Upload
elizabeth-thompson
View
223
Download
3
Embed Size (px)
Citation preview
Practical session of Diabetes Camp 2004
Lee Kar Bik
Diabetes Educator QMH (Paed) 16 September 2004
The objectives of Diabetes Camp 2004
To promote diabetes education in a more relaxed and non-structural setting.
(Main themes: food exchange and CHO counting, insulin dosage adjustment, exercise and diabetes)
To review their management skill in daily life. To encourage independence, build confidence and
self esteem. To impact a more positive attitude in coping with
the illness. To create a safe and fun environment.
Diabetes Camp 2004 Place: 西貢黃宜州青年營營地 Date: 22/10/04 --- 24/10/04 Participants: 95 DM children Hospitals: 12 Age groups: 8-10 (18) 11-12 (23) ≥13 (54) Sex: female – 51 male – 44 Years of diagnosis: From ~3 months to 17 years Groups: 12 (different ages and sex), 7-8 persons/group Room: 12 Female (7) Male (5) Workers: Doctors / DM nurses / Dietitians / MSW / Camp facilitators / volunteers from parents
Role of Diabetes educators/ DM nurses within a DM Camp To provide educational and recreational activities To provide knowledge in management of exercise
and hypoglycaemia To provide psychological and physical support to
younger patients To prevent and manage hypoglycaemia To ensure safety outdoors activities To co-ordinate dosage reduction To identify patients at risk of unstable blood
sugar To monitor patients daily diabetes care . Dextrostix monitoring . Insulin injection technique . Dietary intake
Role of leader within the camp
鼓勵營友積極地參與營內各種活動節目。
協助職員維持營內活動之秩序。
鼓勵其他營友遵守營內的規條。
協助指導年幼的營友做血糖測試和注射胰島素。
協助照顧較年幼的營友 , 肯定他們已跟進各人的食物表所訂的份量。
協助教導其他營友在日常生活中怎樣去調較胰島素量及食物 , 運動和胰島素 的關係。
Role of leader within the camp
協助教導其他營友怎樣去處理低血糖反應。
鼓勵營友們需積極地面對糖尿病 , 給予他們一個正面的榜樣適應由糖尿病所帶來的負面情緒反應。
鼓勵大家去分享和思考各人心中面對糖尿病的疑難和矛盾。
若有任何疑難或困擾問題 , 歡迎轉介職員去協助解決。
盡量鼓勵團隊精神。
DM camp programDay 1 (2004-10-22)09:15 Assembly09:30 -12:00 Depart SK Pier Settle and grounding Introduce facilitators Trust lean (partner/group) Group name & Slogan Find facilitator12:00 – 13:00 Lunch ( including check H’stix and injection)13:15 – 17:00 Small group activities (outdoor)18:00 – 19:00 Dinner (including check H’stix and injection)19:00 – 19:30 Sharing 19:30 – 20:00 Briefing for Field trip20:00 – 21:00 Basic Map Reading21:00 – 22:00 Preparation for Field trip22:00 End
DM camp program
Day 2 (2004-10-23)08:00 – 09:00 Breakfast
09:30 – 18:00 Field trips
18:00 – 19:00 Dinner (including check H’stix and injection)
19:00 – 20:00 Preparation for Camp Fire
20:00 – 22:00 Camp Fire
22:00 End
Dm camp program
Day 3 (2004-10-24) 親子日營08:00 – 09:00 Breakfast
09:30 – 12:00 Small group activities (parents to join)
12:00 – 13:00 Lunch (including check H’stix and injection)
13:00 – 1400 Packing
14:00 – 16:00 增進親子溝通工作坊 16:00 – 16:30 Closing Ceremony
16:30 End
Blood MonitoringBlood glucose monitoring Frequency: before breakfast
before lunch
before dinner
before bed
or 3 a.m.
