺎﺕ ﻃﻮیﻞ ﺍﻟﻤﺪﺕ‬
•   Long-term complications             ‫• ﺗﺪﺍﻭی ﻃﻮﺭی پﻼﻥ گﺮﺩﺩ ﺗﺎ ﻧﺸﻮ‬
•   Treatment designed to optimize         ‫ﻭ ﻧﻤﻮ، ﺍﻧکﺸﺎﻑ ﺑیﺸﺘﺮ ﻭ کﺎﻫﺶ‬
    growth and development and                           .‫ﺍﺧﺘﻼﻃﺎﺕ گﺮﺩﺩ‬
    minimize complications




                                                               AFAMS
                         Classification
                          ‫ﺗﺼﻨیﻒ ﺑﻨﺪی‬
•   Type I: absolute or complete       ‫: ﻓﻘﺪﺍﻥ آﺸکﺎﺭ یﺎ کﺎﻣﻞ‬I‫ﺗﺎیپ‬  •
    insulin deficiency                                       ‫ﺍﻧﺴﻮﻟیﻦ‬
•   Type II: insulin resistance       ‫: ﻣﻘﺎﻭﻡ ﺩﺭﻣﻘﺎﺑﻞ ﺍﻧﺴﻮﻟیﻦ‬II ‫ﺗﺎیپ‬
                                                                   •
•   Maturity-onset diabetes of
                                   ‫• ﺷﺮﻭﻉ ﺩیﺎﺑﺖ ﺩﺭ ﻧﻮﺟﻮﺍﻧﺎﻥ کﻪ ﺑﻪ‬
    youth
                                            ‫ﺳﻦ پﺨﺘﻪگی ﺭﺳیﺪﻩ ﺍﻧﺪ‬
                                                   ‫• گﺴﺘﺸﻨﻞ ﺩیﺎﺑﺖ‬
•   Gestational diabetes




                                                             AFAMS
Diagnostic Blood Tests
 ‫ﺗﺴﺖ ﻫﺎی ﺗﺸﺨﺼیﻪ ﺧﻮﻥ‬




                         AFAMS
               Diagnostic Blood Tests
                ‫ﺗﺴﺖ ﻫﺎی ﺗﺸﺨﺼیﻪ ﺧﻮﻥ‬
•   Blood glucose                              ‫• ﺗﻌیﻦ ﺳﻮیﻪ گﻠﻮکﻮﺯ ﺧﻮﻥ‬
•   Fasting blood glucose - requires    – ‫• ﺗﺴﺖ ﺗﻌیﻦ ﺳﻮیﻪ گﻠﻮکﻮﺯ ﺧﻮﻥ‬
    over night fast and collected      ‫ﺿﺮﻭﺭﺕ ﺍﺳﺖ ﺗﺎ ﻣﺮیﺾ ﺍﺯ ﻃﺮﻑ ﺷﺐ‬
    first thing in the morning          ‫چیﺰی ﻧﺨﻮﺭﺩ ﻭ ﺍﻭﻟیﻦ ﺍﻗﺪﺍﻡ ﺟﻤﻊ آﻮﺭی‬
•   Glucose tolerance test -If
                                                   ‫ﺧﻮﻥ ﺩﺭ ﺻﺒﺢ ﺍﺟﺮﺍ گﺮﺩﺩ‬
    glucose concentration is greater
                                         – (GTT) ‫• گﻠﻮکﻮﺯ ﺗﻮﻟﺮﺍﻧﺲ ﺗﺴﺖ‬
    than 200 mg/dl it is considered
                                        ‫ﺩﺭﺻﻮﺭﺗیکﻪ ﺍﺷﺒﺎﻉ گﻠﻮکﻮﺯ ﺑیﺸﺘﺮ‬
                                        ‫( ﻣﺜﺒﺖ ﺗﻠﻘی‬GTT) ‫002 ﺑﺎﺷﺪ‬mg/gl ‫ﺍﺯ‬
    positive(GTT)  
                                                                   ‫ﻣیگﺮﺩﺩ‬
•   Glycosylated hemoglobin test         ‫•گﻼیکﻮﺳیﻠﺘﺪ ﻫیﻤﻮگﻠﻮﺑیﻦ ﺗﺴﺖ‬
    (HbAlc) - reflects glycemic        ‫– ﺳﻮیﻪگﻠیﺴﻤیک ﺭﺍ ﺩﺭ ﺑیﺶ ﺍﺯیک‬
    levels over a period of months                     ‫ﻣﺎﻩ ﻣﻨﻌکﺲ ﻣیﻨﻤﺎیﺪ‬




                                                                   AFAMS
                      Manifestations
                      ‫یﺎﻓﺘﻪ ﻫﺎی کﻠیﻨکی‬
•   Classic triad of symptoms:                        ‫• ﺳﻪ ﻋﺮﺽکﻼﺳیک‬
     – Polyuria:excessive thirst                       ‫- پﻮﻟی یﻮﺭیﺎ‬
     – Polydipsia: excretes large                     ‫- پﻮﻟی ﺩپﺴیﺎ‬
        amount of urine                                  ‫- پﻮﻟی ﻓﺠیﺎ‬
     – Polyphagia: constantly                           ‫• ﺑی ﺣﺎﻟی، ﺿﻌیﻔی‬
        hungry                          ‫• ﻣﻤکﻦ ﺩﺭﻧﺰﺩ ﻣﺮیﺾ ﺍﺿﻄﺮﺍﺏ‬
•   Lethargy, weakness              .‫ﺩیﺪﻩ ﺷﻮﺩ ﻭ ﺿیﺎﻉ ﻭﺯﻥ ﻣﻌﻤﻮﻝ ﺍﺳﺖ‬
•   May see anorexia; weight loss    ‫• ﺍﻧﺘﺎﻧﺎﺕ ﻧکﺲ کﻨﻨﺪﻩ ﻫﻤﺮﺍﻩ ﺑﺎ ﺍﻧﺘﺎﻧﺎﺕ‬
    common                                       ‫ﺍیﺴﺖ ﻣﻬﺒﻠی ﺩﺭﺟﻨﺲ ﻣﻮﻧﺚ‬
•   Recurrent infections with
    vaginal yeast infections in
    females




