1. From the case study, identify the key issues of concern you have for Lachlan and his family. Explain how/why you identified these issues/concerns.
Considering Lachlan’s developmental age, what communication strategies and specific practice models might you use when interacting with Lachlan and his family? Remember to consider his rights and the family’s rights, family and child centred care.
1. Lachlan is diagnosed with type 1 diabetes mellitus. Lachlan age is adolescent and this is most rapid age for growth and development both in terms of physical and psychological aspects. However, in case of Lachlan, his growth may stop due to his disease condition. In such scenario parents, society members and school teachers should force Lachlan to take care of himself. Lachlan is not much worried about his disease and health. Lachlan is more concentrating towards his sports activities and not towards his glucose record maintenance. He skipped to write few of his glucose records during his lunch time. Moreover, Lachlan is skipping his lunch for playing basketball. In the growing age of Lachlan, there should not be much effect on health by skipping one lunch. However, Lachlan case is different. He is suffering through type 1 diabetes mellitus and in this disease condition there is the possibility polyurea and consequent increased thirst, xerostomia and fatigue (Atkinson et al., 2014).
These conditions may lead to the fall of Lachlan during his sports activities. In such scenario, family members of Lachlan and school teacher should give more attention to the health of Lachlan and convince him to take proper lunch before playing basketball. However, in case of Lachlan it seems, his mother is not giving much attention to his health and she is denying to administer insulin to Lachlan as she hates needles to be used for administration of insulin. His father is also not available on regular basis to administer insulin, as most of the time he is occupied with family business. Lachlan doesn’t have enough understanding about the seriousness of the disease and administration of the insulin on the regular basis. Due all these circumstances, there is irregular administration of insulin to Lachlan and control of glucose level is difficult. Lachlan age is very active age and Lachlan is also no different from other same age children. He always tries to compete with his peers in all type of activities. However, it is not affordable in his case. It is evident form the case that Lachlan is not getting much attention from society members about his disease care. Lachlan age is very sensitive age and there is possibility that Lachlan may feel detached from society and it may have negative impact on his social and psychological development. Lachlan has to ride his bike for good amount of time for the lengthy distance. However, due to his disease condition he may get fatigued due to continuous bike riding and possibility of fall or accident (Benetos et al., 2013).
2. Most important nursing intervention required Lachlan is to educate him about his disease condition. Nurse should tell him importance of good health for his long term physical and psychological development. Lachlan age is capable of understanding the importance of good health. Nurse should tell him that he should be competitive enough to do all the activities like his peers. To achieve equality with his peers, he should be maintaining his health in good condition. To achieve this good health condition nurse should teach him about proper diet and maintenance of glucose level. Nurse should monitor Lachlan for increase in body weight and development of other disease like celiac disease hypertension, nephropathy, retinopathy, thyroid disease and dyslipidemia. Psychological diseases include delinquent behavior and depression (Franz et al., 2002).
Nurse should tell Lachlan to take advantage of his age to control his glucose level. This is the age in which human physiology is most active and with proper medicine and diet he can control his glucose level. As age increases, it would be difficult for him to control his glucose level. Nurse should also educate him about the risk of overuse of medication for the glucose level control. Nurse should tell him that, there would be possibility of hypoglycemia due to the overuse of medication used for glucose control (Svoren et al., 2003).
Nurse should educate Lachlan about the different types of insulin formulations available for the glucose control. So that, he can use these different formulations based on his convenience. If there is sudden increase in the glucose level he can use short acting insulin and if his glucose level is slightly higher and he wants to maintain it, he can use long acting insulin preparations. Nurse should advise him to consult physician on the regular basis for the proper administration of the insulin. Based on the level of glucose level, there would be change in the dose of the insulin. Consultation with the physician would be helpful to avoid overuse and underuse of insulin (Murphy, 2003).
Nurse should tell him importance of self management of glucose level by using insulin. Nurse should convince him to manage glucose level on his own and to convince this, nurse should give examples of self management of glucose by other patients. To implement, self management of glucose in Lachlan, nurse should teach him glucose measurement technique like use of glucometre and functioning of glucometre. Nurse should also ask him to keep record of glucose measurement at multiple time points in a day and discuss it with the physician. So that, physician can analyze the pattern of his glucose level and amend the treatment strategy accordingly (Kirk and Stegner, 2010).
