Diabetes A Comprehensive Update. Leader Guide

Transcription

1 4498 Diabetes A Comprehensive Update Leader Guide

2 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION Title of Educational Activity Contact Hours 3 The presenter for our programs are the script writers who write the program guide and the script for the programs. The facilitator/subscriber/purchaser of our program can also be considered the presenter as he/she directs the class and the participants through the guide and the video. The distribution of sheets, glossary of terms, taking of the pretest/post test and discussion of correct answers takes about 30 minutes. Each part of the video has a pretest/post test to be distributed, completed and discussed. The discussion questions take approximately minutes to discuss adequately. Questions are provided for each part of the video. There is a Case Study that takes approximately 20 minutes to discuss. 2

3 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION (continued) Objectives Content (Topics) Time Frame Facility Teaching Method List objectives in Operational and Behavioral terms Part I 1. Identify the signs and symptoms of diabetes and understand how diabetes is diagnosed. List each topic area covered and provide a description or outline of the content to be presented Part I Overview of the signs and symptoms of diabetes and a review of the criteria needed for diagnosis of diabetes. Review of the different types of diabetes: Type 1, Type 2 and gestational diabetes. State the time frame for the topic area Part I 10 minutes pre-test 25 minute Video presentation 20 minute discussion questions 15 minutes post-test List the faculty persons or presenter for each topic Part I Script writer On site facilitator Describe the teaching method (s) used for teaching Part I Video presentation Discussion questions 2. Demonstrate how to perform a home glucose test and be able to recognize blood glucose goals. Detailed step-by-step display of how to perform blood glucose testing. Review of blood glucose goals provided along with sample testing times. Script writer Video presentation. 3. Identify treatment of diabetes through diet, exercise and stress management. Part 2 4. Understand the action of the different types of oral agents used in treatment of diabetes. Detailed overview of carbohydrate counting and meal planning. Brief overview of benefits of exercise and stress management. Part 2 Review of all the oral diabetes agents. 5 different classes are reviewed along with the action and possible side effects of each drug Part 2 10 minute pre-test 25 minutes for video presentation 20 minutes for discussion questions 15 minutes for posttest Script writer Part 2 Script writer Video presentation with sample carbohydrate meals. Part 2 Video presentation 3

4 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION (continued) Objectives Content (Topics) Time Frame Facility Teaching Method List objectives in Operational and Behavioral terms Part 2 5. Demonstrate how to give an insulin injection and how the onset, peak and duration of the various types of insulin. 6. Identify the symptoms and treatment of hypoglycemia List each topic area covered and provide a description or outline of the content to be presented Part 2 Detailed step-by-step demonstration on how to prepare and give insulin injections. Detailed overview of the action of the various types of insulin. Overview of signs and symptoms of hypoglycemia and how to treat hypoglycemia. State the time frame for the topic area Part 2 Part 2 List the faculty persons or presenter for each topic Script writer Describe the teaching method (s) used for teaching Part 2 Video presentation. 5 minute case study Script writer Video presentation. 7. Discuss ways to prevent long-term complications. 8. Discuss how to manage diabetes during illness. Brief overview of long-term complications including micro-vascular and macrovascular complications. Overview of how to prevent or delay complications. Overview of daily foot care practices. Review of sick day guidelines and management to prevent further problems from occurring, such as DKA or HHNK. 5 minute case study Script writer Video presentation. Script writer Video presentation. 4

5 Diabetes Update Part 1 identifies what diabetes is and the treatment goals for the patient including glucose monitoring, diet, exercise and stress management. Part 2 identifies diabetes medications, acute and long-term complications and sick day management. Objectives 1. Identify the signs and symptoms of diabetes and understand how diabetes is diagnosed. 2. Demonstrate how to do a home glucose test and recognize blood glucose goals. 3. Identify foods that contain carbohydrates. 4. Identify benefits of exercise. 5. Discuss ways to reduce stress. 6. Describe / explain the action of the different types of oral agents. 7. Demonstrate how to give an insulin injection and the onset, peak and duration of the various types of insulin. 8. Identify the symptoms and treatment of hypoglycemia. 9. Discuss ways to prevent long-term complications. 10. Discuss how to manage diabetes during illness. 5