                                                                  AFAMS
                   Type 1 – Diabetes
                     ‫ﺗﺎیپ 1 - ﺩیﺎﺑﺖ‬
          Type 1‫ﻧﻮﻉ ﺍﻭﻝ‬                       Diabetes‫ﺩیﺎﺑﺖ‬

Body size‫ﺷﺮﻭﻉ‬                     Normal or thin‫ﻧﻮﺭﻣﺎﻝ یﺎ ﻻﻏﺮ‬
Onset‫ﺍﻧﺪﺍﺯﻩ ﺑﺪﻥ‬                   Abrupt‫ﻧﺎگﻬﺎﻧی‬
Blood glucose‫ﺳﻮیﻪ گﻠﻮکﻮﺯ‬          Fluctuates with exercise and
‫ﺩﺭﺧﻮﻥ‬                             Infection
                                  ‫ﺑی ﺛﺒﺎﺗی ﺑﺎ ﺗﻤﺮیﻨﺎﺕ ﻭ ﺍﻧﺘﺎﻥ‬
Ketoacidosis‫کیﺘﻮﺍﺳیﺪﻭﺯﺱ‬           Common‫ﻣﻌﻤﻮﻝ‬
Sulfonylurea responsiveness       Rare‫ﻧﺪﺭﺗ‬
‫پﺎﺳﺦ ﺩﻫی ﺩﺭﻣﻘﺎﺑﻞ ﺳﻠﻔﻮﻧﺎیﻞ یﻮﺭیﺎ‬
Insulin required‫ﺿﺮﻭﺭﺕ ﺍﻧﺴﻮﻟیﻦ‬     All‫ﺗﻤﺎﻣﺎ‬

Insulin dosage‫ﺩﻭﺯ ﺍﻧﺴﻮﻟیﻦ‬         Increases until total diabetes
                                  occurs
                                  ‫ﺍﻓﺰﺍیﺶ ﻣی یﺎﺑﺪ ﺗﺎﺯﻣﺎﻧیکﻪ ﻣﺠﻤﻮﻋﻪ‬
                                  ‫ﺩیﺎﺑﺖ ﺑﻮﺟﻮﺩآیﺪ‬                AFAMS
                            Type 2 – Diabetes
                              ‫ﺗﺎیپ 2 - ﺩیﺎﺑﺖ‬
            Type 2‫ﻧﻮﻉ ﺩﻭﻡ‬                       Diabetes‫ﺩیﺎﺏ‬


Onset‫ﺷﺮﻭﻉ‬                           Insidious, often found by screening
                                       ‫ﺷﺪیﺪ، ﺑﻌﻀی ﺍﻭﻗﺎﺕ ﺗﻮﺳﻂ ﻣﻌﺎیﻨﻪ ﺩﺭیﺎﻓﺖ‬
                                                                    ‫ﻣیگﺮﺩﺩ‬
Body size‫ﺍﻧﺪﺍﺯﻩ ﺑﺪﻥ‬                 Frequently obese‫ﻗﺎچی ﻣکﺮﺭ‬

Blood glucose‫ﺳﻮیﻪ گﻠﻮکﻮﺯ‬            Fluctuations are less marked‫ﺑی ﺛﺒﺎﺗی‬
‫ﺩﺭﺧﻮﻥ‬                               ‫کﻤﺘﺮ ﺩیﺪﻩ ﻣیﺸﻮﺩ‬
Ketoacidosis‫کیﺘﻮﺍﺳیﺪﻭﺯﺱ‬             Infrequent‫ﻧﺎﺩﺭ‬

Sulfonylurea-responsiveness         Greater than 50%
‫پﺎﺳﺦ ﺩﻫی ﺩﺭﻣﻘﺎﺑﻞ ﺳﻠﻔﻮﻧﺎیﻞ یﻮﺭیﺎ‬     %50 ‫ﺑیﺸﺘﺮ ﺍﺯ‬
Insulin required‫ﺿﺮﻭﺭﺕ ﺍﻧﺴﻮﻟیﻦ‬       Less than25%     %25 ‫کﻤﺘﺮ ﺍﺯ‬

Insulin dosage‫ﺩﻭﺯ ﺍﻧﺴﻮﻟیﻦ‬           May remain stable‫ﻣﻤکﻦ پﺎیﺪﺍﺭ ﺑﺎﻗی‬
                                    ‫ﺑﻤﺎﻧﺪ‬                       AFAMS
          Medical Treatment- Type I
               ‫ﺗﺪﺍﻭی ﻃﺒی –ﺗﺎیپ‬I
•   Insulin therapy               ‫• ﺗﺪﺍﻭی ﺑﺎ ﺍﻧﺴﻮﻟیﻦ‬
•   Goals:                                   ‫• ﺍﻫﺪﺍﻑ‬
                              ‫- ﻧﺸﻮ ﻭﻧﻤﺎ ﻭ‬
     – Normal growth and             ‫ﺍﻧکﺸﺎﻑ ﻧﺎﺭﻣﻞ‬
        development          ‫- ﻃﻔﻠیﺖ ﻓﻌﺎﻝ‬
     – Happy and active                      ‫ﻭ ﺧﻮﺵ‬
        childhood             ‫-ﺟﻠﻮگیﺮی‬
                                       ‫ﺍﺯ ﺍﺧﺘﻼﻃﺎﺕ‬
     – Prevent
        complications




                                              AFAMS
                  Check on Learning
                    ‫ﺍﺭﺯیﺎﺑی آﻤﻮﺯﺵ‬
Question: What type of                ‫ﺳﻮﺍﻝ:چی ﻧﻮﻉ ﺩیﺎﺑﺖ‬
  diabetes is characterized           ‫ﺗﻮﺳﻂ ﻓﻘﺪﺍﻥ ﺍﻧﺴﻮﻟیﻦ‬
  by insulin deficiency?                 ‫ﻣﺸﺨﺺﻣیگﺮﺩﺩ؟‬
Answer: Type I                             ‫ﺟﻮﺍﺏﺗﺎیپ ﺍﻭﻝ‬
                                                   :




