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Hipoglikemi

Hipoglikemi

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Published by Amal Shohib
Hipoglikemi
Hipoglikemi

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Published by: Amal Shohib on May 18, 2013
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02/10/2014

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Caring for people with diabetes

Overview of diabetes
 Diabetes means that blood glucose in

Bloodstream
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the body (often called blood sugar) is too high  Glucose comes from the food we eat  Glucose is transported by the blood stream to all the cells in the body. Muscle
G
G G G

G

Overview of diabetes
 Insulin helps the glucose from

food get into your cells.
G

Muscle
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insulin

 Insulin is a chemical (a

hormone) made in a part of the body called the pancreas.

PANCREAS

Overview of diabetes
 If your body doesn't make

enough insulin or if the insulin doesn't work the way it should, glucose can't get into cells.  Glucose stays in the blood.  Blood glucose levels get too high, causing diabetes.

Muscle

Bloodstream

Complications of diabetes  Diabetes can cause increased risk of:  Heart Problems  Stroke  Eye sight problems  Kidney problems  Foot problems .

Treatment goals  Symptom free  Prevent short term complications  Prevent long term complications  Quality of life = Lifestyle focus .

blood fats and adequate body weight  Healthy Eating  Regular carbohydrate  High in fibre  Low in fat (particularly saturated fat)   Low in added sugar Adequate energy /protein/fluids/vits and mins .Healthy eating  To help control blood glucose.

Exercise / activity  30 minutes moderate intensity most days preferably all  Helps to:  Increased insulin sensitivity  Decreased insulin requirements  Weight reduction  Lipid control  Blood pressure control .

Insulin and tablets  Type 2 diabetes treatment may be Healthy eating  Healthy eating + tablets (several different types of tablets may be on combination of tablets  Healthy eating + tablets + insulin  Healthy eating and insulin   Type 1 diabetes always require insulin May have long acting 1-2 times a day  Short and long acting 1-4 times a day  Continuous – insulin pump  .

What you need to know!  Blood glucose level that is considered low  Signs and symptoms  Causes  Plan of action to treat  Strategies to prevent hypoglycaemia .

Hypoglycaemia .

80 mg/dl dengan gejala klinis . atau kadar glukosa darah .Definition of hypoglycaemia  in people with diabetes who are treated with insulin or oral hypoglycaemic agents  Hipoglikemi bila : kadar glukosa darah < 60 mg/dL.

Penyebab  Makan kurang dari aturan  Berat badan turun  Sesudah olahraga  Sesudah melahirkan  Sembuh dari sakit  Makan obat yang sifatnya serupa  Pemberian suntikan insulin yang tidak tepat DPMI Workforce Development – The Alfred Workforce Development Team June 2005 .

Causes of Hypoglycemia Excess of insulin and some oral hypogycemic agents insulin Insufficient food or delayed meal or snack Extra physical activity or exercise Alcohol consumed without food or excess alcohol DPMI Workforce Development – The Alfred Workforce Development Team June 2005 .

mual.lesu. bibir atau tangan gemetar  Stadium gangguan otak berat : tidak sadar dengan atau tanpa kejang.Tanda klinis hipoglikemi  Stadium parasimpatik : lapar. sulit bicara. kesulitan menghitung sementara  Stadium simpatik : keringat dingin pada muka. . TD turun  Stadium gangguan otak ringan : lemah.

Symptoms feeling dizzy/shaking profuse sweating headache pins and needles around mouth excessive hunger .

Cognitive impairment  Symptoms of cognitive impairment Peculiar behaviour Altered vision Loss of consciousness Lack of concentration .

Nocturnal hypoglycemia  Symptoms may include:  Sweating  Vivid dreaming  Restlessness  Incontinence  Waking with a headache  High or low fasting levels .

Act quickly .

PENATALAKSANAAN HIPOGLIKEMIA SADAR  TIDAK SADAR Suntik 50 cc Dx 40% (atau glukagon 0. .bila penyebab insulin) Infus Dx 10% 6 jam/kolf Pantau GD tiap ½ jam beri larutan gula murni 20-30gram Minum gula-gula (bukan pemanis pengganti gula atau guladiet/gula diabetes Obat DM stop sementara Pantau glukosa darah 1 – 2 jam Pertahankan GD-200 mg/dL (apabila sebelumnya tdk sadar) Cari penyebab Belum sadar GD masih < 100 mg/dL Ulangi suntik 50 mL Dx 40% Pantau GD tiap 1/2jam Belum sadar Ulangi suntik 50 mL Dx 40% Pantau GD tiap 1/2jam Belum sadar GD ~ 200 mg/dL Suntik hidrokortison 100 mg per 4 jam selama12 jamatau Deksamethason 10 mg iv bolus dilanjutkan 2 mg tiap 6 jam dan manitol iv 1 ½ .2 g/kg BB setiap 6 – 8 jam.5-1 mg iv/im. Caripenyebab kesadaran menurun.

Never Never give food to an unconscious person .

Seek further medical help.Treatment if unconscious  Position in the left lateral position and withhold any food or fluids. intramuscularly or intravenously. .  If glucagon is available it can be administered subcutaneously.

Tugas kita bukanlah untuk berhasil. karena didalam mencoba itulah kita menemukan dan belajar membangun kesempatan untuk berhasil . Tugas kitaadalah untuk mencoba.

Hyperglycaemia .

What you need to know!  What is hyperglycaemia  Causes  Describe the main principles of the treatment  Diabetic Ketoacidosis  Hyperosmolar non ketotic coma .