6 GLOSSARY OF TERMS Beta Cells: Cells that make insulin. Continuous glucose sensor: A device similar to a Holter Monitor that is inserted in the subcutaneous tissue in the abdomen and is used to monitor glucose readings in the interstitial fluid. The device is manufactured by MiniMed and is being used in physician offices only at this time. Diabetic Ketoacidosis (DKA): A condition that mainly effects people with type 1 diabetes. The body is unable to metabolize carbohydrates due to lack of insulin, the body then metabolizes fat for the energy it needs. The burned fat produces ketones which are toxic to the body. This condition can be life threatening if not treated, also known as diabetic coma. Person will experience S & S of hyperglycemia along with positive ketones in urine and a fruity odor to the breath. Gestational diabetes: The type of diabetes that occurs during pregnancy. There is glucose intolerance during the pregnancy and usually diminishes after delivery. Glucowatch: A new type of glucose meter that provides painless noninvasive measurements every 20 minutes up to 12 hours. The watch sends a tiny electric current through the skin and measures the glucose in the interstitial fluid. It also has a safety feature, which will alarm for high and low blood sugars. The device should be available in the middle to 3 rd quarter of the year Hyperglycemia: High blood sugar, generally>140 mg/dl or above, resulting from not enough insulin or too much food. Symptoms include increased thirst, hunger, urination and fatigue. Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNK): A condition that can affect people with type 2 diabetes. Often blood sugar levels are greater than 800mg/dl. Similar to DKA but does not result in ketoacidosis. Hypoglycemia: Low blood sugar, generally below 70mg/dl., resulting from too much insulin or activity or not enough food. Symptoms include: feeling weak, shaky, sweaty, confused and hungry. Can be fatal if left untreated. 6

7 GLOSSARY OF TERMS (continued) Type 1 diabetes: The type of diabetes in which the body produces little or no insulin. The person must take daily insulin injections to prevent ketoacidosis and to sustain life. The onset is rapid and it typically affects people <30years of age. Type 2 diabetes: The type of diabetes in which the body produces insulin, but there is decreased tissue responsiveness to insulin and excessive production of glucose in the liver. The onset is gradual and the symptoms may be mild or undetected. Insulin Pen: Alternative to insulin syringe; two types: disposable and refillable; allows for convenience and ease in delivering insulin. Insulin Pump: Small computerized device (approximately the size of a pager device); delivers insulin continuously throughout the day; has (2) rates of delivery: basal and bolus. Basal rate delivers a certain amount of insulin every hour (can be higher or lower dose based on time of day and activity). Bolus rate is amount of insulin given before each meal, snacks and for elevated blood sugar readings; requires a high level of responsibility from the patient. 7

8 Pre Test Part 1 Directions: Circle T for true statements and F for false statements. T F 1 Type 1 diabetes can usually be controlled by diet and exercise only. T F 2 Normal blood glucose before meals is mg/dl. T F 3 Insulin helps glucose enter the cells where it can then be used for energy during pregnancy. T F 5 People with diabetes only need to be concerned with the amount of sugars in foods. T F 6 A free food has no sugar. T F 7 The HbA1c test gives the average blood sugar over the past 8-12 weeks and is recommended every 3 months. T F 8 Regular exercise can reduce insulin needs up to 30%. T F 9 People with diabetes should be encouraged to carry medical identification and a form of carbohydrate at all times. T F 10 Stress has no effect on blood glucose levels. 8

9 Discussion Questions Part 1 1. What are your agency s/facility s policies and procedures on diabetes teaching? Who s responsibility is it to provide diabetes teaching? 2. What resources are available to you for diabetes education? 3. How did you react when you encountered your first patient with hypoglycemia and how did you feel? 4. What type(s) of diabetes do you find in your patients? 9

10 Post Test Part 1 Directions: Choose the most appropriate answer for the following questions. 1. Insulin s job is to help the body: a. turn sugar into energy b. store sugar in the blood c. get rid of sugar d. turn fat into fat 2. Symptoms associated with diabetes include: a. polyuria b. polyphagia c. fatigue d. all of the above 3. Type 1 diabetes is a metabolic disorder caused by: a. high sugar diet b. an autoimmune or idiopathic pancreatic islet destruction c. delayed insulin secretion in response to glucose d. none of the above 4. Risk factors for developing Type 2 diabetes are: a. family history b. smoking c. obesity d. a & c only 5. HbA1c or glycosylated hemoglobin is a diagnostic lab test that estimates: a. the average blood lipid level over the past 8-12 weeks b. the amount of functioning beta cells in the pancreas c. the average blood sugar levels in the past 8-12 weeks d. the average blood sugar levels in the past 6 months 10