                                                 AFAMS
                 Nursing Care- Type I
                 ‫ﻣﺮﺍﻗﺒﺖ ﻧﺮﺳﻨگ – ﻧﻮﻉ ﺍﻭﻝ‬
•   Normal growth and              – ‫• ﻧﺸﻮ ﻭ ﻧﻤﺎی ﻭ ﺍﻧکﺸﺎﻑ ﻧﺎﺭﻣﻞ‬
    development - teaching           ‫ﻣﺮیﺾ ﻭ ﻓﺎﻣیﻞ ﻣﺮیﺾ ﺭﺍ‬
    patient and family regarding      ،‫ﺩﺭ ﺭﺍﺑﻄﻪ ﺑﻪپﺘﻮﻓﺰیﻮﻟﻮژی‬
    pathophysiology, blood              ‫گﻠﻮکﻮﺯ ﺧﻮﻥ، ﺍﺭﺯیﺎﺑی‬
    glucose self-monitoring,
                                       ‫ﺷﺨﺼی ﻭ ﺗﻄﺒیﻖ ﺍﻧﺴﻮﻟیﻦ‬
    and insulin administration
                                                  ‫ﺗﺪﺭیﺲ ﻧﻤﺎیﺪ‬




                                                          AFAMS
                 Nursing Care- Type I
                 ‫ﻣﺮﺍﻗﺒﺖ ﻧﺮﺳﻨگ – ﻧﻮﻉ ﺍﻭﻝ‬
•   Cope with chronic illness -    ‫• ﺗﺪﺍﺑیﺮ ﻣﺮﺍﻗﺒﺘی ﺍﺯ ﺍﻣﺮﺍﺽ‬
    enable the child to cope       ‫ﻣﺰﻣﻦ – ﺩﺭ ﻣﺠﺎﺩﻟﻪ ﺑﺎ ﺍﻣﺮﺍﺹ‬
    with a chronic illness, have   ،‫ﻣﺰﻣﻦ ﻃﻔﻞ ﺭﺍ کﻤک ﻧﻤﺎیﺪ‬
    a happy and active
    childhood
                                      ‫ﻃﻔﻞ ﺭﺍ ﺧﻮﺷﺤﺎﻝ ﻭ ﻓﻌﺎﻝ‬
                                                   ‫ﻧگﻬﺪﺍﺭیﺪ‬




                                                      AFAMS
                Nursing Care- Type I
                  I ‫ﺗﺪﺍﻭی ﻃﺒی –ﺗﺎیپ‬
•   Prevent complications -               – ‫• ﺟﻠﻮگیﺮی ﺍﺯ ﺍﺧﺘﻼﺗﺎﺕ‬
    maintaining blood glucose at   ‫گﻠﻮکﻮﺯ ﺧﻮﻥ ﺭﺍ ﺩﺭ ﺳﻄﺢ ﻧﺎﺭﻣﻞ‬
    consistently normal levels.      ‫آﻦ ﻧگﻬﺪﺍﺭیﺪ. ﺗﺪﺍﺑیﺮ ﺗﻐﺬیﻮی‬
    Nutritional management




                                                         AFAMS
                      Nursing Care- Type I
                        I ‫ﺗﺪﺍﻭی ﻃﺒی –ﺗﺎیپ‬
•   Special Teaching:                                          :‫• ﺗﺪﺭیﺲ ﺧﺎﺹ‬
     – Hyperglycemia: Insulin under          ‫-ﻫﺎیپﺮگﻼیﺴﻤیﺎ: ﺍﻧﺴﻮﻟیﻦ ﺗﺤﺖ‬
        dose; food overdose.                            .‫ﺩﻭﺯ ﻏﺬﺍ ﺑﻠﻨﺪﺗﺮ ﺍﺯ ﺩﻭﺯ‬
          • Signs and symptoms -
             polyuria, polydipsia,           ،‫• ﺍﻋﺮﺍﺽ ﻭ ﻋﻼیﻢ – پﻮﻟی یﻮﺭیﺎ‬
             polyphagia, fruity odor to        ‫ﺗﻨﻔﺲ ﻣیﻮﻩ ﺑﻮ،ﺧﺴﺘگی، ﺩﺭﺩ ﻫﺎی‬
             breath, fatigue, abdominal      .‫ﺑﻄﻨی، ﻟﺐ ﻫﺎی ﺳﺮﺥ، ﺭﻭی ﺳﺮﺧی‬
             pain, red lips, flushed face.
                                                        ‫• ﺗﺪﺍﻭی – ﺍﻧﺴﻮﻟیﻦ ﻣﻨﻈﻢ‬
          • Treatment - Regular insulin




                                                                       AFAMS
               Nursing Care- Type I
                 I ‫ﺗﺪﺍﻭی ﻃﺒی –ﺗﺎیپ‬
– Special Teaching:                                :‫– ﺗﺪﺭیﺲ ﺧﺎﺹ‬
  – Hypoglycemia - excess         ‫– ﻫﺎیپﻮگﻼیﺴﻤیﺎ – ﺗﻤﺮیﻦ‬
     exercise, too little food,   ،‫ﺑیﺶ ﺍﺯ ﺣﺪ، ﻣﻘﺪﺍﺭ کﻢ ﻏﺬﺍ‬
     insulin overdose                ‫ﺩﻭﺯ ﺑیﺶ ﺍﺯ ﺣﺪ ﺍﻧﺴﻮﻟیﻦ‬
  • Signs and symptoms -
                                      ،‫• ﺍﻋﺮﺍﺽ ﻭ ﻋﻼیﻢ –ﺧﺴﺘگی‬
     fatigue, hunger, pale,
     clammy, diaphoresis,             ،‫گﺮﺳﻨگی، ﺧﺴﺎﻑ، ﻣﺮﻃﻮﺏ‬
     tremors, lethargy,           ،‫ﻋﺮﻕ ﺯیﺎﺩ، ﻟﺮﺯﻩ، ﺑی ﻋﻼﻗﻪکی‬
     headache                                            ‫ﺳﺮﺩﺭﺩ‬
  • Treatment - administer                    ‫• ﺗﺪﺍﻭی – ﺟﻮﺱ ﻧﺎﺭﻧﺞ‬
     glucagon, orange juice, or              ‫کﺎﺭﺑﻮﻫﺎیﺪﺭیﺪ ﻓﻤی‬
     carbohydrates orally