Hyperglycaemia  Persistent BGL over 10 mmol/L  Signs and symptoms of hyperglycaemia  Polyuria  Polydipsia  Blurred vision  Weight loss  Infections. thrush  Tired .

PERKENI. 2006) DPMI Workforce Development – The Alfred Workforce Development Team June 2005 .Kadar glukosa darah sewaktu dan puasa sebagai patokan penyaring dan diagnosis DM (mg/dl) Bukan DM Belum pasti DM 100 – 199 90 – 199 100 – 125 90 – 99 DM Kadar glukosa darah sewaktu Kadar glukosa darah puasa Plasma Vena Darah kapiler Plasma vena Darah kapiler < 100 < 90 < 100 < 90 ≥ 200 ≥ 200 ≥ 126 ≥ 100 ( Konsensus Pengelolaan dan Pencegahan DM tipe 2 di Indonesia.

Causes of Hyperglycaemia  Increased weight  Incorrect foods or amount of foods  Forgetting or insufficient medication lack of physical activity  Stress  Certain medications  Illness /infections .

Treatment  Relieve symptoms  Increase monitoring  Identify cause treat accordingly  Observe for signs of concurrent illness or infection .

.Ketoasidosis  Merupakan defisiensi berat dan akut dari suatu perjalanan penyakit diabetes melitus. oleh hati.  Peningkatan produksi gula. peningkatan mobilisasi lemak. penurunan penggunaan gula. dan pembentukan keton.

.

3  HCO3 = 15 mEq/l  Keton dalam serum  Ketonuria  Ketidakseimbang elektroli (K. Na dan CL) .4 masalah metabolik  Hiperosmolar (hiperglikemi dan dehidrasi)  Metabolik asidosis (akumulasi keton)  Hilangnya volume ekstraseluler (diuresis osmotik)  Ketidakseimbangan elektrolitm Laboratorium :  Kadar glukosa darah > 250 mg/dL  pH <7.

pernafasan Kussmaul (kompensasi mencegah penurunan pH) .Tanda klinis :  Dehidrasi : haus.turgor menurun. kelemahan. hipotensi. nafas bau keton. membran mukosa kering. koma  Kinis lain : nyeri perut. nadi cepat dan lemah  Metabolik asidosis : mual. hangat.muntah.letargi.

Tindakan cepat .

1. nadi) jika shok berikan 10ml/kg normal saline iv. Breathing : oksigen masker 3. B. Circulation : monitor fungsi jantung (TD.Resusitasi A. . C Airway : pastikan jalan nafas paten 2.

Bila kadar glukosa darah < 200 mg/dl. dalam bentuk bolus (intravena) dosis 180 mU/Kg BB.5 liter pada 30 menit kedua. 1. Bila glukosa darah < 200 mg/dL.Penanganan Rehidrasi : Pemberian cairan sebanyak 1 liter pada 30 menit pertama kemudian 0. dilanjutkan dengan drip insulin 90 mU/jam/kgBB dalam NaCl 0. . kecepatan dikurangi menjadi 45 mU/jam/g BB. Bila glukosa darah stabil sekitar 200-300 mg/dL selama 12 jam. Insulin: Insulin mulai diberikan pada jam ke-2.9%. NaCl 0. 2. Setelah itu cairan diberikan sesuai tingkat dehidrasi. dilanjutkan dengan drip insulin 1 – 2 unit/jam dan dilakukan sliding scale setiap 6 jam.9% segera diganti dengan dextrose 5%.

Bikarbonas : Koreksi natrium bikarbonat dilakukan bila pH<7.Penanganan 3. Kalium 5. KAD yang berat 4. Pemberian bikarbonas hanya dianjurkan pad. Antibiotik : Antibiotik diberikan untuk mencegah infeksi atau meluasnya infeksi.1. .

Penanganan Tujuan : mengkoreksi kelainan patofisiologis yang mendasari :  Gangguan keseimbangan elektrolit  Kadar glukosa darah  Gangguan asam basa  Mengobati faktor pencetus .

.

diare. Resiko tinggi infeksi/ sepsis berhubungan dengan kadar glukosa tinggi. penurunan fungsi leukosit 1. penurunan masukan oral. Nutrisi kurang dari kebutuhan tubuh berhubungan dengan ketidak cukupan insulin. kehilangan gastric berlebihan. status hypermetbolisme 3.Diagnosa Keperawatan Defisit volume cairan berhubungan dengan diuresis osmotic sekunder akibat hyperglikemi. muntah 2. .

3.9%) Lakukan pemasangan kateter (sesuai kondisi klien) Kolaborasi pemberian kalium. mukosa membran dan turgor kulit Monitor intake dan out put / jam Pertahankan cairan peroral maupun intravena (NaCl 0. Pantau TTV. 4. 2.Tindakan Manajemen cairan/ elektrolit 1. 5. kaji pulsasi. bikarbonas .

mual. 3. pH. Auskultasi bising usus Catat keluhan kembung. 6. muntah Beri makanan cair yang mengandung nutrien dan elektrolit jika memungkinkan Observasi tanda hipoglikemi Lakukan pemeriksaan GDS/jam Lakukan pemeriksaan GD.Tindakan manajemen hiperglikemi 1.aseton. HCO3 Pemberian terapi insulin . 5. 7. 2. 4.

4. 2. Observasi tanda-tanda infeksi Tingkatkan universalprecaution Berikan posisi semi fowler Auskultasi bunyi nafas Antibiotik .Tindakan kontrol infeksi 1. 3. 5.

Anda akan tampil secemerlang yang berbakat .Bila anda belum menemkan pekerjaan yang sesuai dengan bakat anda. bakatilah apapun pekerjaan anda sekarang.

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