Health Assessment in Diabetes Mellitus
The health assessment of diabetes is the first step in the health management of diabetes mellitus. This is conducted to determine the health needs of the person that will be incorporated in the plan of care. The health assessment commonly includes history taking and the overall physical examination of the patient. Some health practitioners focus only on the systems or organs that are commonly affected by chronic exposure to diabetes, but, it is better to cater all systems and organs because there are some instances wherein clients manifest other signs and symptoms of the disease in a very unfamiliar way. These unfamiliar manifestations are sometimes more valuable in the plan of care than the common ones.
1. HISTORY TAKING
This is done among diabetic patients to detect the severity of diabetes and its current effects or complications, and trace its possible cause/s. This also aids in the diagnosis or ruling out diabetes among new patients with diabetes-like symptoms.
a. Current manifestations. This obtains the manifesting signs of diabetes that causes discomfort to the patient that made him/her seek medical attention. This will be the guide in making management plan at home which include diet, exercise, and possible insulin or oral hypoglycemic therapy. This include the following:
a.1. The presentation of the three classical signs of hyperglycemia (elevated blood glucose level), the 3 P’s:
*Polyuria or the frequent urination
*Polydipsia or the extreme sensation of thirst
*Polyphagia or the extreme sensation of hunger
a.2. The other presenting signs that may be indicative of complications or late diagnosis of diabetes leading to the involvement of other body organs and functioning are:
*Poor wound healing
b. Family history. This is commonly assessed to determine familial tendency in the acquisition of diabetes mellitus. Any history of diabetes from the immediate relatives (parents and grandparents) would put the person at higher risk of developing diabetes. Genetic influence is considered the most probable cause of the development of diabetes mellitus.
*Lifestyle. This is assessed to determine the possible aggravating causes of diabetes mellitus present to the patient, once he/she is negative of familial tendency. The lifestyle of the patient is one of the highly linked possible causes of diabetes. An example of these includes smoking, food preferences and daily activities (sedentary lifestyle).
2. PHYSICAL ASSESSMENT
The overall review of systems and general health condition of the patient is beneficial to conduct for it reveals the severity of diabetes and its possible involvement of other organs and their functioning. The common focus of assessment includes:
a. Eyes. The eyes may or may not show signs of development of retinopathy, representing its involvement to hyperglycemia. This may be assessed for the presence of changes in vision associated with:
b. Mouth. The inclusion of the mouth assessment pays attention to possible development or presence of infections that may include gingivitis and mouth ulcers.
c. Cardiovascular and peripheral circulation. One of the most common complications of diabetes is the issue on oxygenation that commonly affects the heart muscles and its functioning like that of myocardial infarction (MI) and ventricular enlargements. Once the heart is affected, some of the most common manifestations would include:
*Weak pedal pulses
d. Gastrointestinal. As the person suffers from chronic hyperglycemia, the more likely he/she develops gastrointestinal problems including:
*Diarrhea and/or constipation
*Hunger and thirst
e. Genitourinary. The diabetic person may also have one or more of the following urinary problems once the kidneys and its functioning is affected:
*Urinary incontinence (nocturia or bed wetting is the most common)
*Recurrent urinary tract infection (UTI) among women
f. Skin. Due to the poor wound healing characteristic of diabetes, it is also essential to assess for the presence of any breakage in the integrity of the skin and presence of infection old wounds. The skin is also a good indicator of the fluid status of the patient through assessing for the skin turgor. Dehydration brought by polyuria (diuresis) may be assessed as poor skin turgor.
g. General status. The patient may also be assessed for the general status including weight gain or loss and fatigability which signifies poor metabolic functioning and fluid imbalance, the very nature of diabetes.