                                                          AFAMS
                 Check on Learning
                   ‫ﺍﺭﺯیﺎﺑی آﻤﻮﺯﺵ‬
Question: What is the        ‫ﻫﺎیپﺮگﻼیﺴﻤیﺎ‬    ‫ﺳﻮﺍﻝ: ﺗﺪﺍﻭی‬
  treatment for                                 ‫چی ﺍﺳﺖ؟‬
  hyperglycemia?                  ‫ﺟﻮﺍﺏ:ﺭیگﻮﻟﺮ ﺍﻧﺴﻮﻟیﻦ‬
Answer: Regular insulin




                                                  AFAMS
Patient and Family Teaching
     ‫ﺗﺪﺭیﺲ ﻣﺮیﺾ ﻭ ﻓﺎﻣیﻞ‬




                          AFAMS
      Patient and Family Teaching
           ‫ﺗﺪﺭیﺲ ﻣﺮیﺾ ﻭ ﻓﺎﻣیﻞ‬
•   Instruct patient and family           ‫• ﻣﺮیﺾ ﻭ ﻓﺎﻣیﻞ آﻨﺮﺍ ﺩﺭﺑﺎﺭﻩ ﻣﻮﻗﻌیﺖ‬
    about the location of the             ‫پﺎﻧکﺮﺍﺱ ﻭ ﻭﻇﺎیﻒ ﻧﻮﺭﻣﺎﻝ پﺎﻧﻘﺮﺍﺱ‬
    pancreas and its normal                                      .‫ﺭﻫﻨﻤﺎﺋی ﻧﻤﺎیﺪ‬
    function                            ‫ﺍﺭﺗﺒﺎﻁ ﺍﻧﺴﻮﻟیﻦ ﺭﺍ ﺑﺎ پﺎﻧﻘﺮﺍﺱ ﺷﺮﺡ ﻧﻤﺎیﺪ‬
•   Explain relationship of insulin     ‫• ﻣﻌﻠﻮﻣﺎﺕ ﺑﺸکﻞ ﺗﺪﺭیﺠی ﻃﻮﺭی ﺍﺭﺍ یﻪ‬
    to the pancreas
                                          ‫گﺮﺩﺩ کﻪ ﻃﻔﻞ ﻭﻓﺎﻣیﻞ ﻃﻔﻞ، آﻨﺮﺍ ﺩﺭک‬
•   Give information gradually
    and at level of understanding                                        .‫ﻧﻤﺎیﺪ‬
    of child and family                    ‫• ﻣﺎﻧیﺘﻮﺭﻧﻤﻮﺩﻥ گﻠﻮکﻮﺯ ﺩﺭﺧﺎﻧﻪ ﺑﺎیﺪ‬
•   Home glucose monitoring                ‫ﺑﺮﺍی ﺗﻤﺎﻡ ﻣﺮیﻀﺎﻥ ﻭﻣﺴﺌﻮﻟیﻦ ﻣﺮﺍﻗﺒﺖ‬
    should be taught to all young                          .‫کﻨﻨﺪﻩ ﺗﺪﺭیﺲ گﺮﺩﺩ‬
    patients and care givers              ‫- ﻧﻮﺍﺣی ﻣﺨﺘﻠﻔﻪ ﺳﺘﺮپ یﺎﺳﺘیک‬
     – Rotate sites of finger sticks,     ‫( ﺩﺭﻫﻨگﺎﻡ ﺗﺴﺖ‬finger sticks) ‫ﺍﻧگﺸﺖ‬
        sides of the fingers               ‫ﺧﻮﻥ ﺭﺍ ﺗﻌﻮیﺾ ﻧﻤﻮﺩﻩ ﻭ ﻫﻢ ﺍﺯﻧﻮﺍﺣی‬
     – Rotate injection sites                      .‫ﻣﺨﺘﻠﻔﻪ ﺍﻧگﺸﺘﺎﻥ ﺍﺳﺘﻔﺎﺩﻩ گﺮﺩﺩ‬
                                           .‫- ﻧﻮﺍﺣی ﺯﺭﻕ ﺭﺍ ﺗﻐیﺮ ﺩﻫیﺪ‬


                                                                      AFAMS
                ‫‪Check on Learning‬‬
                  ‫ﺍﺭﺯیﺎﺑی آﻤﻮﺯﺵ‬
‫‪Question: Who should be‬‬                ‫ﺳﻮﺍﻝ: ﺑﺮﺍیکی ﺑﺎیﺪ‬
  ‫‪taught home glucose‬‬                        ‫ﻣﺎﻧیﺘﻮﺭﻧﻤﻮﺩﻥ‬
  ‫?‪monitoring‬‬                    ‫گﻠﻮکﻮﺯ ﺭﺍ ﺩﺭﺧﺎﻧﻪ ﺗﺪﺭیﺲ‬
‫‪Answer: Young patients‬‬                              ‫ﻧﻤﻮﺩ؟‬
  ‫‪and their care givers‬‬          ‫ﺟﻮﺍﺏ: ﺑﺮﺍی ﻣﺮیﻀﺎﻥ ﺟﺪیﺪ‬
                            ‫ﻣﺼﺎﺏ ﺷﺪﻩ ﻭ ﺍﺷﺨﺎﺹ کﻪ ﺍﺯ آﻨﻬﺎ‬
                                                   ‫ﻣﺮﺍﻗﺒﺖ‬




                                                 ‫‪AFAMS‬‬
Nutrition Management
      ‫ﻣﻨﺠﻤﻨﺖ ﺗﻐﺬی‬




                                                                 