11 Post Test Part 1 (continued) 6. The main source of carbohydrates in the diabetes meal plan is: a. bread, grains and cereals b. fish and meats c. green leafy vegetables d. fats and oils 7. A free food : a. contains no sugar b. can be eaten in unlimited quantities c. has <20 calories d. contains no fat 8. The benefits of exercise for people with diabetes are: a. lower blood glucose levels b. lower blood pressure c. improves circulation d. all of the above 9. The type of exercise most beneficial to a patient with diabetes is: a. running b. walking c. swimming d. weight lifting 10. Stress can be reduced by: a. exercise b. eating a healthy diet c. rest d. all of the above 11

12 Pre Test Part 2 Directions: Circle T for true statements and F for false statements. T F 1. Humalog insulin is an intermediate acting insulin. T F 2. Hyperglycemia occurs when the blood sugar is <70 mg/dl. T F 3. Retinopathy is a long-term complication of diabetes resulting from high blood glucose levels. T F 4. Insulin is used for Type 2 diabetes that has failed an adequate trial of diet, exercise and oral medications. T F 5. Diabetes medications should be temporarily stopped during illness. T F 6. NPH or Lente insulin peaks in 6-12 hours. T F 7. People with diabetes should examine their feet daily. T F 8. Glucophage works by stimulating the pancreas to produce more insulin. T F 9. Liver function tests should always be performed prior to starting Avandia or Actos. T F 10. Glucagon should only be given when a person is unable to swallow or if they lose consciousness due to a low blood sugar reaction. 12

13 Discussion Questions Part 2 1. Can you discuss the onset, peak and duration of regular, NPH and Ultralente insulin? 2. What complications of diabetes have you seen in your patients? How could they have prevented those complications? 3. What risk factors can you see in your patients that make them more prone to complications? What can they do to prevent complications? 4. You are taking care of an elderly patient with a history of type 2 diabetes with poor eyesight. Her physician changed her treatment regime from oral hypoglycemic agents to insulin. The patient does not want to take the needle because she can t see the numbers on the syringe and is afraid she may over medicate herself. What alternative does this patient have for insulin administration that would provide ease and accurate dosing? 5. You are caring for a teenage boy who has had type 1 diabetes for 5 years. He is extremely sick and unable to keep any food or fluids down. He hasn t taken his insulin or tested his blood sugar today. What should be done to manage his diabetes during his illness? 13

14 Post Test Part 2 Directions: Circle correct answer, only one answer is correct. 1. The action of sulfonylureas is to: a. decrease insulin production b. increase insulin production c. keep liver from releasing too much glucose d. make muscle cells more sensitive to insulin 2. The preferred site for an insulin injection is: a. the abdomen b. the thighs c. the arms d. all of the above 3. The duration of Ultralente insulin is: a. 10 hours b hours c hours d. 2 days 4. Which of the following are symptoms of high blood sugar: a. increased thirst b. increased urination c. tiredness d. all of the above 5. Which of the following is not a symptom of hypoglycemia: a. weakness b. sweating c. increased thirst d. shakiness 14

15 Post Test Part 2 (continued) 6. Patients who develop Hyperglycemia Hyperosmolar Nonketotic syndrome (HHNK) are: a. people with type 2 diabetes b. children with type 1 diabetes c. both a and b d. none of the above 7. Which of the following is not a characteristic of diabetic ketoacidosis (DKA): a. ketones in urine b. Kussmaul s breathing c. fruity odor to breath d. rapid heart rate 8. During illness blood sugars should be monitored every: a. hour b. 2-4 hours c. 6 hours d. once a day is adequate 9. Glucagon is: a. given to raise blood sugar levels b. given to lower blood sugar levels c. given to reduce the amount of glucose released from the liver d. should be given to anyone experiencing low blood sugar 10. A good principle of foot care to instruct your patient is to: a. use corn pads to prevent accidental removal of the corn b. always trim the nails at an angle c. after washing, dry feet thoroughly, especially between the toes d. walk barefoot when in the house to allow the feet to air and stay dry. 15

