1. Cause
Diabetes is a common endocrine metabolic diseases, the cause has not yet fully understood. Drink for the clinical features, polyuria, and more food and weight loss syndrome. Poor control can cause many complications. At present, the incidence of diabetic patients with tuberculosis are relatively high. Sugar as a result of the lack of protein can not take full advantage of the lower body resistance and immunity. Human immunity to TB are: congenital and acquired immunity, two kinds of immunity. Which acquired a strong immunity to Mycobacterium tuberculosis after BCG vaccination or after infection with specificity. After being infected by Mycobacterium tuberculosis incidence, depending on the number of bacterial invasion and virulence, the body's immune system and body's allergic reactions and other factors. Over the past few years we in the treatment of tuberculosis among treated patients with diabetes on the number of cases of pulmonary tuberculosis. The treatment of pulmonary tuberculosis in the clinical course of disease is relatively slow. I am years from 1998 -2003 a total of 35 cases of complications in patients admitted to our nursing experience now described below.
2. Objects and care
2.1 Object
35 cases of this group, 18 cases of male and 17 females, aged 25-75 years old, diabetic patients with tuberculosis.
2.2 Nursing
2.2.1 Food care: diabetes diet is the most basic of measures, regardless of insulin or oral hypoglycemic medication patients need to control diet, in order to stabilize the patient's condition. Stressed the importance of diet therapy, to give the patient or family members repeatedly tell the control diet is the most basic method of treatment of diabetes, medication alone is not satisfactory efficacy. Diet to patients alone, the church and the preparation of the patient calculated calorie recipes, and strictly enforced. Caloric intake may exercise discretion to increase malnutrition, obesity reduce it to the amount of fat a day should be tightly controlled selection of the best no more than 40g of vegetable oil. Promote use of crude fiber content of food in order to increase gastric motility, slow digestion and absorption, add enough of the vitamin B vitamins in particular. Reasonable distribution of food,wish to avoid eating more than the burden of insulin.
2.2.2 to observe the reaction of nursing administration: insulin therapy should be closely monitored patients. Often the following symptoms: pale, palpitation, a cold sweat, dizziness, nausea and hunger, as were unclear, the above symptoms should be attention. Low blood sugar reactions generally occur in the injection of insulin for half an hour (when not eating), or 3-4 hours or caused by excessive insulin, or brittle diabetic patients, urine negative for several days, insulin reduction is not timely. To prevent low blood sugar reaction, generally half an hour in each meal fasting insulin injection. Observed after injection should also pay attention to. Timely treatment of low blood sugar reactions, first of all, the patients lying, oxygen, proper eating carbohydrates such as sugar, biscuits, etc., often can be eased. Low blood sugar coma if a timely notice of a doctor. 50% intravenous glucose 40-60ml. Timely collection of urine, blood and ready to actively cooperate with the inspection of doctors jointly controlled hypoglycemia caused by drug overdose.
2.2.3 diabetic patients with clinical TB care: After the merger of anti-tuberculosis drug-sensitive TB declining, relatively long treatment duration. The performance of patients after onset of symptoms: low-heat in the afternoon sweating, fatigue, poor appetite, weight loss. Women may have menstrual disorders or amenorrhea. Respiratory symptoms: cough, sputum, chest pain, breathing difficulties have varying degrees of hemoptysis. TB as quickly as possible in order to effectively control the situation in tuberculosis before chemotherapy in patients with sputum smear investigation. Second AFB, blood, urine, liver function of the time, a chest X-ray. Treatment of sputum smear during the second month, every three months to check blood, urine, liver function of the time. Chest X-ray taken at the end of a course of treatment.
TB patients to take anti-TB chemotherapy in TB control in the play a decisive role. Of active tuberculosis chemotherapy must adhere to the early days, the joint, regular, regular, full use of the principle of drug-sensitive. Standard chemotherapy: mild 12-18 months, 18-24 months of severe, short-course chemotherapy, treatment is started 2-3 months strengthening phase, the consolidation phase of the whole 2-3 months. Chemotherapy, we should be monitoring of management. Such as the use of rifampicin (RFP) and to observe the liver, any change in liver function, whether the yellow staining of skin, nausea, vomiting. Use of ammonia, oxygen acid (PAS) have stomach discomfort. Use of pyrazinamide (PZA) in deep joints feel any pain. Taking isoniazid (INH) whether symptoms of tinnitus. Star阿卡米sulfate (KM) intravenous administration of this drug have some renal toxicity, routine laboratory tests before treatment. Blood urea nitrogen medication review process once a month. Period in the clinical treatment of the disease should strictly monitor the changes in the integrated care initiative.
3. The results
Over the past few years we have a doctor of clinical nursing staff in patient treatment and care, 81% diabetes mellitus to achieve a cure rate of tuberculosis. 19% of patients with diabetes as a result of relatively heavy, drug-sensitive TB declining, stable disease treatment, has received satisfactory results.
4. Discussion
Diabetic patients with pulmonary tuberculosis care:
4.1 Treatment of diabetes mellitus with clinical tuberculosis more difficult. Diabetes as a result of disordered glucose metabolism, resulting in strengthening the role of gluconeogenesis, resulting in accelerated decomposition of antibody protein complement and reduce the generation of immune globulin. After the merger of anti-tuberculosis drug-sensitive TB decline, a longer course of treatment. The performance of patients after onset of symptoms: low-heat in the afternoon sweating, fatigue, poor appetite, weight loss. Women may have menstrual disorders or amenorrhea. Respiratory symptoms: cough sputum, chest pain, breathing difficulties and varying degrees of hemoptysis. In order to control the disease as soon as possible. Clinical timely application of anti-tuberculosis chemotherapy treatment, in the treatment of close observation, we monitor the care of chemotherapy drugs. More side-effects of anti-TB drugs, drugs in the treatment of sensitive observation, and symptomatic treatment if the drug is not sensitive to the dressing was changed in time in order to achieve therapeutic effect.
4.2 during treatment to guide our patients with the nursing staff to be patient and eliminate tension, to maintain a good attitude. Indoor ventilation to maintain indoor air fresh. Frequently in stable condition after the step-by-step outdoor static, not fatigue, strict compliance with the orders on time and on medication, to control blood sugar, keep the skin clean to prevent infection to prevent complications.
