Diabetes care essay: Case and Nursing Interventions.

1.Place the correct type of diabetes beside the anatomy, physiology, pathophysiology description.

Type 1 diabetes

Type 2 diabetes

Pre diabetes

Gestational diabetes.

2a.Below is a list of some of the potential conditions of diabetes that can impact on the care of a person with diabetes– complete the table for the -:

Common pathological indicators

Q2b.You have been asked to administer the following emergency medications for a patient who has been brought into the emergency departments with ketoacidosis.

For each emergency medication in the table below, explain the following:.

As A EN please explain your scope of practice in regards to IV medications?

3.You are to assist the RN in the creation of a management plan for Simon In the table below please outline 2 goals and 2 expected outcomes for each goal Keep each goal and outcome realistic to Simon’s case study

4.Simon’s wife Mary has been told about the National Diabetic Services Scheme (NDSS) and would like to know what provisions for support and funding do they provide for diabetics.

5.Aside from the NDSS, discuss 3 other credible diabetic organisations that you could suggest for Simon and his wife to access that will assist with their support – you may also include local support groups.

6.Discuss 2 ways you as the EN can liaise with diabetic services so that you know what to recommend to Simon and his family.

7.You are teaching Simon about managing his blood glucose levels and taking oral glipizide (Glucotrol). Which of the following statements made by Simon indicates to you that he needs additional teaching?

8.Outline 3 ways you can ensure that Simon and his wife understand the management of his condition

9.Discuss how a family / carers understanding of diabetes can affect a diabetic person’s planning and implementation of any devised plan.

10.Discuss briefly 2 environmental and 2 social factors within the general population of Australia that contributes to diabetes Environmental factors Social factors

11.Discuss Briefly 3 factors experienced by Aboriginal and/or Torres Strait Islander people that may contribute to their higher rates of diabetes.

12.Discuss 3 issues relating to diabetic care delivery or services in Australia

“Why do I have to have diabetes, why can’t I be normal, it’s so frustrating?”

13a.Outline 4 factors that can influence self-esteem in a young person

13b.As a nurse hearing these comments from Chloe, outline 4 nursing strategies you could help Chloe with, to build up her self-esteem

Types of Diabetes and Pathophysiology

Place the correct type of diabetes beside the anatomy, physiology, pathophysiology description.

Type 1 diabetes
Type 2 diabetes
Pre diabetes
Gestational diabetes.

Gestational Diabetes	Causes insulin resistance Placenta produces hormones that can block the action of insulin Higher than normal blood glucose levels first appear during pregnancy.
Type 1 diabetes.	Pancreas is involved Onset often abrupt Pancreas does not produce insulin Symptoms include excessive thirst and urination thirst and Is not reversible
Pre diabetes.	Pancreas is involved Pancreas does not produce enough insulin Pancreas progressively loses the capacity to produce insulin
Type 2 diabetes.	Pancreas is involved Blood glucose levels are higher than normal Impaired fasting glucose No signs or symptoms Impaired glucose tolerance

2a. Below is a list of some of the potential conditions of diabetes that can impact on the care of a person with diabetes– complete the table for the -:

Common pathological indicators
Emergency nursing interventions you may assist with under the RNs guidance once the condition has been established – this can include medications to be administered.
(This means what you can do after you have done vitals, BGL, DRABCD)