16 Pre Test/Post Test ANSWER SHEET PRE TEST PART 1 PART 2 1. F 1. F 2. F 2. F 3. T 3. T 4. T 4. T 5. F 5. F 6. F 6. T 7. T 7. T 8. T 8. F 9. T 9. T 10. F 10. T POST TEST PART 1 PART 2 1. a 1. b 2. d 2. a 3. b 3. c 4. d 4. d 5. c 5. c 6. a 6. a 7. c 7. d 8. d 8. b 9. b 9. a 10. d 10. c 16

17 These case studies are to be completed by the RN participants to meet ANCC guidelines. Diabetes Case Study Case study #1: Leo, a 68 year old single male was admitted to the hospital with a foot ulcer he states was caused by an ant bite. He also complains of excessive thirst and urination. Leo s admission blood work revealed a random glucose of 359 mg/dl and a HbA1c reading of 9%. Leo weighs 285 lbs. and is 5 7. Other medical history includes liver damage from past ETOH abuse. Leo has been sober 5 years. Leo controls his diabetes by diet and exercise but admits to not testing his blood sugar at home. He hasn t exercised in a year and he eats whatever is available. 1. What medications could benefit Leo? 2. What does Leo need to learn about diabetes management? 3. What could Leo have done to prevent the foot ulcer? Case study #2: Beth, a 16 year old female with a 4 year history of type 1 diabetes was spending the night at her friend Tammy s house. Beth and Tammy stayed up late watching a movie and pigging out on junk food. To prevent going too high, Beth gave herself an extra injection of insulin. After going to bed, Beth woke up feeling sweaty, her skin was clammy, and she was shaky. Tammy didn t know that Beth has diabetes. Beth told Tammy that she was thirsty and would be right back. She went to her friends kitchen but was unable to find anything to eat or drink and passed out. Tammy found her and called her parents. 911 was called and on arrival of EMS, Beth s blood sugar was 34 mg/dl. An IV was started and dextrose was given, Beth ended up spending the night in the hospital. 1. What should Beth have told her friend Tammy and Tammy s parents? 2.What should Beth have done differently to prevent this from happening? 17

18 References American Diabetes Association. (1996). American Diabetes Association Complete Guide to Diabetes. Alexandria, VA.: American Diabetes Association. Anderson, R., etal..managing Your Diabetes. Eli Lilly and Company, Indianapolis, IN. Diabetes Treatment Center of America (1999) Current Trends in Diabetes Management. Nashville, TN.: Diabetes Treatment Centers of America. Diabetes Treatment Centers of America (1998). Patient Education Manual. Diabetes Treatment Centers of America. Edelman, S., Henry, R. (1999). Diagnosis and Management of Type 2 Diabetes. (3 rd ed). Professional Communication, Inc. Eli Lilly and Company (1998). Humulin Pen. Indianapolis, IN: Eli Lilly and Company. Funnell, M.M., Hunt, C., Kulkarni, K., Rubin, R., & Yarborough, P. (1998). American Association of Diabetes Educators. A Core Curriculum for Diabetes Education (3 rd ed). Chicago, IL.: Port City Press, Inc. Takeda Pharmaceuticals America (1999), Actos. Takeda Pharmaceuticals America, Inc. and Eli Lilly and Company. Walsh, J., & Roberts, R. (1994). Pumping Insulin. (2 nd ed). San Diego, CA.: Torrey Pines Press. 18

19 Participant Evaluation of Objectives Please evaluate this program by circling the number that best represents how well this program met the following objectives: 4=Excellent 3=Good 2=Average 1=Poor 1. Identify the signs and symptoms of diabetes and understand how diabetes is diagnosed. 2. Demonstrate how to do a home glucose test and recognize blood glucose Identify foods that contain carbohydrates Identify benefits of exercise Discuss ways to reduce stress Describe / explain the action of the different types of oral agents. 7. Demonstrate how to give an insulin injection and the onset, peak and duration of the various types of insulin Identify the symptoms and treatment of hypoglycemia Discuss ways to prevent long-term complications Discuss how to manage diabetes during illness Do you feel you met your personal objectives? Time required to complete this program? Minutes COMMENTS Return this form to the facilitator who distributed the learning materials. Thank you. 19

