Case Study: Type1 Diabetes
Case Study: Type1 Diabetes
1. Cultural considerations
Healthcare practitioners often work with a diverse population and they sometimes face the challenge that the culture of a patient forms a barrier in care provision. The healthcare practitioners can have an easier time when the view barriers coming from culture as a biomedicine aspect. The practitioner’s competence will be evaluated based on the provision and delivery of an appropriate diabetes care as per the culture of the patient. This calls for them to have knowledge in the cultural knowledge area and to have the right skills for cultural assessment, intercultural communication, cultural intervention levels, community partnership development and adapting education of a patient. It is necessary for the heath care provider to understand the health believes and behaviors of patients, illness, practices and beliefs, diet beliefs and to have the right skills of communicating with patients.
2. Critical indicator
Blood sugar is the critical indicator of diabetes Mellitus. Studies indicate that there is great prevalence of glucose metabolism abnormality among patients who at the time of AMI not considered having diabetes. An increase glucose level of 18mg/dl is often associated with increased risk of mortality by 4% among non diabetic patients. The presence of blood glucose level is the sole predictor of mortality in the long duration among patients without or with known diabetes. Patients with blood glucose level of 200mg/dl, and those without diabetes have similar mortality rate to those with already diagnoses diabetes. The blood glucose level measurement will tremendously help in identifying patients facing long-term mortality risks.
3. Nursing diagnosis
The diagnosis of diabetes Mellitus patients to most nurses is usually based on data analysis. The data is based on the estimation of fluid volume under hypoglycemia, gastric excess loss; limited input, metal mess, nausea, vomiting and diarrhea. The nurses will also measure the changes in the loss of nutrition below the body requirements as a result of decreases retrieval and insulin insufficiency. This is caused by the increase in protein metabolism and fat metabolism. The nurses will inquire whether the patient feels nauseated, or has a full stomach or abdominal pains. Other considerations include the examination of consciousness status and stress hormones release, such as, cortical and epineprfim. The patient will also face a high risk of diseases and injury. This is due to the decreased functioning level of the leukocyte, high glucose level and changes in circulation. Other infections that patients are likely to contact include respiratory infection, UTI, hypoglycemia episodes, and decreased visual acuity. Generally patient feels fatigue, helplessness, fear, sexual dysfunction, and ineffective coping with the illness.
4. What is a primary collaborative
The blood glucose level elevation is usually encountered among many patients being admitted to the ED. These are patients that suffer from acute myocardial infarction. This is the case that Mr. J is undergoing. The increased blood glucose level is a predicator of various complications in hospitalization and of death. Patients suffering from unstable angina and acute myocardial infarction conditions are recognized as acute coronary syndrome, which is the high blood glucose of up to 60% at the time of admission. This is associated with cardiac death and a higher rate of failure in the left ventricular. The elevation of blood glucose level is basically associated with the reduction of glucose utilization and insulin insensitivity during at the acute coronary syndrome. This leads to the increase of stress hormones, such as, corticosteroids and catecholamine. This leads to unfavorable conditions especially in the acute coronary syndrome outcome based on a wide range of effects on function and myocardial function.
5. Characteristics of DKA
Diabetic ketoacidosis is a problem that occurs among diabetic people. This condition takes place when the body is incapable of utilizing sugar as the source of fuel. It happens when there is not enough insulin or nay insulin in the body. The lack of sugar utilization leads to the use of fat as a substitute. Diabetic ketoacidois is a symptom of type 1 diabetes among individuals who have not experienced any other symptom of the disease. It can occur after one has been diagnosed with type 1 diabetes. Those already diagnosed with type 1 diabetes experience DKA when they get infections and illnesses, injury, missing surgeries, or insulin doses. The main symptoms of DKA include rapid and deep breathing, flushed face, dry mouth and skin, stomach pain, vomiting and nausea and fruity smelling breath.
6. The priorities of management
Urine sample will be used to test ketone. Blood testing of the same is also possible but more expensive. Immediate treatment should be provided by taking about 15g of glucose or any other rapid acting sugar, such as 8 oz of skim milk, fruit juice ½ cup, 3 life savers and 3 glucose tablets. One will later wait for about fifteen minutes so as to monitor blood glucose and when still the patient will eat another sugar intake of 15gm. This continues up to when the sugar level reaches its normal point. It is necessary to contact care provider whenever the client suffers from hypocylemia two to three times in a week.
7. Purposes of the prescribed orders
Prescribed orders are provided by doctors and physicians to guide the patient one what should be done. Prescribed orders cover the medication to take, the food to eat, and not to eat and the time for taking the prescribed pills. Prescribed orders can also include the need for the patient to carryout exercises at the specified times.
8. Prescribed orders
Adverse reactions usually takes place among a certain population of patients, and this will mean that there will be an increase in the medications number taken each day. Those at higher risk are those in critical care, the elderly and those undergoing surgical procedures that are highly complicated.
9. Drug-drug and drug-food. herbal interactions
It is necessary to custom tailor drug treatment to each individual patient so that the prescribed drug does not inappropriately tamper with other prescribed diet or herbal remedies. This will help in increasing the efficiency of the drug and at the same time elevating toxicity caused by drug, food and herbal interaction.
10. Dawn and Somogyi phenomenon
The Somogyi phenomena mean a pattern of hypoglycemia that remains undetected and followed by hyperglycemia when the blood sugar level rises to over 200. This condition usually happens during the night. However, it can occur at any time when too much insulin is in the blood. Somogyi phenomena are usually caused by manmade aspects. This means that it takes place as a result of diabetes and insulin pills that may be too strong at the wrong time. These phenomena can be preventing when one takes a protein snack before bed, such as, yogurt, cheese, or nuts. It is recommended that one should go to bed when the glucose level is much higher than usual.
The dawn phenomena take place when the body responds to the morning hour’s hormones. Everyone has this occurrence. After sleeping the hormones are released so that the body cells are restored and maintained. These hormones include cortisol and catecholamines, which are growth hormones. They trigger the blood sugar to rise. This phenomenon is common in pregnant women and for individuals with diabetes with little insulin circulating in the blood stream. It can be prevented when one does exercises late in the evening so that by night the glucose level will be lowered.
11. Client education for type 1 diabetes Mellitus
Patients suffering form type I diabetes should be educated on self-care and managementThe patients will be required to take the glucose measurement tool kit where they will self monitor their glucose and know how to maintain it a normal level. This will help them know if the treatment given is working. They will be required to know that they should also do lab blood test periodically to determine hemoglobin level and blood sugar level. They will also be taught on the right diet that will maintain the blood sugar at a normal pace.
12. The nursing implications
The nurses are responsible in guiding patients with type 1 Mellitus on the care plan. They will be responsible in helping patients manage the condition at home and in helping the gain lifelong insulin therapy. They act as reminders of the patients in advising them to get insulin injections daily or twice in a day. The nurses have the duty to work with other multidisciplinary individuals, such as, selected specialists, dietitians, nurses, and physicians.
Reference
Stranders I et al (2004) Admission Blood Glucose Level as Risk Indicator of Death after Myocardial Infarction in Patients with and Without Diabetes Mellitus. Archives of Internal Medicin. Vol 23 982-988.
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