Clinical Case: Gestational Diabetes Mellitis And Hyperglycemia

Priority Problems Based on ABCDE Framework

This paper discusses the second clinical case, which is about Ms. Cho Chang, who is a 28-year-old female. From the analysis of the case study and based on the ABCDE, one of the problem that Ms. Cho is facing is hyperglycemia. This is because the tests indicate that the patient has a blood glucose level of 26mmol/L, which is way above the normal blood sugar. The other condition is that the patient is at the risk of high blood pressure (BP) with BP of 140/80. All the other vital signs are within the normal range.

Hyperglycemia is a condition where the levels of glucose in the blood are beyond normal levels.  This is an indication of diabetes. Hyperglycemia develops as a result of the pancreas producing low levels of insulin (Tadros et al., 2019). Insulin is critical in moving the glucose from the bloodstream to the cells which use glucose to produce the energy needed in the body.  This condition is also caused by the failure of the body to use insulin properly and hence resulting in excess blood glucose. Hyperglycemia is associated with genetic factors since research indicates that 46% of patients who are diagnosed with diabetes have a family history of the condition (Mansfield et al., 2019). Some of the risk factors which may contribute to Cho suffering from this condition include lack of physical exercise. The other main contributing factor is that she is pregnant, and this increases the risk of suffering from hyperglycemia. The clinical manifestation of the condition includes frequently urinating, increased thirst, headache, fatigue, and problems with vision. This condition is also associated with increased weakness of the body. It also causes confusion and dizziness, such as what Cho is experiencing (Tadros et al., 2019).

Ms. Cho is also suffering from high blood pressure. This is a condition that increases the pressure of the blood in the arteries. It is highly risky since it may result in serious heart diseases that could endanger the life of the patient. Blood pressure is determined by the amount of blood pumped by the heart and the resistance in the flow of the blood. Blood pressure increases as a result of the narrowing of the arteries (McLean et al., 2016). When the arteries become narrow, the resistance to the flow of blood increases, and hence resulting in hypertension, hypertension can come about as a result of excess fat in the body. People who are overweight or obese are at increased risk of suffering from hypertension. The other risk factors include family history, poor diet, and excessive use of tobacco and alcohol. A person can be suffering from hypertension for a long duration without realizing that they have the condition. During this time, the disease can result in damage to the blood vessels (Morrissey et al., 2016). The signs and symptoms of high blood pressure include severe headache, confusion, and excess tiredness. The other symptoms of the disease include irregular breathing, problems with the vision, and pains in the chest. If not treated, hypertension could lead to stroke or kidney failure (Sanchez et al., 2019).

Pathophysiology of Hyperglycemia and High Blood Pressure

Patient education- Education is very critical for people suffering from hyperglycemia. Education helps in improving the literacy of the patient since it improves their understanding of the condition. Understanding of hyperglycemia is very important since it is a lifetime condition, and hence Cho needs to understand the need and how to manage the condition to prevent adverse effects. According to Middleton et al. (2017), education is critical since it involves teaching the patient how they should monitor their blood glucose at home. This is critical in ensuring that the treatment plan is working. It is also important since it enables the patient to control aspects such as diet and avoids stressful situations when they find that their blood glucose is above the required level. Education for hyperglycemia patients is also very effective in preventing complications. This is because the intervention enables one to ensure that the blood glucose remains stable, if the patient realizes that the blood glucose level has been continuously high. They can visit the hospital for a further checkup to avoid further complications (Farrar, 2016).

Exercise- According to the American Diabetes Association, people living with diabetes should undertake at least 150 minutes of physical activity per week (Batta et al., 2019). The physical exercise plan should be developed in collaboration with the doctor to avoid excess activities, which can lower the blood glucose level below the recommended standards. The doctor assisting the patient in preparing the physical exercise plan should evaluate how the patient is faring. This helps in setting goals that can help improve the health outcomes of the patient. Research indicates that physical exercise is a very effective intervention for hyperglycemia. Physical activities work appropriately since exercising helps in keeping the body active. This, therefore, provides an opportunity for the body to use the excess glucose in the blood and hence resulting in the blood glucose level getting balanced (Senanayake et al.,2018). For this intervention to work, the patient must make the exercise a routine to ensure that their BGL is in check at all times. Depending on the individual glycemic target of the patient, they can keep increasing the duration of the exercises so that they can eventually attain the targeted BCL. Research indicates that physical exercise intervention is effective in managing hyperglycemia for 40% of patients who maintain the exercise routine for three months or more (Annamalai,  2017).