Condition	Most common pathological indicator of the condition	Discuss 2 emergency nursing interventions for each condition you may assist with under the guidance of an RN. Your answer should be in-depth and demonstrates specialised understanding.
hypoglycaemia	The pathological indicator of hypoglycaemia is reduced levels of glucose in blood.	The nurse should monitor glucose and provide medical nutrition therapy.The patient should feed on high level of carbohydrates to match the insulin regimen.This will prevent the cases of hypoglycaemia.
hyperglycaemia	Diabetes mellitus	The nursing intervention is through administration of insulin that breaks down the excess glucose in blood.Another nursing intervention is education on regular exercise and healthy lifestyle such as cessation of smoking.
ketoacidosis	The most common pathological indicator of ketoacidosis is Diabetes mellitus type 1	The nursing intervention involves continuous monitoring whether the patient is using injections or subcutaneous infusion to assist in the glycemic control.The nurse should also educate on a healthy diet that is high in carbohydrates and fibre.
Hyperosmolar Hyperglycaemic Syndrome (HHS)	This is a complication of type 2 diabetes mellitus.	The nursing interventions in this case involves assessing skin turgor,the mucous membranes and thirst.This is just to provide data for comparison.

Q2b. You have been asked to administer the following emergency medications for a patient who has been brought into the emergency departments with ketoacidosis.

For each emergency medication in the table below, explain the following:

The mode of action
The route of administration
The reason for its use in the treatment of Ketoacidosis

Emergency medication	Action of medication and why it is used
0.9% NaCl solution 1?L/hr	Sodium Chloride drug is usually introduced through the oral route.Since it is basic,it works by neutralizing the excess acids in the blood(Hahr & Molitch, 2015).Since ketoacidosis is the elevated levels of acids in blood,Nacl is a base and would therefore reduce the elevated acidic conditions by neutarilization.
Insulin Infusion 0.1?U/kg/hr.	Insulin is usually introduced to the body through the IV route.It acts by breaking down the excess glucose in the blood to form the less harmful glycogen as the end product(Inzucchi et al., 2014).The insulin infusion is therefore used to reduce the high level of blood glucose.

As A EN please explain your scope of practice in regards to IV medications? (Max 60 words)

As an enrolled nurse,the scope of practice in regards to IV medications include adhering to the rights of drugs.This includes the right patient,the right dose,right time as well as the right route of administration which is the Intraveneous route in this case.I also have to counter check the medicine before it is injected to the patient.

Case study 1

Simon is a 54 year old male lawyer who lives in Burleigh on the Gold Coast. He was diagnosed as a type 2 diabetic 2 mths ago. He has been married for 25 years to Mary a marketing consultant; they have 2 children who are both living at home while attending university.

He has had frequent visits to his GP to try and get his blood glucose under control; however he is having issues with this and also coping with his diagnosis.

Simon is 180cm tall, weighs 100kgs, waist circumference of 104cm = a BMI of 29 this puts him in the overweight category and the high risk range for diabetic complications.

Simon also smokes approx. 4-6 cigarettes a day, drinks wine most evenings and struggles to eat healthy due to long work hours and meetings. Simon also tries to walk early in the morning however only seems to manage this on weekends. As he is in work shoes all week he likes to walk in thongs.

Simon has been reluctant to face the fact he has diabetes, however he has been feeling a bit low lately and has decided it’s time to “sort his disease out”, the doctor has recommended that he attend diabetic education and planning which is conducted at the nearby community health centre where you work.

In conjunction with the Diabetic RN you sit down with Simon and his wife to create a plan

You are to assist the RN in the creation of a management plan for Simon

In the table below please outline 2 goals and 2 expected outcomes for each goal

Keep each goal and outcome realistic to Simon’s case study

Note – Simon will have a follow-up appointment in 6 weeks’ time to review his progress and plan

Health education / promotion	2 goals	2 expected outcomes for the goals
Exercise	Simon is able to exercise more. The BMI to reduce and be within the normal range.	Simon is able to exercise regularly The BMI of Simon will fall within the normal range after exercise.
Diet & weight loss (body mass index or waist to hip ratio)	To ensure that simons weight reduce to desirable levels. To ensure that Simon eat a healthy diet full of fibres.	Simons weight reduce to desirable level. Simon eats on a healthy diet especially carbohydrates.
Smoking cessation	To ensure that Simon quits smoking. To ensure that Simon has the knowledge on the negative effects of smoking.	Simon quits smoking and another desired outcome is that Simon learns the dangers of smoking on his health.
Foot and eye care	The first goal Is to prevent infection of the foot and the second goal is to prevent infection of the eyes.	Simons eyes do not infected.The second goal is to ensure that his foot does not get infected.