Lachlan is very much interested in sports. However, nurse should advise him not play high energy requirement games, rather he should walk for about half an hour daily to keep proper check on his glucose level (Zisser et al., 2011). Diet is the most important factor for the control of glucose level in the patients with type 1 diabetes. In such scenario, nurse should make proper diet plan for Lachlan so that his glucose level would be in control and at the same time this diet would provide all the required nutrients for his growth. Diet in the adolescent age of Lachlan would have long term effect on his physical growth (Evert et al., 2013).
3. Peer Pressure:
Lachlan age is more inclined towards their peers and children in this age would like to spend more time with their peers. However, in case of Lachlan it is not true. Due to type 1 diabetes Lachlan cannot participate in all the activities like his peers. Due to this, he may feel pressure on his own and there is possibility that he may feel isolated from his peers. In such scenario, parents of Lachlan should support him and give him confidence that he can participate in all the activities with his peers, once he recovered from type 1 diabetes (Gilmore and Meersand, 2013
; Shek et al., 2011).
Changing Dependency Relationships:
In Lachlan age, children feel independent because they can perform most of their activities independently on their own without help of parents. They are physically and psychologically capable of doing all their activities and at the same time they prefer to spend more time with their peers and share everything with peers. This feeling independence from parents, may lead to disagreement between parents and Lachlan. Lachlan may not obey advice and instructions from his parents because he may feel pressurized due to their advice for maintaining his glucose level. Overall, this may lead to the improper management of Lachlan’s type 1 diabetes (Gilmore and Meersand, 2013; Shek et al., 2011).
In adolescent age children become more confident about their all types of activities and try to be independent from their parents. If this independence is for positive activities, it would be fruitful for both Lachlan and his parents. Due to his independence, Lachlan’s parents may become happy. At the same time, parents should take care that, he should not misuse his independence for wrong activities. Parents should promote his independence in positive direction by giving him assurance that he can take care of his diabetes on his own. In this Lachlan age, may inclined more towards his peers. In such scenario parents should advise him to select his peers very carefully so that he would get good company and utilize his independence for positive outcome (Gilmore and Meersand, 2013; Shek et al., 2011).
Risk Taking Behaviors:
Male children of Lachlan age are more susceptible to risk taking behaviors such as smoking, alcohol consumption and addictive drugs. All these activities may lead to the inadequate management of diabetes in case of Lachlan. Parents of Lachlan should monitor his risk taking behaviors, so that he would not develop these risk taking behaviors (Gilmore and Meersand, 2013; Shek et al., 2011).
4. Lachlan age is adolescent age and this age is more dynamic age. In this age, there are rapid changes in the physical, psychological and emotional aspects of the Lachlan. Changes in all these parameters may lead to the inadequate management of diabetes in case of Lachlan. In case of physical parameters, there would be change in body weight and parents and nurse should advise him to change dose of insulin in relation to the change in body weight. Also, in his age control of glucose level is achievable with moderate treatment. Hence, nurse should advise parents and Lachlan to consult physician frequently so that there would not be overdose of insulin and consequent hypoglycemia. In this age Lachlan, would like to be independent in all his activities. Parents should exploit his independence positively and give him freedom and confidence to take care of his diabetes on his own. Nurse should make his parents aware of possibility of habitual development of smoking, alcohol consumption and drug addiction. Because all these activities would affect negatively to physical and mental development of Lachlan and also it would negatively affect proper management of diabetes in case of Lachlan (McWhinney and Freeman, 2009).
Nurse should advise Lachlan’s parents that he should not feel socially isolated due to his diabetes. Because social isolation in this age would hinder his mental development. This may lead to the loss of confidence and it may affect his studies and other activities. Nurse should make realize parents that he should not feel mediocre as compared to his peers. This may happen because Lachlan would not be able to perform all the activities like his peers. This isolation can be prevented by maintaining privacy of his diabetes. Adolescent age of Lachlan is preferred to spend more time with his peers. Nurse should advise parents to take advantage of this and ask his peers to monitor his eating habits and exercise, which would be helpful to control his glucose level. Nurse should also advise his parents to take help of his peers for his glucose control (McCarthy and Kushner, 2007).
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