Medication- According to Clark et al., (2018), antihypertensive therapy reduces blood pressure by a weighted mean difference of -8.2/-4.2mm Hg, and -11.7/-6.5mm Hg for two strata of entry blood pressure. Medication for treating high blood pressure has therefore been found to be very useful, mainly when used in combination with non-pharmacological interventions such as diet. Medication helps in lowering systolic blood pressure and hence reducing the potential complication of hypertension.  The type of drugs prescribed to the patient depends on the level of blood pressure the patient is experiencing (Clark et al., 2018). The possible side effects of the drugs are considered before the drugs are prescribed. For Cho, the doctor must consider her state of pregnancy. The drugs administered to the patient should also not worsen his existing medical conditions. Some of the medications used in treatment include thiazide diuretics, angiotensin-converting enzymes(ACE) inhibitors, and angiotensin two receptor blockers(ARB). These drugs reduce blood pressure by preventing the production of body chemicals, which result in the narrowing of blood vessels and hence resulting in a decrease in blood pressure (Kaboli et al., 2018). Calcium channel blockers are also used. They work by relaxing the muscles of the blood vessels and hence reducing blood pressure. These drugs also work by slowing the heart rate and thus decreasing blood pressure to normal levels. Nurses should assist the patients in adhering to the prescribed medication since it is a major determinant of the health outcomes of the patient (Clark et al., 2018)

Interventions for Hyperglycemia and High Blood Pressure

Diet modification- Research indicates that changing diet is critical in lowering the blood pressure of patients. One of the actions that Cho should undertake is the reduction of salt intake. Evidence from various clinical trials and meta-analysis studies indicates that an increase in the consumption of salt increases blood pressure( Francois et al., 2018). Therefore, patients suffering from high blood pressure should minimize the consumption of food rich in sodium.  Evidence also suggests that increased intake of potassium is critical in lowering blood pressure. This is because potassium prevents the thickening of the artery muscles and hence preventing the condition (Kaboli et al., 2018). Potassium is available in foods such as fruits and vegetables, and therefore patients need not take potassium pills. Patients with high blood pressure need to avoid foods that are rich in fat and calories. This is because of this type of food results in the accumulation of fat in the blood vessels. The accumulation of fat results in narrowing the arteries and other blood vessels and hence interfering with the flow of blood. Nurses should offer dietary counseling to the patient. The nurse should advise Cho on the type of food that she needs to avoid and the diet which is appropriate in managing hypertension ( Francois et al., 2018).

Proper discharge planning is very critical to avoid readmission and to ensure that the health of the patient is not compromised. For the effective discharge of Ms. Cho, there must be a multidisciplinary collaboration between the healthcare professionals involved in the care of the patient. The team needs to identify the needs of the patient when they will be recuperating at home. It is also critical to determine the resources that Ms. Cho will require to aid in the recovery process. When discharging the patient, the nurse must uphold the moral nurse’s principles of nursing. When deciding on discharge, the nurse should consider whether the home environment of the patient will help the patient to recover accordingly (Young-Hyman et al., 2017).  The discharge planning also needs to look at whether the patient has someone to take care of them properly. Since the patient is at the 30^th week of gestation, she needs a lot of care and attention, given the fact that she is suffering from hypertension and hyperglycemia (Vlachopoulos and Terentes-Printzios, 2019). According to the social justice framework, it is also critical to ensure that the patient has access to prenatal care to ensure the life of the unborn child and the mother is not endangered by the new health condition (Young-Hyman et al., 2017). Cho should be able to get a convenient health assessment from time to time to ensure that the vital signs remain in check to avoid further complications. The nurse should provide a system of reminders to assist the patient to adhere to the medication and the other interventions which have been suggested. Strict adherence to the treatment plan is very critical for Ms. Cho to recover and manage the medical condition.

Discharge Planning for the Patient

References

Annamalai, A., 2017. Diabetes Mellitus and Acute Hyperglycemia. In Medical Management of Psychotropic Side Effects (pp. 23-30). Springer, Cham.