Simon’s wife Mary has been told about the National Diabetic Services Scheme (NDSS) and would like to know what provisions for support and funding do they provide for diabetics.

In regards to the NDSS, outline 3 ways this service can assist Simon and his family – must include 1 funding benefit that applies to Simon. (Max 80 words)

The NDSS can be of benefit to Simon and the Wife in different ways.It can provide funds,offer education and provide necessary nursing interventions.The function of the National Diabetic Services Scheme is to provide funds to diabetic patients so that they can get access to a healthy lifestyle(Johansson et al., 2016).It also ensures that all the patients are educated on how well they can manage the conditions and this will really be of benefit to Simon.Finally,simon might get the necessary nursing interventions from the program such as IV injections of insulin.

Aside from the NDSS, discuss 3 other credible diabetic organisations that you could suggest for Simon and his wife to access that will assist with their support – you may also include local support groups.

You must also identify the service and what they offer that will compliment Simon’s needs. Within your answer identify how Simon can make contact with these groups and identify who else within the interdisciplinary team would benefit from this information (Max 60 words)

There are different organizations in Australia that deal with diabetes that I can recommend to Simon.They include the Australian Diabetes Educators Association,Australian Diabetes Society and finally the State and Territory Diabetes Organisations.All this organizations provide funds for diabetes patients.They also provide nursing interventions and educate patients on healthy lifestyles(Razmpoosh, Javadi, Ejtahed, & Mirmiran, 2015).The contacts for this particular organizations can be found on the Australian Ministry of Health Website.

Discuss 2 ways you as the EN can liaise with diabetic services so that you know what to recommend to Simon and his family. (Max 30 words)

The two ways in which I can liaise with diabetic services is by seeking updates on new available interventions and finally seeking recommendations on a regular basis on how best to assist diabetic patients like Simon.

You are teaching Simon about managing his blood glucose levels and taking oral glipizide (Glucotrol). Which of the following statements made by Simon indicates to you that he needs additional teaching?

"If I overeat at a meal, I will still take the usual dose of medication."

"Other medications besides the Glucotrol may affect my blood sugar."

My diabetes won't cause complications because I don't need insulin." Correct

"When I am ill, I may have to take insulin to control my blood sugar."

Outline 3 ways you can ensure that Simon and his wife understand the management of his condition (Max 30 words)

Potential Conditions and Nursing Interventions

There are three ways in which I can ensure they have understood.One is asking questions to evaluate them.Secondly,I will ask them to teach back so that am sure they have understood and finally use of visual aids.

Discuss how a family / carers understanding of diabetes can affect a diabetic person’s planning and implementation of any devised plan. (80 word limit)

If one of the family members or the carers understands diabetes,they will positively affect the patients planning and implementation of any devised plan.This is because they will offer or will provide the best advice to the patient on how well to improve on the plan(Sen, Chakraborty, & De, 2016).They will also assist the patient to adhere to the plan since they are fully aware of the consequences if they don’t adhere to the plan.

Discuss briefly 2 environmental and 2 social factors within the general population of Australia that contributes to diabetes (Max 80 words)

Environmental factors	Social factors
Access to healthy food.Majority of the Australians do not access healthy food and therefore consume foods that are low in fibre but high in sugar and fats leading to diabetes.	Low education whereby some of the Australians end up with less knowledge on the management of diabetes.
Living in sedentary environment.Majority of Australians live in sedentary environment that does not adhere to physical exercise and proper diet and therefore contributes to diabetes.	Low income among some of the Australians makes it hard for them to eat on healthy foods and this increases diabetes.