20 NEVCO Account # REQUEST FOR CERTIFICATES FOR CONTACT HOURS TYPE the NAMES, LICENSE NUMBERS AND JOB TITLES (RN, LPN, MSW, CNA, PT, etc.) of the people who are to be issued a certificate for contact hours for attending the continuing education program: (Facility Name) (Title and Number of Video Program) This request must be submitted along with the completed roster and evaluation sheets for the above named program NAME LICENSE NO. JOB TITLE

21 Must be completed by the facilitator EVALUATION OBJECTIVES: TIB Bank Center th Street N., Suite 207 Naples, Florida (800) Fax (888) FACILITATOR S EVALUATION (NEVCO Video Education Program) (1) To assess extent to which the program was appropriate, adequate and effective. (2) To identify, continue to develop and evaluate effective quality assurance activities. Title of Program Date Place of Employment Job Title Please evaluate the presentation by circling the number that best describes your rating. 4 Excellent 3 Good 2 Average 1 Poor ORGANIZATION OF COURSE Material was organized to facilitate learning The amount of material covered was adequate and accurate There was effective use of time to cover the subject CONTENT OF THE FACILITATOR S GUIDE List total number of objectives in this facilitator s guide List by number the objectives that were met The test material reflected the objectives listed Content can be used to improve nursing practice Content reflected knowledge level and needs of learner The material was current Evaluate Test Questions Pre-Test Discussion Questions Post-Test FACULTY PRESENTING (Video) The presentation was The presenter explained the material The presenter demonstrated knowledge of material OVERALL RATING I felt this teaching method was COMMENTS (Please make suggestions for future topics and additional comments about the presentation or instructor) Thank you for your time in completing this evaluation! We appreciate your comments and suggestions. The NEVCO Educational Staff 1995 Revised 10/2004

22 EVALUATION (NEVCO Video Education Program) TIB Bank Center th Street N., Suite 207 Naples, FL (800) Fax (888) Must be completed by every participant EVALUATION OBJECTIVES: (1) To assess extent to which the program was appropriate, adequate and effective. (2) To identify, continue to develop and evaluate effective quality assurance activities. Title of Program Date Place of Employment Job Title OBJECTIVES Total number of objectives in program Circle the number of objectives that WERE met Circle the number of objectives that were NOT met Please evaluate the presentation by circling the number that best describes your rating. 4 Excellent 3 Good 2 Average 1 Poor ORGANIZATION OF COURSE Material was organized to facilitate learning The amount of material covered was adequate and accurate CONTENT OF THE PRESENTATION The test material reflected the objectives listed Content and/or skills demonstrated can improve my ability to perform my job Content reflected knowledge level and needs of learner The material was current Time for questions was Effective use of time to cover subject was Graphics were beneficial NEVCO FACULTY (who prepared the program and/or appeared in interviews) The presentation was well prepared The presentation explained the material well The presenter demonstrated knowledge of material OVERALL RATING I felt this teaching method was Facilities and classroom were adequate COMMENTS (Please make suggestions for future topics, content of program and instructors) Thank you for your time in completing this evaluation! We appreciate your comments and suggestions. The NEVCO Educational Staff 1995 Revised 10/2004

23 PRINT OR TYPE TIB Bank Center th. Street N., Suite 207 Naples, FL (800) Fax: (888) CONTINUING EDUCATION ROSTER This form must be completed and returned to NEVCO. Keep a copy for your facility, but return the original to NEVCO. Account # Number and title of Video Program Dates Given Contact Hours Name of Facility Address of Facility City/State/Zip RN Facilitator Signature ROSTER OF PARTICIPANTS Participant Name Participant Signature License # Soc. Sec. # National Educational Video, Inc. TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama , California CEP8803 and Kentucky This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

24 Participant Name Participant Signature License # Soc. Sec. #

25 599 9 th Street N., Suite Naples, FL Fax: Certificate of Completion This is to certify that Attended and Completed National Educational Video, Inc. TM Program Number and Title For contact hours On Date Facility / Agency Name Facility / Agency Address RN / Facilitator CERTIFICATE FOR ASSISTANTS ONLY National Educational Video, Inc.TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama , California CEP8803 and Kentucky This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

26 CERTIFICATE OF COMPLETION For each participant who has successfully completed a continuing education program, please make a copy of the blank NEVCO Certificate (on reverse side) and fill in the following information: 1. Name of the learner 2. Program title and number 3. Number of contact hours 4. Date the program was completed 5. Name and address of your Agency / Facility 6. Signature of the RN / Facilitator responsible for offering the program