Batta, R.A., Kasabri, V., Akour, A., Hyassat, D., and Albsoul-Younes, A., 2018. Impact of clinical pharmacists intervention on management of hyperglycemia in pregnancy in Jordan. International journal of clinical pharmacy, 40(1), pp.48-55.

Clark, C., Smith, L., Cloutier, L., Konya, J., Todkar, S., Mcdonagh, S., Clark, O., Glynn, L., Taylor, R. and Campbell, J., 2018. Interventions to improve control of hypertension; what works (and what doesn’t)?. Journal of Hypertension, 36, p.e136.

Farrar, D., 2016. Hyperglycemia in pregnancy: prevalence, impact, and management challenges. International journal of women’s health, 8, p.519.

Francois, M.E., Myette-Cote, E., Bammert, T.D., Durrer, C., Neudorf, H., DeSouza, C.A., and Little, J.P., 2018. Integrative Cardiovascular Physiology and Pathophysiology: Carbohydrate restriction with postmeal walking effectively mitigates postprandial hyperglycemia and improves endothelial function in type 2 diabetes. American Journal of Physiology-Heart and Circulatory Physiology, 314(1), p.H105.

Kaboli, P.J., Howren, M.B., Ishani, A., Carter, B., Christensen, A.J. and Vander Weg, M.W., 2018. Efficacy of Patient Activation Interventions With or Without Financial Incentives to Promote Prescribing of Thiazides and Hypertension Control: A Randomized Clinical Trial. JAMA network open, 1(8), pp.e185017-e185017.

Mansfield, C., Manivannan, S., Cameron, E.M., Garg, V. and Basu, M., 2019. Dose-response Effect of Hyperglycemia in Maternal Diabetes Mediated Congenital Heart Defects. Circulation Research, 125(Suppl_1), pp.A650-A650.

McLean, G., Band, R., Saunderson, K., Hanlon, P., Murray, E., Little, P., McManus, R.J., Yardley, L. and Mair, F.S., 2016. Digital interventions to promote self-management in adults with hypertension systematic review and meta-analysis. Journal of hypertension, 34(4), p.600.

Middleton, S., Coughlan, K., Mnatzaganian, G., Low Choy, N., Dale, S., Jammali-Blasi, A., Levi, C., Grimshaw, J.M., Ward, J., Cadilhac, D.A. and McElduff, P., 2017. Mortality reduction for fever, hyperglycemia, and swallowing nurse-initiated stroke intervention: QASC Trial (Quality in Acute Stroke Care) follow-up. Stroke, 48(5), pp.1331-1336.

Morrissey, E.C., Durand, H., Nieuwlaat, R., Navarro, T., Haynes, R.B., Walsh, J.C. and Molloy, G.J., 2016. Effectiveness and content analysis of interventions to enhance medication adherence in hypertension: a systematic review and meta-analysis protocol. Systematic reviews, 5(1), p.96.

Sanchez, A., Chung, S.C., Mejia, A., Ramirez, F.E., Shavlik, G.W., Bivens, R.L., Brown-Fraser, S. and Gallant, R.D., 2019. Multiple lifestyle interventions reverses hypertension. Cogent Medicine, 6(1), p.1636534.

Senanayake, P.D., Bonilha, V.L., W Peterson, J., Yamada, Y., Karnik, S.S., Daneshgari, F., Brosnihan, K.B. and Hollyfield, J.G., 2018. Retinal angiotensin II and angiotensin-(1-7) response to hyperglycemia and an intervention with captopril. Journal of the Renin-Angiotensin-Aldosterone System, 19(3), p.1470320318789323.

Tadros, M., Clarke, H., Gopalani, R., Palma, S. and Shwin, M., 2019. Impact of serial blood glucose monitoring and treatment in patients with corticosteroid-induced hyperglycemia in the inpatient setting.

Vlachopoulos, C. and Terentes-Printzios, D., 2019. Global interventions in hypertension. Heart and Metabolism, p.25.

Young-Hyman, D., de Groot, M., Hill-Briggs, F., Gonzalez, J.S., Hood, K. and Peyrot, M., 2017. In the article listed above, the second recommendation for anxiety disorders on page 2133 reads:“People with hypoglycemic unawareness, which can co-occur with fear of hypoglycemia, should be treated using Blood Glucose Awareness Training (or other evidence-based similar intervention) to help re-establish awareness of hypo-glycemia and reduce fear of hyperglycemia.”. Diabetes Care, 40.