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Pt.'s w/ additional risk factors for neuropathies have --

>40 years of age


Nerve damage is likely to be a combination of factors, such as --

metabolic dysfunctions
high blood glucose
low levels of insulin
long duration of DM
abnormal fat levels


Neurovascular factors (neuropathies) --

can lead to damaged blood vessels that carry O2 and nutrients specifically to the nerves.


Autoimmune factors (neuropathies) --

can cause inflammation in the nerves, or mechanical injury to nerves (carpal tunnel syndrome).


What are some controllable risk factors for neuropathies?



Sx of neuropathies include the following --

- Numbness, tingling, or pain in the toes/feet/legs/hands/arms/fingers
- wasting of muscles of the feet or hands
- indigestion, nausea, vomiting
- diarrhea or constipation
- dizziness or faintness due to drop in postural BP
- problems with urination (frequency/inability)
- erectile dysfunction or vaginal dryness
- general weakness


What are the four main types of neuropathies?



Peripheral neuropathies

Affects the farthest extremities; Sx include numbness, or insensitivity to pain, temperature, tingling, burning, or prickling sensation, sharp pains, or cramps, extreme sensitivity to even a light touch to the area, and loss of balance and coordination.
Symptoms can be worse at night
May also cause muscle weakness, and lead to changes in a pt.'s gait


Why is proper foot care for diabetic patients important?

Blisters and sores appear on the numb areas of the foot because the pressure or injury goes unnoticed.


When should the foot inspections be performed when visiting provider?

They should be inspected each time the pt. visits the provider, even when the visit is unrelated to a problem with the feet.


Why should DM patients avoid the use of heat treatment for their feet?

If pt. has peripheral neuropathies present, they may be unaware of burning until the damage to skin has occurred.


Autonomic Neuropathies

affects nerves of the autonomic nerve system these nerves control the heart, regulate BP, digestion, respiratory system, urinary system, sensory organs, and the sexual responses.
they may affect the system that restores BG levels to normal after hypoglycemic episode; results in loss of warning signs and cannot recover w/o loss of intervention


What happens when the heart and circulatory systems are affected due to autonomic neuropathies?

It may intervene with the body's ability to adjust BP and HR. Results in sharp drop in BP w/ position changes, or the HR remaining high instead of rising and falling in response to normal function/exercise.


If the digestive system becomes damaged due to autonomic neuropathies, what will the S/S be?

The stomach may empty too slow (gastroparesis) and lead to persistent nausea, vomiting, bloating, and loss of appetite. nerve damage to the esophagus may make swallowing difficult, while nerve damage to the bowels can cause constipation alternating with frequent, uncontrolled diarrhea --especially at night. weight loss becomes a problem w/ such s/s.


If the urinary system becomes damaged due to autonomic neuropathies, what will the S/S be?

May prevent the bladder from emptying completely; urine remains stagnant in the bladder accumulating bacteria that can travel up to the kidneys. may cause the bladder to lose control and cause urinary incontinence.


If the reproductive system becomes damaged due to autonomic neuropathies, what will the S/S be?

decreased sexual response in both genders; does not affect sex drive. it will affect the ability for a man to have an erection and woman's ability to secrete lubrication during arousal.


How does autonomic neuropathies affect the body's ability to sweat?

W/ the inability to sweat, the body will be unable to regulate body temp and will produce signs commonly seen with many severe body reactions-- such as hypoglycemic symptoms. nerve damage can also produce profuse sweating at night or while eating.


How are sensory organs affected by autonomic neuropathies?

The eyes are primarily affected; it can affect the pupils making them less responsive to changes in light. individual may find it difficult to drive at night.


Focal Neuropathies

painful and unpredictable, and most often seen in older patients. most often affects the head, torso or leg. may cause an inability to focus the eye, double vision, aching behind one eye, paralysis to one side of the face (bell's palsy), severe pain in the lower back or pelvis, pain in front of the thigh, chest or abdominal pain that is sometimes mistaken for heart disease, heart attack, of appendicitis. tends to improve itself over weeks or months and does not cause long term damage.


Proximal Neuropathy

AKA Lumbosacral plexus neuropathy or femoral neuropathy. Pain generally starts in thighs, hips, buttocks, or legs --affecting one side of the body.
This neuropathy causes weakness in the legs, producing the inability to rise form seated position w/o help. can also lead to gait problems and muscle contractures since pt.s compensate for the weakness in one leg. This neuropathy is more common in DM II and in older patients of this category.


With diabetic neuropathy, what is the first treatment of choice?

Trying to bring the BG levels within the normal ranges. good glucose control may delay the onset or further problems.
Tx also includes pain relief and other meds needed depending on the type of nerve damage.


When is an artificial airway required?

When an immobile or unconscious patient needs assistance to ensure proper ventilation.


What are the indications and details of an Endotracheal Tube (ETT)?

Established on an unconscious pt. who cannot breathe on their own; most common in neonatal and ped pt.'s, even for long term care; when placed under emergency conditions, the tube may be removed within 48-72 hrs (or up to a week). Long term use of ETT can cause tracheal stenosis, mucosal ulcers (5-7 days after placement) and tracheal rupture. continuous care of the tube can alleviate these complications in neonatal and peds pt. 's


How do you ensure proper placement of ETT?

Verified by auscultation and CXR.


How are ETTs secured?

Secured into place by taping the ends of the tube; tape should be tight enough prevent migration of tube, but must allow one finger to be placed under the tube at any point.


When should the ETT be suctioned?

Performed as needed or at intervals ordered by Physician. Aseptic technique will be used; Suction catheter should be less than half as long as the ETT; catheter should be occluded 5 sec at a time and SPO2 should be monitored at all times. pt. may be hyperventilated prior to each suctioning procedure


Why should you NOT suction the trachea after performing suctioning of the oral pharyngeal airway?

To diminish chances of infection and lessen the opportunities of bacteria traveling into the trachea and lungs.


When would a tracheostomy usually performed?

When a ventilator will be necessary for an extended period of time. Long term support; helps prevent the aspiration of secretions.


Describe a Tracheostomy

Tube can be cuffed or uncuffed; pt.'s on a positive-pressure ventilator need a cuffed tube (foam or soft balloon cuff); when using a soft balloon cuff, pressure must be checked at least every 8 hrs.


Why do we suction the tracheostomy tube?

To remove secretions from the lower respiratory air passage. Aseptic tech used; provide O2 before the procedure and maintain aseptic technique throughout the process.