                                                                    AFAMS
                Nutrition Management
                      ‫ﻣﻨﺠﻤﻨﺖ ﺗﻐﺬی‬
•   Nutritional needs of diabetic       ‫• ﻣﻮﺍﺩ ﺗﻐﺬی ﻧیﺎﺯﻣﻨﺪی ﺍﻃﻔﺎﻝﺩیﺎﺑیﺘیک ﺍﺳﺖ‬
    children                                      ‫• ﺍﻫﺪﺍﻑ کﻠی ﺷﺎﻣﻞ ﺗﺄﻤیﻦ ﻧﺸﻮ ﻭﻧﻤﻮ‬
•   Goals include ensuring normal        ‫ﻭﺍﻧکﺸﺎﻑ ﻧﺎﺭﻣﻞ، ﺗﻮﺯیﻊ ﻣﻮﺍﺩ ﻏﺬﺍﺋی گﺮﻓﺘﻪ‬
    growth and development,             ‫ﺷﺪﻩ کﻪ کﻨﺘﺮﻭﻝ ﻣیﺘﺎﺑﻮﻟیک ﺭﺍ کﻤک ﻧﻤﻮﺩﻩ‬
    distribute food intake so that it                 .‫ﻭﺭژیﻢ ﻏﺬﺍﺋی ﺭﺍ ﻣﺠﺰﺍ ﻣیﻨﻤﺎیﺪ‬
    aids metabolic control and to                            ‫• ﺗﻌﻠیﻤﺎﺕ ﺍﺩﺍﻣﻪ ﺩﺍﺩﻩ ﺷﻮﺩ‬
    individualize the diet                  ‫• ﺟﻬﺖ ﺗﻄﺒیﻖ ﻭﺣﻤﺎیﺖ، کﻮﺷﺶ ﺑیﺸﺘﺮ‬
•   Education is ongoing                                              .‫ﺑکﺎﺭ ﺑﺮﺩﻩ ﺷﻮﺩ‬
•   Offer much reinforcement and                           ‫• ﺍﺻﻄﻼﺣﺎﺕ ﻭﺍﺿﺢ گﺮﺩﺩ‬
    support                             ‫• ﺑﻪ ﺧﺼﻮﺻیﺎﺕ ﻓﺮﻫﻨگی ﻭﻣﺄﺨﺬﺍﺕ ﺷﺨﺼی‬
•   Clarify terms                                                        .‫ﺍﺣﺘﺮﺍﻡ گﺮﺩﺩ‬
•   Respect cultural patterns and            :‫• ﺍﻫﻤیﺖﺭژیﻢ ﻓﺎیﺒﺮی ﺗﺸﺮیﺢ گﺮﺩﺩ‬
    personal preferences                       ‫ﻧﺸﺎﻥ ﺩﺍﺩﻩ ﺷﺪﻩ کﻪ ﺳﻮیﻪ ﺷکﺮ ﺧﻮﻥ ﺭﺍ‬
•   Explain importance of fiber                                         ‫کﺎﻫﺶ ﻣیﺪﻫﺪ‬
    diets: has been shown to reduce
    blood sugar levels


                                                                            AFAMS
                 Check on Learning
                   ‫ﺍﺭﺯیﺎﺑی آﻤﻮﺯﺵ‬
Question: What is the          ‫ﺳﻮﺍﻝ: ﻫﺪﻑ ﺍﺯ ﻓﺎیﺒﺮ ﺩﺭﺭژیﻢ‬
  purpose of fiber in the     ‫ﻣﺮیﻀﺎﻥﺩیﺎﺑیﺘیکچی ﺍﺳﺖ؟‬
  diabetic diet?                 ‫ﺟﻮﺍﺏ: کﺎﻫﺶ ﺳﻮیﻪ ﺷکﺮ‬
Answer: Reduce blood          ‫ﺩﺭﺧﻮﻥ، کﺎﻫﺶ کﻮﻟیﺴﺘﺮﻭﻝ‬
  sugar levels, lower serum   ‫ﺧﻮﻥ ﻭ ﺑﻌﻀﺎ کﺎﻫﺶ ﺿﺮﻭﺭﺕ‬
  cholesterol & sometimes                .‫ﺍﻧﺴﻮﻟیﻦ ﻣیﺒﺎﺷﺪ‬
  reduce insulin
  requirements




                                                AFAMS
Insulin Management
   ‫ﻣﻨﺠﻤﻨﺖ ﺍﻧﺴﻮﻟیﻦ‬




                     AFAMS
                 Insulin Management
                    ‫ﻣﻨﺠﻤﻨﺖ ﺍﻧﺴﻮﻟیﻦ‬
•   The dose of insulin - the dose     ‫• ﺩﻭﺯ ﺍﻧﺴﻮﻟیﻦ – ﺩﻭﺯ ﺍﻧﺴﻮﻟیﻦ ﺗﻮﺳﻂ‬
    of insulin is measured in units,      ‫یﻮﻧﺖ ﺍﻧﺪﺍﺯﻩ ﻣیﺸﻮﺩ، ﻭ ﺳﺮﻧﺞ ﻫﺎی‬
    and special syringes are used in   ‫ﺧﺎﺹ ﺑﺮﺍی ﺗﻄﺒیﻖ آﻦ ﺍﺳﺘﻔﺎﺩﻩ ﻣیﺸﻮﺩ‬
    its administration                     ‫• ﻭﺍﻟﺪیﻦ ﻭﻃﻔﻞ ﺭﺍ ﺩﺭﺑﺎﺭﻩ ﺗﻄﺒیﻖ‬
•   Teach parents and child about      ‫ﺍﻧﺴﻮﻟیﻦ آﻤﻮﺯﺵ ﺩﻫیﺪ – ﻣﻌﻤﻮﻟﺘﺮیﻦ‬
    the administration of insulin -     7 ‫ﻣیﺘﻮﺩ ﺗﺤﺖ ﺍﻟﺠﻠﺪی ﻣیﺒﺎﺷﺪ. ﺳﻨیﻦ‬
    usual method is subcutaneous. 7
                                       ‫ﺳﺎﻟﻪ یﺎ ﺑﻠﻨﺪ ﺗﺮ ﺍﺯ آﻦ ﺗﺪﺭیﺲ ﻣیﺸﻮﺩ‬
    years and older can be taught to
    perform self-injections.
                                                    .‫کﻪ ﺧﻮﺩ ﺗﻄﺒیﻖ ﻧﻤﺎیﺪ‬




