WPADE.org

By Annette R. Karnash, R.N., M.N.

Having diabetes appears to be linked to a 65% higher risk of developing Alzheimer’s disease. A study of data from the Religious Orders Study of Catholic nuns, priests and brothers analyzed the relationship between Alzheimer’s and Diabetes for 5 years. Eight hundred and twenty four participants underwent periodic neurophysiogical testing of cognitive systems including general knowledge working memory, perceptual speed and recognition of spatial patterns. One hundred and fifty one participants developed Alzheimer’s, including 31 with diabetes, a 65% higher risk of developing Alzheimer’s for those with diabetes compared to those without diabetes.

Knowing that diabetes is associated with vascular diseases that affect the brain and thinking, is this connection a vascular process? Knowing also that diabetes increases atherosclersclerosis and cholesterol and that high cholesterol aggravates Alzheimer’s, could it be a cause and effect relationship or simply an association?

By Annette R. Karnash, R.N., M.N.

If everyone would practice preventive dentistry, a trip to the dentist could be as benign as a trip to the hairdresser. By flossing, brushing with fluoride tooth paste and using a bacteria killing mouth wash, trips to the dentist for dental problems could be reduced. Modern technology found additional preventive techniques that may even prove to be even more appealing. Eating 1 ounce of certain cheeses such as Swiss, aged cheddar or Monterey Jack, eliminates the acid production of plaque.

Plaque is a soft film of bacteria, saliva and minute food particles that stick to the teeth and places you at higher risk for developing cavities. Of course, what is good for your mouth does not necessarily hold true for you waistline or your arteries. So not 3 or 4 ounces, only 1 ounce is suggested. Research has also shown that chewing gum containing sorbitol for 10 minutes after meals or snacks helps to neutralize the acids that form on dental plaque which leads to cavities. It stimulates the flow of saliva and squirts it between the teeth into crevices where decay breeds. Evan a gelatin candy like Gummi Bears may produce a cavity reducing ability similar to that of sorbitol gum after ten minutes of chewing. With its rubbery consistency and citric acid, which combine to produce the same effect as gum, the candy acts as an inexpensive Water Pik, stimulating the flow of saliva and squirting it between the teeth.

Gummi bears do contain sugar and corn syrup, two proven cavity producers, so it is best to brush and flush afterward. Whether the positives outweigh the negatives is a matter of dental debate, but it is something that we need to bring to the attention of our diabetic patients.

By Annette R. Karnash, R.N., M.N.

Because the patient has a need, we have a job to do
Because the patient has a choice, we must be the better choice
Because the patient has sensibilities, we must be considerate
Because the patient has an urgency, we must be quick
Because the patient is unique, we must be flexible
Because the patient has high expectations, we must excel
Because the patient has influence, we have the hope of more patients
Because of the patient, we exist.

By Annette R. Karnash, R.N., M.N.

Does your teaching increase your patient’s knowledge of the disease? Does it motivate them to make necessary life style changes? How do you determine that your teaching benefits your patient? How do you measure if learning has taken place?

A systematic method of evaluating your teaching cannot only help to assess your program’s success but can identify your strengths and weaknesses. In patient teaching, it is important to determine the patient’s knowledge base of the disease (diet, foot care, diabetic identification, exercise, signs and symptoms of hypo and hyperglycemia, the importance of carrying glucose etc.), and if necessary behavior changes are taking place. What methods do you use to determine this? Observations, phone calls, personal interviews, written questionnaires? If questionnaires – what types – multiple choice, completion, true or false? What percentage of complaints do you receive? Do they even answer the questionnaires? If not, have you found ways to encourage compliance – including a statement to ensure confidentiality, providing a stamped self addressed envelope, or follow-up calls? Did you provide adequate time for teaching? Have you encouraged staff to reinforce teaching? Have patients been allowed to adequately demonstrate blood sugar monitoring, insulin administration etc. prior to being expected to go it alone?

Negative responses to this feedback can provide you with opportunities to: adjust your program content, use different teaching strategies, including more visual aids or written information, provide a better learning environment, speak louder, and allow more group discussions or demonstrations. Today’s nursing professional needs creative practitioners who can cope with current revolutionary changes brought about by automation, advances in medical science and the expansion of health services. We need to respect and encourage imaginative and unusual ideas, proved opportunities for learning and encourage independent learning and thinking. What have you learned from your patients, teacher?