Diabetes mellitus is a metabolic body disorder that is anticipated to have affected a large population in Australia. The leading cause of diabetes mellitus is due to the failure or defects on the pancreas which is the body organ that secretes insulin and results to high glucose levels in the blood (Zwar et al, 2017). Nurses play a vital role in the management of the diabetic patient. The following scenario demonstrates a case of a patient of the at the middle age with diabetes complication.
Component A
Patient A is a 32-year-old man with 3-years history of type 2 diabetes mellitus. Patient A was diagnosed with diabetes mellitus three years ago where he presented the symptoms of hyperglycemia for one year before diagnosis. He had a high rate of blood glucose levels at 118-127 mg/dl which was an indication of borderline diabetes. At the first time of diagnosis, Patient was advised to start engaging in activities to reduce weight (Dempseyet al, 2014).
The patient A has been trying to reduce weight as he increased exercise for the six months but there was no much significant change (Dietz et al, 2015). The physician prescribed the patient A on glyburide 25 mg every morning. He stopped taking the drug due to dizziness which was often accompanied by a feeling of minor agitation and sweating mostly at afternoons (Capoccia, Odegard and Letassy, 2016).
Patient A also takes 10 mg of Lipitor (atorvastatin) for hypercholesterolemia. The patient tolerated and adhered to the medication for the daily schedule. For the past six months, he had also been taking pancreas elixir, chromium picolinate, and Gymnema Sylvester so that he could improve his effort to control the disease. The Patient A has been very reluctant in testing his blood glucose level while at home. During the Doctor’s appointment, patient A explained that he had never falling seek sick in his early life as it is in nowadays. The patient said that he does understand why he has diabetes despite that he ceased from taking sugary foods.
His wife has been encouraging him to treat diabetes through herbal medicines and weight loss supplements of which she always researches on the internet for the recent diabetes management updates. Patient A’s diet history shown that he used to take a lot of carbohydrates in the form of pasta and bread. His dinner has been usually 2 cups of cooked pasta, three to four slices of bread (Italian) and hamade sauce. His wife prepared plain grilled meats for him but patient A most of the time he found it tasteless. Patient A was once a smoker, but he stopped ten years ago. The patient had never seen any dietician before, and he has never been instructed for self-monitoring of the blood glucose.
The medical records of his appointment indicated that his (A1C, hemoglobin) has never been less than 8%. The blood pressure of the patient had been 150/70, 166/88 and 148/92 mmHg measured on separate occasions for the past one year at a local healthcare screening center (Cicolini et al, 2014). The recent medical records of the patient A, shown that he has been remarkably healthy for the past many years. Based on the assessment of the patient A’s medical history, physical examination, laboratory results, and records, the following were the final assessment; Obesity (BMI 32.4 kg/m2), hyperlipidemia, uncontrolled type diabetes mellitus (A1C>7%), low understanding of diabetes, elevated microalbumin level of urine, self- care management and lifestyle deficit.
The physical examination of the patient A shown that he had a fasting capillary glucose level: 166 mg/dl, weight178Ib; 5’2″; mass body index: 32. 6kg.m2. The blood pressure of the right arm read 154/96 mmHg, lying and that of the right arm while sitting read 140/90 mmHg. Pulse rates were 88bpm and respirations of 20 per minutes. The heart rate rhythm was regular with no gallops. The condition of patients A has been as before after his last assessment for he has been advised and given several appointments by his close General Practitioner (GP). With all the findings and assessment of the Patient A, there is a need for a clearer program of self-management to the people within the community as they seemed to have little knowledge about the best control approaches of diabetes (Willis et al, 2014).
Component B
The Australian government has included diabetes as one of the national health concerns due to its related mortality and morbidity rates and substantial national health expenses. The healthcare cost of Australia from 2004 to 2005 on diabetes was equivalent to A$989 million. As a registered nurse working within the prominent population at a regional public healthcare center, I am supposed to take immediate program strategies to educate the youths about the management and control of diabetes.