                                                                 AFAMS
Insulin Management
   ‫ﻣﻨﺠﻤﻨﺖ ﺍﻧﺴﻮﻟیﻦ‬




                     AFAMS
                 ‫‪Insulin Management‬‬
                    ‫ﻣﻨﺠﻤﻨﺖ ﺍﻧﺴﻮﻟیﻦ‬
‫•‬   ‫,‪Automatic injection devices‬‬            ‫• ﺍﺯﻭﺳﺎیﻞ ﺗﺰﺭیﻘیﺍﺗﻮﻣﺎﺗیک،‬
    ‫‪insulin pump and needle-free‬‬         ‫ﺍﻧﺴﻮﻟیﻦ پﻤپ ﻭ آﻠﻪ ﺗﺰﺭیﻖ ﺑﺪﻭﻥ‬
    ‫‪injectors - easy to use and‬‬             ‫ﺳﻮﺯﻥ ﺑﻪ آﺴﺎﻧی ﺍﺳﺘﻔﺎﺩﻩ ﻧﻤﻮﺩﻩ ﻭ‬
    ‫‪promote independence‬‬                  ‫ﻣﺮیﺾ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯﺍیﻦ ﻭﺳﺎیﻞ‬
‫•‬   ‫‪Site is rotated to prevent poor‬‬                         ‫ﻣﺴﺘﻘﻞﻣیگﺮﺩﺩ.‬
    ‫‪absorption and injury to‬‬              ‫• ﺟﻬﺖﺟﻠﻮگیﺮی ﺍﺯ ﺟﺬﺏ ﻏیﺮ‬
    ‫.‪tissues‬‬                            ‫ﻣﻨﺎﺳﺐ ﻭ آﺴیﺐ پﺬیﺮی ﺍﻧﺴﺎﺝ ﺍﺯ‬
‫•‬   ‫‪Construction paper and site‬‬       ‫ﺳﺎﺣﻪ ﺑﻄﻮﺭ ﻧﻮﺑﺖ ﻭﺍﺭ ﺍﺳﺘﻔﺎﺩﻩ گﺮﺩﺩ.‬
    ‫‪rotation patterns are useful‬‬             ‫• کﺎﻏﺬ کﺎک ﺑﺮﺍی ﺗﻨﻈیﻢ ﻭ‬
    ‫‪teaching tools‬‬                         ‫ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺳﺎﺣﻪ ﺑﻄﻮﺭ ﻧﻮﺑﺖ ﻭﺍﺭ‬
                                       ‫ﻭﺳﺎیﻞ ﺧﻮﺏ ﺑﺮﺍی آﻤﻮﺯﺵ ﻣیﺒﺎﺷﺪ.‬




                                                                   ‫‪AFAMS‬‬
Insulin Management
   ‫ﻣﻨﺠﻤﻨﺖ ﺍﻧﺴﻮﻟیﻦ‬




                     AFAMS
                  ‫‪Check on Learning‬‬
                    ‫ﺍﺭﺯیﺎﺑی آﻤﻮﺯﺵ‬
‫‪Question: At what age can‬‬        ‫ﺳﻮﺍﻝ: ﺩﺭکﺪﺍﻡ ﺳﻦ ﻣیﺘﻮﺍﻥ ﺑﺮﺍی‬
  ‫‪children be taught insulin‬‬     ‫ﻃﻔﻞ ﺯﺭﻕ ﺍﻧﺴﻮﻟیﻦ ﺭﺍ ﺗﺪﺭیﺲ‬
  ‫?‪self-injection‬‬              ‫ﻧﻤﻮﺩ ﺗﺎ ﺗﻮﺳﻂ ﺧﻮﺩﺵ ﺯﺭﻕ ﻧﻤﺎیﺪ؟‬
‫.‪Answer: Usually 7 and up‬‬         ‫ﺟﻮﺍﺏ: ﻣﻌﻤﻮﻻ ﺳﻦ 7ﺳﺎﻟگی ﻭ‬
                                                ‫ﺑﺎﻻ ﺗﺮ ﺍﺯ آﻦ.‬




                                                      ‫‪AFAMS‬‬
                  Home Management
                    ‫ﻣﻨﺠﻤﻨﺖ ﺩﺭﺧﺎﻧﻪ‬
•   Exercise                              ‫• ﺗﻤﺮیﻦ‬

•   Skin care                          ‫• ﻣﺮﺍﻗﺒﺖ ﺟﻠﺪ‬

•   Foot care
                                       ‫• ﻣﺮﺍﻗﺒﺖ پﺎ‬

•   Infections
                                          ‫• ﺍﻧﺘﺎﻧﺎﺕ‬
•   Emotional upsets
                              ‫• آﺸﻔﺘگی ﻫﺎی ﺍﺣﺴﺎﺳﺎﺗی‬




                                             AFAMS
                   Home Management
                     ‫ﻣﻨﺠﻤﻨﺖ ﺩﺭﺧﺎﻧﻪ‬
•   Urine checks                           ‫•چک کﺮﺩﻥ ﺍﺩﺭﺍﺭ‬
                              ‫• ﻋﺪﻡ ﺗﻮﺍﺯﻥ ﺍﻧﺴﻮﻟیﻦ – گﻠﻮکﻮﺯ‬
•   Glucose-insulin
    imbalances                                       ‫• ﺳﻔﺮ‬
                                             ‫یﺎ‬
                                        ‫• ﺗﻌﻘیﺐ پیگﺮﺩی‬
•   Travel
                                              ‫• ﻋﻤﻞ ﺟﺮﺍﺣی‬