Discuss Briefly 3 factors experienced by Aboriginal and/or Torres Strait Islander people that may contribute to their higher rates of diabetes. (Max 80 words)

There are three factors that contribute to the high rates of diabetes among the Aboriginal and Torres Strait Islander people.They include genetic predisposition,unhealthy lifestyle and lack of knowledge on management of the condition.Studies have established that majority of this community are living a westernised life and consuming food that have low fibre and rich in fats and sugar and this increase incidence of diabetes.Besides,they also smoke (Westaway, Seager, Rheeder, & Van Zyl, 2005).The genetic make up of this people was also meant to adapt to scarce food but it is now prompting obesity which is a risk factor for diabetes.

Discuss 3 issues relating to diabetic care delivery or services in Australia (Max 60 words)

One of the issues related to diabetic care in Australia is sheds.This is an initiative where the elderly meet at designated places to get education on how to control diabetes.Another issue is the control or regulation of diet especially among the indigenous communities since they are supplied healthy food from a central store.The final issue is commitment from the government in providing education on management of diabetes through the Ministry of Health.

Case study 2ue

You are the EN on shift at a multipurpose medical centre; your next patient to review prior to the doctor is Chloe aged 15 a Type 1 Diabetic in year 10 at school. While you are taking her vitals and BGL you ask her how she has been going, she makes the following comments during your conversation.

“Sometimes you’ll binge eat and you’ll feel disgusting and you’re like, ‘Well, I just won’t inject my insulin for it and it’ll kind of even itself out again’... it sounds screwed up.”

“I’m fat compared to Sara”

“Why do I have to have diabetes, why can’t I be normal, it’s so frustrating?”

13a. Outline 4 factors that can influence self-esteem in a young person (Max 30 words)

Low self esteem can be caused by undesirable characteristics like binge eating.Another factor is certain chronic conditions such as diabetes.Being fat is another cause and finally the inability to achieve their targets.

13b. As a nurse hearing these comments from Chloe, outline 4 nursing strategies you could help Chloe with, to build up her self-esteem (Max 80 words)

As a nurse,I would teach visualization techniques that can assist Chloe replace the negative self images of being fat and the thoughts of why he cant be normal.I would also encourage the client to participate in group therapies with people of the same condition so that they encourage each other.I would also work with the client to identify cognitive distortions that can encourage negative self-appraisal.Finally,I would evaluate Chloes need for assertiveness training tools so that he can pursue the things he needs in life.

References

Hahr, A. J., & Molitch, M. E. (2015). Management of diabetes mellitus in patients with chronic kidney disease. Clinical Diabetes and Endocrinology, 1(1). doi:10.1186/s40842-015-0001-9

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … Matthews, D. R. (2014). Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 38(1), 140-149. doi:10.2337/dc14-2441

Johansson, T., Keller, S., Winkler, H., Ostermann, T., Weitgasser, R., & Sönnichsen, A. C. (2016). Effectiveness of a Peer Support Programme versus Usual Care in Disease Management of Diabetes Mellitus Type 2 regarding Improvement of Metabolic Control: A Cluster-Randomised Controlled Trial. Journal of Diabetes Research, 2016, 1-10. doi:10.1155/2016/3248547

Razmpoosh, E., Javadi, M., Ejtahed, H., & Mirmiran, P. (2015). Probiotics as beneficial agents in the management of diabetes mellitus: a systematic review. Diabetes/Metabolism Research and Reviews, 32(2), 143-168. doi:10.1002/dmrr.2665

Sen, S., Chakraborty, R., & De, B. (2016). Management of Diabetes Mellitus. Diabetes Mellitus in 21st Century, 153-174. doi:10.1007/978-981-10-1542-7_11

Westaway, M. S., Seager, J. R., Rheeder, P., & Van Zyl, D. G. (2005). The effects of social support on health, well-being and management of diabetes mellitus: a black South African perspective. Ethnicity & Health, 10(1), 73-89. doi:10.1080/1355785052000323047

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