The Australian Institute of health and welfare showed that the persons aged between 15 to 24 years were the most uneducated about the control measures of diabetes (Dawson, Nkowane and Whelan, 2015). The advanced nurses play a primary role in educating the community on the medical management concerning diabetes. The proper combination of expertise and clinical skills in counseling and teaching enables the care delivery at an appropriate manner that is not only cost reducing but also effective. As one of the registered nurses, I played an important role in advanced nursing practice in sharing the understanding of diabetes with the patient A who was very confused about his condition. I shared with the patient his health outcomes and educated him on the importance of regular self-monitoring to avoid further complications of diabetes mellitus.
The application of the nursing standard and diabetes mellitus guidelines in partnering with the patient not only improves the care services but also strengthens the patient responsibility as a self- manager (MacMillan et al, 2014). In accordance with the 2016 census the local regional I was working as a registered nurse, an approximately 1.6% of youths had little knowledge on diabetes mellitus than the middle age populations in the urban areas. In the local health care center, the primary nursing model of care was applied. This is where one nurse was allocated to several patients within the assigned beds. Throughout the nursing activities, the nurse had to work in consultation with the other nurses in charge, the department medical officer, the allied health professional like dietician, physiotherapist, pathologist, radiologist, and also the medical registrar.
This collaboration helped the nurses to be more thorough during the assessments and have significant autonomy in their responsibilities and this encouraged holistic patient-centered care and better nurse-patient interactions. About 15- 17% of the young persons with type diabetes mellitus were using the involved treatment plans as they were advised by their general practitioners so as to maintain their glycemic control. The optimum and regular self-management of diabetes mellitus was one of the key health outcomes that the Patient A never utilized in controlling his diabetes (Kueh et al, 2015).
This means that patient A had inadequate knowledge about self- management education. This created a difference in the other health outcomes like normal clinical outcomes. The patient A was very reluctant in checking his blood glucose level and also, he sometime refuses to take his prescribed drugs such as glyburide due to dizziness effects. There is a significance linkage between adhering to the self- management therapy and optimum clinical outcomes. The transition from the youthful age to the fathering age or the working-age result to lack of structure and thus, it complicates the self- management which may lead to poor management of diabetes.
The other key outcome for the patient A his habit of skipping medication and optimum clinical outcomes only because of some minor side effects which normal sometimes when someone is at the beginning of a long-term chronic illnesses. Skipping medication for diabetes result to deteriorating of the health of a patient. The patient A also used to try many methods and different health practitioners as he wanted to reassure his condition very fast (Vlachopoulos et al, 2015). This is contrary to the diabetes mellitus management where the victim has to adhere to the doctor’s advice and follow the medications as prescribed to get better result of the disease.
Some of the technologies that would help patient A to achieve optimum clinical outcomes and self- management are discussed below (Strainet al, 2014).
Regular monitoring of the glucose level is a contemporary technology Australia which has been known to improve the control of glycemia through maintenance of the standard compliance in the body. Continuous monitoring of the body’s glucose level for at least twice each day is always useful as one can monitor every reading either low or high (Younossi et al, 2016). Some patients adopt the administration of insulin to regulate their diabetes. Other use insulin pumps which contain rapid insulin action which is delivered through the infusion into the body via the subcutaneous layer around the abdomen or to the thighs.
The insulin pump action tries to mimic the regular insulin that is produced by the pancreas. It requires keen observation as the pump program has to be managed well and proper recording of the patient’s blood glucose level and the number of carbohydrates he or she consumes to enable the pump to titrate the required quantity of insulin (Woolf et al, 2015).
One of the importance of using the pump is the less hyperglycemic and hypoglycemic episodes as a result of continuous infusion and also the more significant lifestyle flexibility. Most youths with diabetes rarely adhere to the insulin injections. Although the development of a practical device that administers while calculating the appropriate dosage in the body, self-management remains the most recommended method before the use of the insulin pump (Rubino et al, 2016).
