Norms and standards on materials, equipment, supplies and general
competencies are dealt with in the chapter on chronic diseases. This chapter
deals specifically with competence and referral standards for diabetes.
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Reference Prints and Educational Material
1.1 See chronic diseases
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Equipment
2.1 Sphygmomanometer with different size cuffs
2.2
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Medicine and Supplies
3.1 As per EDL list
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Competence of Health Staff
4.1 Staff know that prevalence of diabetics in South Africa is high
(10% in Indian community and 5 – 6% in the black community) and estimate
how many cases there are in clinic catchment areas and are alert to
identify them early.
4.2 The interrelationship between abdominal obesity, hypertension and
cardiovascular disease and initial presentation with complications of
diabetics are known. Hypertension patients are investigated for diabetes.
4.3 All pregnant women have urine examined for glycosuria.
4.4 Patients suspected of having diabetes (history and risk factors,
clinic blood and urine testing indicating diabetes) are referred to
hospital for diagnosis.
4.5 Nurse knows where to phone the nearest hospital/doctor for advice.
4.6 Staff counsel on disease acceptance, continuity of care and
compliance.
4.7 On return from diagnosis the patient is further educated in an
inter-active problem solving way on:
4.8 Prevention detection and management of complications
4.9 Principles of nutrition, physical activity, hygiene and weight control
4.10 Self-monitoring with urine glucose strips or preferably blood glucose
strips and maintaining urine glucose free.
4.11 Maintaining a body mass of (kg/m) for men 20 - 27 and women 19 - 26.
4.12 The drugs used.
4.13 The symptoms and treatment for hypoglycaemia.
4.14 Contraception and pregestational counselling.
4.15 Not smoking.
4.16 Six monthly or annual referral for assessment of progress, depending
on the control of diabetes mellitus and complications.
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Indicators For Referral
5.1 Urgent referral to the nearest hospital :
5.1.1 If nausea and vomiting, dehydration and hypotension, ketonuria
(>2+) significant hyperglycaemia with symptoms, stupor, confusion,
coma, deterioration in vision, gangrene, severe infections (TB,
pneumonia)
5.2 As soon as possible:
5.2.1 Pregnancy
5.2.2 Newly diagnosed cases
5.2.3 Recurring hypoglycaemic symptoms
5.2.4 Foot problems
5.2.5 Recurring hyperglycemia/glycosemia
5.2.6 Persistent infections.
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Patient Education
6.1 all hypertensive or obese patients or those with a family history
of hypertension are given non-pharmacological advice
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Records
7.1 See chronic diseases
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Community based services
8.1 See chronic diseases
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Records
9.1 See chronic diseases
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