•   Follow-up

•   Surgery




                                                     AFAMS
                  Nursing Diagnosis
                    ‫ﺗﺸﺨیﺺ ﻧﺮﺳﻨگ‬
•   Risk for injury related to        ‫• ﻣﻮﺟﻮﺩیﺖ ﺧﻄﺮ ﺟﻬﺖ ﺍیﺠﺎﺩ ﺟﺮﺣﻪ‬
    hypoglycemia or diabetic                                   ‫ﺑﻪ‬
                                        ‫کﻪ ﻣﺮﺑﻮﻁ ﻫﺎیپﻮگﻼیﺴﻤیﺎ یﺎ‬
    ketoacidosis (hyperglycemia)                                  ‫ﺩیﺎﺑیﺘیک‬
•   Outcomes:                                              )
                                     (‫کیﺘﻮﺍﺳیﺪﻭﺯﺱﻫﺎیپﺮگﻼیﺴیﻤیﺎ‬
     – Child will be able to
                                                                     ‫ﻣیﺒﺎﺷﺪ‬
        measure blood glucose
                                                                    ‫• ﻧﺘﺎیﺞ‬
        level with glucometer
                                         ‫- ﻃﻔﻞ ﺑﺎیﺪ ﻗﺎﺩﺭﺑﻪ ﺍﻧﺪﺍﺯﻩ‬
                                            ‫گیﺮی ﺳﻮیﻪ گﻠﻮکﻮﺯ ﺗﻮﺳﻂ‬
     – Child will be adequately                              ‫گﻠﻮکﻮﻣﺘﺮﺑﺎﺷﺪ‬
        hydrated                       ‫- ﻃﻔﻞ ﺑﺎیﺪ ﺑﻪ ﺍﻧﺪﺍﺯﻩ کﺎﻓی‬
     – Child will be                                    ‫ﻣﺎیﻌﺎﺕ گﺮﻓﺘﻪ ﺑﺎﺷﺪ‬
        asymptomatic               .‫- ﻃﻔﻞ ﺑﺎیﺪ ﻏیﺮﻋﺮﺿی ﺑﺎﺷﺪ‬




                                                                 AFAMS
              ‫‪Nursing Interventions‬‬
                   ‫ﻣﺪﺍﺧﻼﺕ ﻧﺮﺳﻨگ‬
‫•‬   ‫‪Teach child home glucose‬‬            ‫• ﻃﺮﺯ ﻣﺎﻧیﺘﻮﺭﻧﻤﻮﺩﻥ گﻠﻮکﻮﺯ ﺑﺮﺍی‬
    ‫‪monitoring‬‬                                         ‫ﻃﻔﻞ آﻤﻮﺯﺵ ﺩﺍﺩ ﻩ ﺷﻮﺩ‬
‫•‬   ‫‪Record vital signs regularly‬‬      ‫• ﻋﻼیﻢ ﺣیﺎﺗی ﻣﻨﻈﻤ یﺎﺩﺩﺍﺷﺖ گﺮﺩﺩ.‬
‫•‬   ‫‪Monitor fluid intake and‬‬        ‫• ﻣﻘﺪﺍﺭ ﻣﺎیﻌﺎﺕ ﺗﻄﺒیﻖ ﺷﺪﻩ ﻭ ﺩﻫﻨﻪ ﺍﺩﺭﺍﺭ‬
    ‫‪output‬‬                                                   ‫ﻣﺎﻧیﺘﻮﺭ گﺮﺩﺩ.‬
‫•‬   ‫‪Serve meals and snacks on‬‬         ‫• ﻏﺬﺍ ﻭ ﻣیﻮﻩ ﺧﺸک ﺑﻪ ﻭﻗﺖ آﻦ ﺻﺮﻑ‬
    ‫‪time‬‬                                                              ‫گﺮﺩﺩ.‬
‫•‬   ‫‪Administer or have patient‬‬           ‫• ﺍﻧﺴﻮﻟیﻦ ﺭﺍ ﺗﻄﺒیﻖ ﻧﻤﻮﺩﻩ یﺎ ﺧﻮﺩ‬
    ‫‪administer insulin as ordered‬‬       ‫ﻣﺮیﺾ ﺑﻘﺪﺭ ﺳﻔﺎﺭﺵ ﺩﺍﺩﻩ ﺷﺪﻩ ﺗﻄﺒیﻖ‬
‫•‬   ‫‪Determine level of‬‬                                                 ‫ﻧﻤﺎیﺪ‬
    ‫‪consciousness‬‬                     ‫• ﺳﻮیﻪ ﺷﻌﻮﺭ ﺭﺍ ﺩﺭﻧﺰﺩ ﻣﺮیﺾ ﺗﻌیﻦ‬
‫•‬   ‫‪Carefully observe patient for‬‬                                      ‫ﻧﻤﺎیﺪ‬
    ‫‪signs of hypoglycemia or‬‬        ‫• ﻣﺮیﺾ ﺭﺍ ﺑﻄﻮﺭ ﻣﺤﺘﺎﻃﺎﻧﻪ ﺟﻬﺖ ﻋﻼیﻢ‬
    ‫‪hyperglycemia‬‬                                       ‫یﺎ‬
                                     ‫ﻫﺎیپﻮگﻼیﺴﻤیﺎ ﻫﺎیپﺮگﻼیﺴﻤیﺎ‬
                                                  ‫ﺗﺤﺖ ﻣﺸﺎﻫﺪﻩ ﻗﺮﺍﺭ ﺩﺍﺩﻩ ﺷﻮﺩ.‬



