Critical Care Nursing Clinics of North America最新文献

One of the life-threatening adverse effects associated with the use of immune checkpoint inhibitors is β cells destruction resulting in type 1 diabetes. Immune checkpoint inhibitor-induced type 1 diabetes (ICI-T1D) usually has a rapid onset requiring admission to the intensive care unit for the management of diabetic ketoacidosis using an insulin drip protocol. Once stabilized patients with ICI-T1D are started on insulin therapy to mimic usual pancreatic function. Insulin administration may be through multiple daily injections or continuous subcutaneous insulin infusions using an insulin pump. People who develop ICI-T1D will require insulin therapy for life.

Many hospitals have a lack of Certified Diabetes Care and Education Specialists leaving a gap in providing the education necessary for patients with diabetes to manage their diabetes after discharge. Training hospital nurses to become diabetes nurse champions can help fill in the gap. In addition to providing the patient with diabetes education, the diabetes nurse champion can advocate for glycemic management in the hospital to improve glycemic goals, reducing the incidence of hypoglycemia and severe hyperglycemia. This article will discuss ways to train nurses to be diabetes nurse champions.

Approximately 38% of the patient population in community hospitals throughout the United States has diabetes mellitus. Hypoglycemia is defined as less than 70 mg/dL. Patients with hypoglycemia are at more risk for clinically adverse outcomes including death. Critical care nurses must recognize the signs and symptoms of hypoglycemia and initiate prompt intervention to reduce the risk of mortality.

Hyperglycemia and diabetes place hospitalized patients at a greater risk for serious complications such as infections, diabetic ketoacidosis, hyperosmolar hyperglycemic state, dehydration, electrolyte imbalances, polypharmacy, and lengthened hospitalization. Identification and proper treatment of hyperglycemia and diabetes are essential to reduce morbidity and mortality, as well as to conserve limited health care resources. This article will summarize the current American Diabetes Association and Endocrine Society recommendations for the management of hospitalized patients with hyperglycemia and diabetes. It will discuss the diagnostic criteria for the identification of diabetes and hyperglycemia, glycemic targets, pharmacologic management of hyperglycemia, and the transition to outpatient care.

The prevalence of pediatric diabetes continues to rise in the United States and worldwide. There are various forms of pediatric diabetes including type 1, type 2, and maturity onset diabetes of youth. The treatment depends on each unique type of diabetes and must be taken into consideration for patients based on presentation and clinical setting. There is limited literature supporting the use of noninsulin medications to manage pediatric diabetes in an inpatient setting. This article focuses on noninsulin medication management of children and adolescents presenting with hyperglycemia in acute care settings, both critically and noncritically ill.

Diabetic ketoacidosis (DKA) and euglycemic DKA are both diabetes-related emergencies. Individuals with DKA can experience extremely elevated hyperglycemia exceeding 250 mg/dL. Although DKA is more frequently observed in people with type 1 diabetes (T1DM), euglycemic DKA, which is characterized by mildly elevated or nearly normal blood glucose at levels below 200 mg/dL, has recently been linked to the use of SGLT-2 inhibitors generally used for type 2 diabetes mellitus (T2DM). Without the substantial hyperglycemia associated with DKA, euglycemic DKA may be clinically overlooked. The pathophysiology, precipitating factors, clinical presentations, treatments, and evaluations of euglycemic DKA and DKA are reviewed.

Hypertension is a common comorbid condition among patients with diabetes, occurring in 71% to 80.6% of diabetes patients in the United States, and contributes to the development of cardiovascular disease. Screening for hypertension and a multifaceted treatment approach, including lifestyle management, pharmacologic therapy, and blood pressure targets are the key to reducing morbidity and mortality associated with uncontrolled blood pressure. Most patients require more than 1 medication to control their blood pressure, and clinicians should follow published guidelines to select the most appropriate and efficacious blood pressure agents for their patients.

There are an estimated 38 million people in the United States who have diabetes mellitus, both diagnosed and undiagnosed. Chronic complications are generally due to insulin deficiency or insulin resistance, with persistent hyperglycemia, dyslipidemia, and other metabolic pathways disorders. They have 2 to 8 times greater risk of cardiovascular (CV) disease including complications from ischemic heart disease, peripheral artery disease, heart failure, and stroke, which can result in death for more than 50% of persons with type 2 diabetes. This article will discuss the latest CV risk reduction guideline recommended for persons with diabetes.

Diabetes self-management education and support (DSME/S) creates the pillars necessary for a person with diabetes (PWD) to build self-confidence in how to manage a diagnosis of diabetes. Health care organizations should remain flexible and adaptable to seeking new methods in providing patient education particularly a PWD. As diabetes diagnosis continues to grow along with different diabetes tools and technology, health care organizations should consider embracing change by implementing the use DSME/S, developing a diabetes management inpatient team, and acquiring Certified Diabetes Care and Education Specialists.