Hospital’s environment must provide mental and physical rest for its patients; it should contribute to overcome the disadvantages of hospitalization: fear and anxiety of the research, treatment, separation from home and family. The hospital’s environment influences on a patient in a lot of ways. That is why the nurse should be an ideal of cleanliness and neatness, she should be sensitive to patients, care about them, support and strength their moral state. Patients with chronic health problems need special nursing.
Diabetes is a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. This leads to an increased concentration of glucose in the blood (hyperglucagonemia). (WHO, 2006) An understanding of the pathophysiology of diabetes rests upon knowledge of the basics of carbohydrate metabolism and insulin action. Any pathological process which involves the pancreas can lead to diabetes. Diabetes develops in approximately 15-18% of patients after a first attack of acute pancreatitis. In case of acute pancreatitis the diabetes is characterized by hypoinsulinemia and hyperglucagonemia, which can cause ketoacidosis. Alcoholic pancreatitis (AP) is the most common form of chronic pancreatitis. Mostly middle-aged people experience this disease, when endocrine and exocrine reserves of pancreas are reduced. The stigmata of alcoholism, liver cirrhosis and portal hypertension are important in the diagnosis of AP. (Kozek, 2003)
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Diet and medical treatment are the mainstay of treatment of diabetes. The diet should be made for each patient individually. The main goal of diet for diabetics is to keep blood sugar levels within such limits which will correspond to the level of a healthy person, as well as the level of blood fats and cholesterol. It is important that this diet needs to be diverse and contain a sufficient amount of essential nutrients – protein, minerals and vitamins. The diet should conform to the principles of good nutrition. The correct composition of the diet for diabetics looks like this 55-60% carbohydrates, 25-20% fat, 15-20% protein. Doctors usually prescribe for diabetics sulfonylurea drugs or meglitinide. (Kastenbuer, 2004)
People suffering from diabetes need special care. Hygiene is the main point of professional care. The cleanliness of the skin needs to be watched very carefully, because of the exposure to pathogenic microorganisms. Patients with diabetes should regularly wash their lower parts as sugar which contains in urine may contact with skin which will contribute to the development of itching and the appearance of micro-organisms. To avoid the formation of gangrene, nurse should focus on washing patient’s feet every day with warm water. Nurse should also give massages for the prevention of pressure ulcers.
When person has diabetes, his/her routine procedures may suddenly withdraw from the schedule; the indicators of glucose levels may vary significantly in response to certain events. Hypoglycemia can affect the process of driving, but should not interfere with obtaining driving license. Drivers should check their blood glucose before they start driving, especially before long journeys. They should always keep snacks and glucose tablets in their cars. If driver experiences symptoms of hypoglycemia, he/she should immediately stop at the roadside.
If there is a person with diabetics in family, it will impact on their ordinary life in a certain way. Relatives try to make life for diabetics easier, less stressful and safe. They usually support the lifestyle (diet, sport) of diabetic.
Analysis of 10-year study, DCCT (Diabetes control and complications trial) showed that for every percentage reduction of glycated hemoglobin, the risk of microvascular complications (retinopathy, nephropathy) was reduced by 35%. The results of this study clearly demonstrate that aggressive glycemic control along with the normalization of blood pressure significantly reduces the risk of coronary heart disease, cerebrovascular disease and peripheral angiopathy in patients with diabetes. (NDIC, 2008)
Over 50% of the adult population of indigenous peoples in the world at the age of 35 years is suffering from diabetes, and their numbers are predicted to grow. In some indigenous communities, the prevalence of diabetes became an epidemic that threatens the very existence of these communities. (Vos, 2007)
Indigenous people have poorer state of health and greater risk of becoming disabled. That is why they die earlier than their peers from non-indigenous population. The difference in average life expectancy between indigenous and non-indigenous population in Guatemala is 13 years, in Panama – 10 years, in Mexico – 6 years, Nepal – 20 years, in Australia – 20 years, in Canada – 17 years, in New Zealand – 11 years.
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