best practice edvince based practice

Kebbeh Flomo

Herzing Uiversity

Introduction

Diabetes type 2 described as a chronic condition that affects the way the body metabolizes sugar, which is one of the essential sources of fuel to anatomy. Type 2 diabetes has a lot of resistance to the effect of insulin. The hormone that regulates the movement of sugar into the cells and, therefore, does not produce enough insulin to maintain the average glucose level in the body. Historically, it is known to affect adult-onset, but today, even children can be victims of the same. That is maybe due to obesity. Cons of this disorder are that it does not have a cure. But the advantages are that losing weight, exercise, and eating well can help in the management of the diseases. Additionally, if eating and doing exercise do not manage, the need for medication or insulin therapy can be useful.

Section 1: a Case study

J.A is a 53-year-old African American woman who is diagnosed her type 2diabetes. Previously, she had already developed hypertriglyceridemia three years later and in 9 years later had hypertension. Despite that, she had other medical conditions such as obesity and diverticulosis. I had to screen and afterward determine the eligibility for a clinical research protocol of using insulin once daily.

Before that, I had to do a physical examination in terms of height, and she was 64inches, 181lb in weight, 31kg/m2 in body mass index, and 40 inches as waist circumference. Blood pressure well controlled on 20 mg lisinopril, which was daily and resulted in 104/70mmHg, which was within the range. Secondly was the laboratory examination, which revealed that there is a fasting lipids panel as follows. 215mg/dl was the total concentration of cholesterol, 940mg/dl triglycerides, and 24mg/dl as direct HDL cholesterol in her body. Additionally, there was also an elevated amount of invalid LDL cholesterol, which was unobtainable due to hypertriglyceridemia. Free fatty acid was 1.1mEq/l, which was above the normal range of (0.1-0.6Eq/L). Hemoglobin A1cwas 9.5%, and fasting blood glucose indicated 304mg/dl. The result, therefore, needed an explanation, but the clients talked about having fasting triglycerides at an elevated amount of 3,000mg/dl. I also inquired about the current medication, and she told me that she is currently using metformin (1,000mg) twice daily and glipizide (Glucotrol XL) 10mg twice daily. The two drugs are to control her blood glucose level in the body. She is also using gemfibrozil (600mg) twice daily for the hypertriglyceridemia and estradiol for menopause concerning her age.

Nursing assessment/intervention

From the above case study of my patient, the following were nursing intervention and assessment I was able to perform. First improving nutrition. I was able to assess the current timing and content of the meal. Since my patient had a problem with diabetes, it was vital to ensure the amount of sugar level. However, I had to advise my patient, especially on the importance of an individualized meal plan, so that he can reduce weight, reduce intake of carbohydrates, and ensure she feeds on a balanced diet. I also discussed with her the goals of dietary therapy concerning her condition. Still, on nutrition, I was able to help my patient to identify problems that might have an impact on dietary adherence and suggested the best possible solution, which I emphasized on the lifestyle changes.

The second invention was to teach my patients about insulin therapy. In this intervention, I was able to reduce the fear of injection. And this can only be done by demonstrating and also explaining not only to her but also the narrative that will help her administer insulin when it comes to insulin self-injection. Lastly, on insulin, I also reviewed the dosage and time of injection about the meal, activity, and bedtime, which should be based on the patient’s individualized insulin regimen.

The third intervention is improving activity tolerance, where I was able to advise my patient to assess blood glucose level before and also after strenuous activity. Secondly, instruct the patient exercise regularly each day. Also, encourage the patient to eat a carbohydrate snack before using it to avoid hypoglycemia.

The fourth intervention was about oral antidiabetic agents, whereby I advised the effect of oral antidiabetic agents. For instance, my patient was using metformin, which its importance includes, diminish insulin resistance, and decrease hepatic glucose production and also intestinal reabsorption of glucose. In this case, I was able to advise my patients on how they take medication and the effects upon which they might experience from the current drug. Due to this, I was able to track medication and side effects upon which I had to change medication to my patient.

Section 2: Pathophysiology of the primary disorder

From the above case study, the pathophysiology process of diabetes type 2 is associated with impaired insulin secretion and increased insulin resistance. Impaired insulin secretion described as a decrease in glucose responsiveness, which observed before any clinical onset of diseases. Among this, impaired glucose tolerance is also induced by a reduction in the glucose-responsive, which in most cases, is in early-phase of insulin secretion.

