Perioperative medical care of patient with diabetes undergoing planned surgery

Uvod: Sladkorna bolezen ali diabetes mellitus je najpogostejša presnovna kronična bolezen. Predstavlja glavni vzrok umrljivosti in zmanjšanje pričakovane življenjske dobe. Z naraščajočo razširjenostjo sladkorne bolezni potrebuje tekom svojega življenja operativni poseg približno 25 % ljudi s sladkorno boleznijo. Kirurško zdravljenje je eden izmed načinov zdravljenja, ki posega v celovitost bolnikovega organizma. Za bolnika predstavlja nenaden preobrat, na katerega se mora prilagoditi in zato potrebuje določen čas, moč in oporo. Pomembno je, da se za vsakega posameznega bolnika s sladkorno boleznijo pred operacijo pripravi individualen načrt obravnave. Dobro organizirana perioperativna zdravstvena nega in multidisciplinarni pristop olajšata izvedbo kirurškega posega na varen način brez akutnih in kroničnih zapletov. Namen: Namen diplomskega dela je predstaviti obravnavo bolnika s sladkorno boleznijo pri načrtovanem kirurškem posegu v splošni anesteziji. Metode dela: Diplomsko delo temelji na deskriptivni metodi. Opravljen je tematski pregled znanstvene in strokovne literature v slovenskim in angleškem jeziku, v spletnih podatkovnih bazah: COBISS, PubMed, CINAHL, Science Direct ter spletnem iskalniku Google Učenjak z uporabo izbranih ključnih besed. Rezultati: Kirurgija je pomembna možnost zdravljenja sladkorne bolezni. Pri bolnikih s sladkorno boleznijo, ki so napoteni na kirurški poseg, je treba ves čas spremljati raven glukoze v krvi z namenom dosega normoglikemije. Vse aktivnosti perioperativne zdravstvene oskrbe in kakovostna organizacija multidisciplinarnega tima so usmerjeni k uspešnem kirurškem zdravljenju, preprečevanju akutnih in kirurških zapletov in čimprejšnjemu okrevanju. Razprava in zaključek: Ključno orodje povezovanja strok in poenotenja pristopov so smernice za klinično obravnavo sladkorne bolezni, ki jih v Sloveniji stroka skladno s strokovnim napredkom in novimi pristopi redno posodablja. Izsledki diplomskega dela so pokazali pomembnost perioperativne zdravstvene nege za kakovostno obravnavo bolnika s sladkorno boleznijo in potek njegovega zdravljenja. Pot do kakovostne perioperativne oskrbe pa je v sodelovanju multidisciplinarnega tima z bolnikom in njegovimi svojci. Multidisciplinaren način obravnave izboljša oskrbo bolnikov, klinično se dosegajo boljši izidi, diagnostika bolezni je bolj natančna, izboljša se psihično in fizično stanje bolnika ter zmanjša umrljivost.Introduction: Diabetes or diabetes mellitus is the most widespread chronic metabolic disease. It is the main cause of death and reduced life expectancy. With the growing prevalence of diabetes, throughout their lives, approximately 25% of diabetes patients require surgical treatment. Surgical treatment is one of the ways of treatment that interfere with a patient’s entire organism. From their perspective, this is a sudden change that they have to adapt to, requiring a certain amount of time, strength and support. It is important that an individual treatment plan is prepared for each diabetes patient prior to the surgery. Well-organised perioperative medical care and a multidisciplinary approach ensure safe surgery, without acute and chronic complications. Aim: The aim of this paper is to present diabetes patient treatment before a planned surgery under general anaesthesia. Methods: This paper uses the descriptive work method. A thematic review of scientific and professional literature in Slovene and English was conducted, searching through COBISS, PubMed, CINAHL and Science Direct online databases and in the Google Scholar online search engine, using the selected keywords. Results: Surgery is an important diabetes treating option. The level of blood glucose should be monitored all the time in diabetes patients that are to undergo surgical treatment, in order to achieve normoglycaemia. All perioperative care activities and quality organisation of a multidisciplinary team ensure efficient surgical treatment, prevent acute and chronic complications and lead to rapid recovery. Discussion and conclusion: A key tool combining disciplines and harmonising approaches is guidelines for clinical treatment of diabetes, which Slovenian professionals regularly update in accordance with scientific progress and newly developed approaches. Findings of this research prove the importance of perioperative medical care for quality diabetes patient treatment and its course. Quality perioperative treatment can be achieved with the cooperation of a multidisciplinary team with the patient and their relatives. A multidisciplinary type of treatment improves patient care, achieves better clinical results, ensures a more accurate disease diagnosis, improves mental and physical state of the patient and reduces mortality rate