A permanent porta Cath is a venous device that is implanted on the upper chest or the arm under the skin which is another option for the patient with chronic diabetes illness. This catheter is located into one of the large blood veins, most likely the jugular or the subclavian vein and settles to the superior vena cava. The other option is an insertion of the catheter in the central peripherally which is a longer intravenous catheter that is inserted into the antecubital blood vein. These catheter stays in the blood vein for about 18 months while maintaining high management integrity (Hay et al, 2014).
One of the problems associated with the peripheral catheter is that it requires weekly flushing through standard salty and heparin locking. The porta Cathy needs to be flushed only after they have been accessed and it is usually after every four weeks. The other demerits of the peripheral catheter are that it remains eternally on the arm which requires the high standard of hygiene and thus it is at high risk of infections (Bolea-Alamañac et al, 2014). For someone like the patient A who is very anxious about recovery from diabetes use of such devices like porta Cath and peripheral catheter could be of more disadvantages than the advantages.
The best-recommended control measures of the diabetes mellitus as advised to the patient A in the case study is self- management. The self- management of diabetes is applicable both in the hospital emergency department for the people with diabetes mellitus and also at homes. The registered nurses only need to have the appropriate education od the management and control of diabetes while performing their duties to the patients. The nurses should also have enough confidence while delivering the appropriate care and information about the disease to their client. Also, self-management education is essential to the diabetic patient as not all the patients can follow the appropriate management plan (Hollis, Glaister and Anne, 2014).
It is essential for all nurses to desire in having the understanding an array of different educational practices and self- management programs that can be individualized. The nurses should incorporate both the diabetes nursing guidelines and medical acre while counseling and maintaining the educating roles to the patients. Operating beyond the educator role is an advanced practice for the nurses to holistically assess the needs of the patient through understanding the patients’ main roles towards the improvement and maintaining their health wellness (Drummond et al, 2015). In conducting the patient’s assessment, the advanced nursing practices explores the medical history of the patient and performing the necessary physical examination.
The self-management education program remains the most appropriate as recommended by the American Diabetes Association through encouraging and providing education at least every year (Holloway and Galvin, 2016). Education programs could be of much importance in advising and directing the patient A on his regular diets and activities such as exercises that could help in regulating the blood sugar level. The control of the glycemic leads to the development of the microvascular outcomes in both the type 1 and type 2 diabetes. It is crucial for the registered nurse to deliver quality education to the patient A and his family to minimize the intake of the fats and caloric while increasing the more physical exercises to sufficiently control the glycemic, obesity and weight (Goff and Dyson, 2015).
Reflective Conclusion
The study has fully improved my knowledge of utilizing the most effective approach to management, diagnosis, and treatment of diabetes. I can deduce that use of self- management education on diabetes in most of the regional areas is the most applicable and efficient program. Acting the patient advocate is one of the crucial roles I played in my clinical practice. The majority of young adults living with type 2 diabetes have the high risk of developing some of the diabetic complications such as diabetes ketoacidosis (Zhang et al, 2014). There is much to recommended the patient A to attain the more appropriate management at the current stage of his illness before that condition worsens. Diabetes ketoacidosis is a life-threatening situation, and due the recent assessment of the patient A, if it develops in his case, it can compromise his body’s immune system which is very critical for a diabetic patient.
There is the need for more education to the youths concerning the control of diabetes regarding the self- continuous monitoring of the blood glucose level. As per the case of patient A, the level state of the illness is towards commencing on self-administer to regulate and maintain his glycemia. As a nurse working in the hospital department where that patient A has several appointments, my role is to encourage him on the best practice guidelines for improving the diabetes condition through proper management of the glycemia.
To ensure this, education to the patient A is primary on how to manage through an individualized daily plan. Therefore, it is the role of the nurses to empower the young adults on self – management at their critical conditions for those living with diabetes. The self- management education, the young adults are prepared to live in productive and effective life’s through their life transitions while minimizing the cases of future health complications as well as morbidity rates.
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