Week 2 project illness

NSG4055- Illness & Disease Management across Lifespan

August 9, 2020

Management of Diabetes Mellitus

The rationale of the Choice

Diabetes mellitus is a serious chronic medical condition that affects about 29.1 million United States citizens. Diabetes is ranked as the seventh leading cause of death. Those who are diagnosed with diabetes have high mortality rates and chances of developing heart attacks as compared to healthy individuals. The cases of diabetes mellitus continue to escalate all over the world thus the need to understand its management and care plans to minimize diabetes-related health/medical, social, and economic complexities. Effective care plans reduce the human costs in terms of disability prevention, reducing medical care costs, and premature death. (WHO, 2020)

Care plan questionnaire

1) What is the level of patient’s level of awareness of diabetes as a medical condition? _____

2) Does the patient understand the risks of having unstable blood glucose levels? ___

3) Is there a risk for infection? ____

4) Does the patient feel powerless over the condition? ____

5) Does the patient understand the risk of developing disturbed sensory perception? ____

6) Does the patient understand the nutritional requirements for the condition? ____

7) Does the patient understand the risk of ineffective therapeutic management? ____

8) Is the patient stressed by the condition and how well can he/she manage it? ____

9) What’s the patient’s support system like? ____

10) What are the patient’s preferences in terms of care and management? ____

11) Does the patient understand the risk for fluid volume deficiency? ____

Psychosocial Care Plans

To ensure effective patient implementation of the treatment plan, their psychosocial issues that might impact self-care must be identified and addressed. These factors may include distressed related to diabetes treatment and worries about possible adverse events or lack of economic and social resources and other mental states such as anxiety, depression, cognitive impairment, eating disorders, and health literacy. (Deborah Young-Hyman, 2016)

In psychosocial care, the following considerations should be made;

1) The care of patients with diabetes should be collaborative and patient-centered to optimize the outcomes of health and improve the quality of life.

2) The caregiver should ensure that there is an assessment of diabetes distress symptoms, anxiety and depression symptoms, eating disorders, as well as cognitive capabilities using standardized tools at first visit followed by periodic interval checks to monitor changes in disease conditions, life circumstances, and treatment.

3) The patient’s performances in terms of self-care/management behaviors should be properly monitored as well as the psychological parameters that may influence their self-management.

4) The intervention strategies must include consideration of assessment of all possible life circumstances that might influence psychological and physical health outcomes.

5) The psychological issues must be addressed upon identification. If the intervention cannot be initiated immediately at the time of visit, the health care provider should provide a referral to a psychiatrist then initiate a follow-up on the progress of the patient.

6) Above all, a care provider must include well-being queries in the patient’s routine care.

Biomedical considerations of the care plan

Nursing assessment of diabetic patient

1) Assessing for hyperglycemia and associated symptoms – high glucose levels cause osmotic effects that off-set physiological balance – initiating appropriate intervention/treatment

2) Monitoring blood glucose levels at bedtime or before meals – pre-meal levels should be maintained at <140mg/dl

3) Assessment of levels of HBA1c over the previous 2 to 3 months – high levels (above 7%) indicate poor management of blood sugar that may lead to complications – ensure proper management.

4) Assessing for slurring of speech, tremors, and anxiety – indications of hypoglycemia that should be treated with 50% dextrose.

5) Assessment of feet pulse, temperature, color, and sensation – to evaluate peripheral neuropathy and perfusion.

6) Assessment of patient’s knowledge and understanding of the prescribed diet – to limit chances of hyperglycemia. Patient education must be initiated where necessary.

7) Monitoring physical activity patterns – ensure the patient is involved in regular physical activity which lowers blood sugar levels and limits cardiovascular problems.

8) Assessing renal failure by monitoring urinary albumin to serum creatinine – the first sign of nephropathy is Microalbuminuria.

Nursing actions in the care of diabetic patients;

1) Proper administration of prandial and basal insulin – keeps glucose levels to normal ranges, promoting tissue perfusion, and eliminating microvascular illnesses.

2) Teaching patients how to carry out self-monitoring of glucose levels at home – to help the patient to self-adjust the insulin doses.

3) Reporting high blood pressure levels above 160 mm/Hg and administering hypertensive drugs as prescribed – eliminate chances of developing stroke, cardiovascular disorders, etc.

Nurse instructions to patients;

1) The nurse should instruct patients to always wear shoes and avoid heating pads – due to their decreased sensation towards the extremities, this should lower their chances of injury infections.

2) The patient should be instructed on how to take oral hypoglycemic medications and educated on the consequences of poor adherence or overdose

3) The patient must be instructed to take insulin per the directions from rapid-acting to short-acting to intermediate-acting and long-acting insulin analogs.

4) The patient must be instructed on the administration and preparation of insulin that include injection procedures, change of anatomical sites of injection, and storage of insulin.

Morbidity and Comorbidity related to Diabetes

It has been established the most prevalent comorbid conditions related to diabetes are hypertension that takes about 82%, followed by obesity/ overweight (78.2 percent cases) then hyperlipidemia observed in 77% of diabetic patients, chronic kidney disease (24%), as well as cardiovascular illnesses. (Rajpathak, 2016) Diabetes has been associated with lower limb amputation, numerous cases of blindness, kidney failure, stroke, and heart attacks that have led to the death of many people worldwide.

Impact of diabetes and morbidity on the overall health of the nation

The existence of numerous morbidity cases related to diabetes seriously hurt the health and prosperity of the nation. A huge amount of financial resources are allocated to take of individuals who have been rendered economically inactive hence massive losses. Other priorities that also ensure economic, social, and political integrity are sacrificed in the process which again translates to poor national health. Diabetes and associated morbidities account for numerous mortality cases that lead to the loss of human resources required in the multifaceted health care system. (Alain G. Bertoni, 2002)

Healthy People 2020 goals and specific objectives for Diabetes Mellitus.

To minimize the burden created by diabetes on the lives of people with DM and to improve the quality of life for all with or at risk of developing the disease. The specific objectives of the organization include; limiting the number of diabetes cases diagnosed annually and also to reduce the mortality rate of the disease.

Alain G. Bertoni, M. M. (2002). Diabetes-Related Morbidity and Mortality in a National Sample of U.S. Elders. American Diabetes Association. Retrieved from https://care.diabetesjournals.org/content/25/3/471.full

Deborah Young-Hyman, M. d.-B. (2016). Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. American Diabetes Association. Retrieved from https://care.diabetesjournals.org/content/39/12/2126#:~:text=Thus%2C%20psychosocial%20factors%20impacting%20self,as%20well%20as%20health%20literacy

Matt Vera, B. R. (2020). 13+ Diabetes Mellitus Nursing Care Plans. NurseLabs. Retrieved from https://nurseslabs.com/diabetes-mellitus-nursing-care-plans/

Rajpathak, S. N. (2016). Prevalence of comorbidities high in type 2 diabetes. Healio Endocrinology. Retrieved from https://www.healio.com/news/endocrinology/20160425/prevalence-of-comorbidities-high-in-type-2-diabetes#:~:text=Within%20the%20cohort%2C%2097.5%25%20of,and%20cardiovascular%20disease%20(21.6%25).

WHO. (2020, June 8). Diabetes. Retrieved from WHO: https://www.who.int/news-room/fact-sheets/detail/diabetes#:~:text=Diabetes%20is%20a%20major%20cause,high%20blood%20glucose%20in%202012.