& p.r.n. Blood sugar analyzer: Optium Recording
Record in camp record sheet and their own record book
Blood monitoringKetone monitoring Measuring serum ketone if BS persistently
> 15 mmol/L (2 consecutive readings if asymptomatic) or if there is intercurrent illness
Blood ketone level <0.6 mmol/l -------------- No action required0.6 – 1.5 mmol/l -------------- Retest blood glucose and blood ketones in 2 – 4 hours1.5 – 3 mmol/l ------------- May be at risk of developing DKA>3mmol/l ------------ Requires immediate emergency treatment
Hypokit Blood glucose analyser & strips Lancets Alcohol prep Gauze Ribena candy (10g/pack)/ Vitasoy 125ml/box (1
0g/box) / biscuit Glucagon I.M.I & 2.5ml syringe +/- Hypostop Bandaid/ Bandage Insect Repelient Record sheet & pen Small sharp box
Medical instrusment (1)
Items:1.Stethoscopes
2.Thermometer
3 .I.V. drip set/ Angiocath / heparin flush and heparin block/ Splint
4. Micropore/ Tagaderm/ Alcohol prep
5. I.V. fluid D5/ NS/ Water for injection
6. I.V. Glucose D20/D50
7. Blood glucose Analyzer/ blood glucose strips
8. Lancet
9. Blood ketone test strip
10. Urine ketone strip
Medical instrusment (2)
11. Syringe (2.5ml/ 10ml, 20ml)/ insulin pen12. Insulin syringe (30u/ 50u)13. Gauze/ bandaid/ Elastic Bandge/ Triangular bandage 14. Sharp box/ gloves15. Medication: Glucagon i.m.i Insulin ( different kinds of insulin) OHA Panadal / Piriton / Stemetil /Maxolon/ Gelusil / Holopon / Lomotil /Ventolin Puff / Hydrocortisone i.v. / Adrenaline i.v.16. Insect Repellent17. Antisan18. +/- Hypostop
Recording
DM camp medical form
Name _______________(Chinese)___________________(English) I.D. No_______________ Age ________ Sex _________ Hospital_________________ Year of Diagnosis________________ Paediatrician_______________ Nurse Educator_____________ DM medication_____________________________________ Other medication____________________________________ Allergy history ______________________________________ Medical history______________________________________ Latest HbA1c_________Blood sugar control range _______________ Diet (Cal / CHO portion)__________________________ Frequency / severity of hypo (recent 3 months)_____/week ______ Any severe hypo : ________require glucagon (Y / N) admission(Y / N)Episode of DKA (in last 12 months)_______________Psychological issue________________________________________Remarks_________________________________________________Emergency contact person________________ Relationship_______Emergency contact phone no________________________________
No. Hospital Name Sex/ Age
Dx /
Yr of Dx
Tel Medical History
Cal/ Cho Portion Diet / Food allergy
Insulin dosage / OHA/ other medication
Emergency Contact Person / Tel
RemarkS
Room no : _________ Team no : ________ Doctor I/C : ________ (Pager __________ ) Nurse Educator I/C ________
Recording
No. Hospital Name Sex/ Age
Dx /
Yr of Dx
Tel Medical History
Cal/ Cho Portion Diet / Food allergy
Insulin dosage / OHA/ other medication
‘E”
Contact Person / Tel
RemarkSCharacteristics
Aims
QMH XXX F/10 Type I DM
10 yrs
Nil 1200 Cal
40/ 0/ 50/ 0/ 50/ 20Lispro 6u BB
Lispro 7u BL
Lispro 7u BDGlargine 20u B bed
Easy to have hypo
Plan to teach injection over abdomen
Room no : _________ Team no : ________ Doctor I/C : ________ (Pager __________ ) Nurse Educator I/C ________
Recording
Blood sugar recording
22/10/2004 Breakfast Lunch Dinner Before bed Night
Day 1 Insulin
H’stix
Hypo
Extra food (simple
sugar/ CHO) Remarks
10月 23日遠足日誌
姓名 : 性別 : 年齡 : _________ 胰島素治療方案 :___________________________ 澱粉質分配 : _________________________
時間
H’stix
Ketone(p.r.n.)
胰島素劑量
胰島素劑量調較由 → 至
減胰島素之百分比(%)
食物種類
澱粉質分
量 (gm)
額外澱粉質
遠足里數
估計遠足所用時間
運動量評分
背囊重量
Rema
rk
Aftercare of DM camp
. Give advise to parents/ caretakers on insulin adjus
tment to prevent delayed hypoglycaemia
. Sent participants’ blood sugar record and special events within the camping to individual hospital.
. Follow up what they had learnt in the camp.