                                                                   ‫‪AFAMS‬‬
                     Nursing Diagnosis
                       ‫ﺗﺸﺨیﺺ ﻧﺮﺳﻨگ‬
• Deficient knowledge regarding              ‫• ﻓﻬﻢ ﻭﺩﺍﻧﺶ ﻧﺎکﺎﻓی ﺩﺭﺑﺎﺭﻩ ﺗﻤﺮیﻦ‬
  exercise                                                             :‫• ﻧﺘﺎیﺞ‬
• Outcomes:                                  ‫- ﻃﻔﻞ ﺑﺎیﺪ پﺮﻭگﺮﺍﻡ ﺗﻤﺮیﻦ‬
   – Child will describe physical                 .‫ﻓﺰیکی ﺭﺍ ﺗﺸﺮیﺢ ﻧﻤﺎیﺪ‬
     exercise program                   ‫ﻫﺎیپﻮگﻼیﺴﻤیﺎ‬       ‫- ﻃﻔﻞ ﺑﺎیﺪ ﺑﺮﺍی‬
   – Child will be prepared for                        .‫آﻤﺎﺩﻩگی ﺩﺍﺷﺘﻪ ﺑﺎﺷﺪ‬
     hypoglycemia                                             :‫• ﻣﺪﺍﺧﻼﺕ ﻧﺮﺳﻨگ‬
• Nursing interventions:                     ‫-ﺗﻤﺮیﻦ ﺳﻮیﻪ ﺷکﺮ ﺧﻮﻥ ﺭﺍ‬
                                                     .‫پﺎﺋیﻦ ﺗﺸﺮیﺢ ﻧﻤﺎیﺪ‬
   – Explain that exercise lowers         ‫- ﺳﻮیﻪ ﺍﻧﺪﺍﺯﻩ ﻓﻌﺎﻟیﺖ ﻃﻔﻞ ﺗﻌیﻦ‬
     the blood sugar level                                          .‫گﺮﺩﺩ‬
   – Determine child's activity level       ‫ﻫﺎیپﻮگﻼیﺴﻤیﺎ ﺭﺍ‬       ‫- ﺍﻋﺮﺍﺽ‬
                                                             .‫ﺗﺪﺭیﺲ ﻧﻤﺎیﺪ‬
   – Instruct as to symptoms of            ‫- ﺗﻌﻠیﻢ ﺩﻫی ﺍﻫﻤیﺖ ﺍﻧﺘﻘﺎﻝ ﺩﺍﺩﻥ‬
     hypoglycemia                              ‫ﺷیﺮﻧی ﺑﺎﺏ ﺩﺭ ﺑﺮﺍی ﺍﻃﻔﺎﻝ‬
   – Teach child importance of          ‫- ﺧﻄﺮ آﺒﺒﺎﺯی ﺭﺍ ﺑﻄﻮﺭﺗﻨﻬﺎیی ﺑﺮﺍی‬
     carrying extra sugar                                 ‫ﻃﻔﻞ ﺑیﺎﻣﻮﺯﺍﻧیﺪ‬
   – Teach child the dangers of
     swimming alone
                                                                        AFAMS
                 Nursing Diagnosis
                   ‫ﺗﺸﺨیﺺ ﻧﺮﺳﻨگ‬
•   Deficient knowledge regarding     ‫• ﻓﻬﻢ ﻭﺩﺍﻧﺶ ﻧﺎ کﺎﻓی ﺩﺭﺑﺎﺭﻩ ﻫﻮیﺖ‬
    identification                                             ‫• ﻧﺘﺎیﺞ‬
•   Outcomes                           ‫- ﻃﻔﻞ ﺑﺎیﺪ ﺍﻫﻤیﺖ پﻮﺷیﺪﻥ‬
     – Child will state                ‫ﺑﺎﺯﻭﺑﻨﺪ کﻪ ﻧﺸﺎﻥ ﺩﻫﻨﺪﻩ ﻫﻮیﺖ‬
        understanding of             .‫ﺍﺳﺖ، ﺑﻄﻮﺭ ﻣﻨﺎﺳﺐ ﺷﺮﺡ ﻧﻤﺎیﺪ‬
        importance of wearing        ‫- ﻓﺎﻣیﻞ ﻃﻔﻞ ﺑﺎﺯﻭ ﺑﻨﺪ کﻪ ﻧﺸﺎﻥ‬
        proper identification        ‫ﺩﻫﻨﺪﻩ ﻫﻮیﺖ ﺍﺳﺖ، ﺑﺎیﺪ ﺑﺪﺳﺖ‬
        bracelet                                            .‫آﻮﺭﺩ‬
     – Family will acquire                            ‫• ﻣﺪﺍﺧﻼﺕ ﻧﺮﺳﻨگ‬
        identification bracelet     ‫- ﻃﻔﻞ ﺑﺎیﺪ ﻫﻮیﺖ ﺧﻮﺩ ﺭﺍ ﺑﻄﻮﺭ‬
•   Nursing interventions                         ‫ﻣﻨﺎﺳﺐ ﻧﺸﺎﻥ ﺩﻫﺪ‬
     – Encourage purchase of        ‫- ﺑﺮﺍی ﺧﺮیﺪﺍﺭی ﻣﻠﺰﻣﺎﺕ ﻫﻮیﺖ‬
        means of identification                    .‫ﺗﺸﻮیﻖ گﺮﺩﻧﺪ‬
     – Child demonstrates proper
        identification
                                                                 AFAMS
                   Check on Learning
                     ‫ﺍﺭﺯیﺎﺑی آﻤﻮﺯﺵ‬
Question: Name one nursing         ‫ﺳﻮﺍﻝ: ﻧﺎﻡ یک ﺗﺸﺨیﺺ ﻧﺮﺳﻨگ ﺭﺍ کﻪ‬
   diagnosis that applies to the        ‫ﺑﺎﻻییک ﻃﻔﻞ ﻣﺼﺎﺏ ﺑﻪ ﺩیﺎﺑﺖ‬
   child with diabetes mellitus.               .‫ﻣﻠیﺘﻮﺱ ﺍﺳﺖ، ﻧﺎﻡﺑگیﺮﺩ‬
Answer: Risk for Injury              ‫ﺟﻮﺍﺏ: ﺧﻄﺮ ﺑﺮﺍی ﺟﺮﺣﻪ، ﻋﺪﻡ ﺩﺍﺷﺘﻦ‬
Deficient Knowledge                                            ‫ﺩﺍﻧﺶ‬




                                                             AFAMS
               Review of Main Points
                   ‫ﻣﺮﻭﺭ ﻧکﺎﺕ ﻣﻬﻢ‬
•   Pathophysiology, etiology,   ‫پﺘﻮﻓﺰیﻮﻟﻮژی، ﺍﺳﺒﺎﺏ، ﺗﺼﻨیﻒ ﻭ‬     •
    classification & diagnosis                       ‫ﺗﺸﺨیﺺ‬
•   Nursing care                           ‫ﻣﺮﺍﻗﺒﺖ ﻫﺎی ﻧﺮﺳﻨگ‬      •
•   Teaching approaches             ‫ﺗﺪﺭیﺲ ﻃﺮﻕ ﺭﺳیﺪﻩگی ﺑﻪ‬         •
                                                      ‫ﻣﺮیﺾ‬
•   Nutritional management                       ‫ﻣﻨﺠﻤﻨﺖ ﺗﻐﺬی‬     •
•   Insulin management                       ‫ﻣﻨﺠﻤﻨﺖ ﺍﻧﺴﻮﻟیﻦ‬      •
•   Home management                            ‫ﻣﻨﺠﻤﻨﺖ ﺩﺭﺧﺎﻧﻪ‬     •
•   Nursing process                           ‫پﺮﻭﺳﻪ ﻧﺮﺳﻨگ‬        •




                                                         AFAMS

				
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posted:8/5/2014
language:English
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