Insulin obstruction is a circumstance where insulin inside the body does now not apply enough activity relative to its blood mindfulness. The disability of insulin movement is dominating bodily organs, which incorporates liver and a muscle tissue is a typical pathophysiological highlight of type 2 diabetes. Insulin opposition creates and grows past to clutter beginning.

The examination concerning the atomic component for insulin development has explained how insulin obstruction is identified with hereditary elements and ecological variables such as hyperglycemia, provocative system. Perceived hereditary components, incorporate not just insulin receptor and insulin receptor substrate (IRS) quality polymorphisms that on the double affect insulin alarms anyway furthermore polymorphisms of frugal qualities which incorporate the three adrenergic receptor quality and the uncoupling protein (UCP) quality, related with instinctive corpulence and sell insulin obstruction. Glucolipotoxicity and fiery go between are additionally significant as the systems for debilitated insulin emission and insulin flagging impedance.

Lifestyle improvement and hostile to diabetic pills such as glucosidase inhibitor, metformin and thiazolidine to treat IGT smother the peril of developing Type 2 diabetes, SU pills, metformin,and insulin is amazing in controlling each microvascular disorder and macrovascular sickness, and ahead of time intercession is crucial to the oversee of macrovascular issue, total intercession, for example, blood strain and lipid the board is amazingly ground-breaking in controlling vascular cerebral pains and diminishing mortality cost, and pioglitazone smothers the repeat of cardiovascular issues. ahead of time and additional exhaustive mediation is extra incredible in controlling vascular migraines and upgrading determination.

Section 3: Evidence based practice as it relates to your primary disorder

Overtreatment is inescapable in medicine and finishes in capacity patient damages and radical expenses in wellness care. Regardless of the way that evidence based absolutely prescription is often scorned as exercise by method for repetition algorithmic medicine, the fitting use of key verification-based drug measures in logical decision making is essential to forestalling overtreatment and selling high-esteem, individualized patient-focused on consideration. Extraordinarily, this bulletin examines the importance of the utilization of outright rather than relative appraisals of advantages to educate cure decisions; considering the time skyline to favorable position of medications; adjusting capacity damages and focal points; and the utilization of shared decision making by method for doctors to involve the influenced individual's qualities and inclinations into cure choices. Directly here, we show the use of those ideas to thinking about the choice of whether to support top to bottom glycemic control to sufferers to confine microvascular and cardiovascular confusions in Type 2 diabetes mellitus. through this perspective, this case will outline how a proof-based medication strategy might be utilized to individualize glycemic dreams and anticipate overtreatment, and might work a format for applying proof-based drug to illuminate treatment choices for various conditions to advance wellness and individualize influenced individual consideration.

Conclusion

In conclusion, type 2 diabetes is one of the most dangerous disorder affecting both young and old. Therefore, there should be measures upon which all nurses should adhere in addressing the issue. I therefore believe that this paper gives an incite about the clinical nursing practices in which should be practiced in ensuring type 2 diabetes is managed. Evidence based practice and pathophysiology of the disease will give upper hand in managing and addressing the issue of type 2 diabetes.

Reference:

Afable, A., &Karingula, N. S. (2016). Evidence based review of type 2 diabetes prevention and management in low and middle income countries. World journal of diabetes, 7(10), 209.

Tuomilehto, J. (2007). Counterpoint: evidence-based prevention of type 2 diabetes: the power of lifestyle management. Diabetes Care, 30(2), 435-438.

Makam, A. N., & Nguyen, O. K. (2017). An evidence-based medicine approach to antihyperglycemic therapy in diabetes mellitus to overcome overtreatment. Circulation, 135(2), 180-195.

Richardson, G. C., Derouin, A. L., Vorderstrasse, A. A., Hipkens, J., & Thompson, J. A. (2014). Nurse practitioner management of type 2 diabetes. The Permanente Journal, 18(2), e134.

Jarvis, C. (2015). Health assessment online for physical examination and health assessment (7th ed.). St. Louis, MO: Saunders (User Guide & Access Code). ISBN# 9780323322256 [EBook]