Describe Essay on a Care plan for Nursing.
Nursing care plan for diabetes patient
The nursing care plan is for the patients who are suffering from diabetes. It is a condition in which the body can’t control the sugar levels. This occurs due to two reasons. One is the body is not able to release enough insulin and the second is the body become resistant to insulin. The range of blood sugar level is from 70-150. If the blood sugar level is less than 70 it is considered as hypoglycemia and if the level is above 150 it is considered hyperglycemia. The particular care plan talks about hyperglycemia (Goolsby, 2012). Hyperglycemia is associated with polyuria, polydipsia, and polyphagia. Uncontrollable form of diabetes is mainly due to lack of patient’s knowledge about diabetes. The patient has less knowledge how to take insulin, not knowing the symptoms, unhealthy diet, and not knowing the proper functioning of medicines and insulin. The events or situations that increases glucose/insulin imbalance are so many. First is previously undiagnosed or newly diagnosed type 1 diabetes; second is the intake of food with high glucose level; the third is adolescence and puberty; fourth exercising in uncontrolled diabetes; and fifth is stress related to illness, infection, trauma, or any injury. The care plan encompasses various aspects. The care plan has four major steps (Armstrong et al, 2013). First is nursing diagnosis, second is nursing goals, third is nursing intervention and fourth is nursing evaluation. One of it include about educating the patient about managing diabetes. Uncontrollable diabetes brings up various fatal conditions like inability to see, peripheral vascular disease, and problems associated with heart.
Nursing Diagnosis
The improper way to manage health is the clear demonstration of uncontrolled diabetes. The nursing diagnosis for the patient having hyperglycemia is as follows:
1) Consuming nutrients and fluids less than the required amount: the patient’s body is consuming fewer nutrients that have led to a reduction in carbohydrate metabolism. It is a due deficiency of insulin. In hyperglycemia generally there is an increase in glucose in the body. Intake of fewer fluids is related to osmotic diuresis. Improper diet leads to various complications like nausea, weakness, vomiting, weight loss, dry skin, stiffness, enlargement in the thyroid gland, and sweet fruit odor or breath.
2) Difficulty in mobilization: The person feels weak, tired and fatigue. He/she can’t run or move properly. He/she can’t perform the daily activities on their own. They feel tired by doing small tasks also. They have a disturbed sleep and rest (Australian Diabetes Society, 2011). This is mainly due to tachycardia and tachypnea when at rest or performing an activity.
3) Circulation: Increase in blood pressure. It is also associated with hypertension, acute MI, and Claudication. The condition causes problems like numbness, tingling in the extremities, foot ulcers, decrement in pulse rate, dry skin, and sunken eyeballs.
4) Psychological disturbances: The patients become stress full and depend on others. They become dependent on others. The signs of it are anxiety and sensitive excitatory.
5) Changes in excretory patterns: The pattern of urinating changes. There is pain, burning sensation, difficulty in passing urine due to urinary infection (Elley & Kenealy, 2011). Sometimes the patient also suffers from abdominal tenderness and diarrhea. The sign of all these symptoms are dilute urine, varying in color from pale to yellow. Due to infection the urine has misty and a foul smell. Some other signs are hard abdomen, bowel sounds and hyperactive urine.
6) Neurosensory: It includes headaches, tingling sensation, numbness and weakness in the muscles. Visual impairment is also seen in many cases. The signs include drowsiness, lethargy, coma, memory loss, seizures, and mental problems.
7) Pain: Abdominal pain at moderate to severe levels. The signs are grimacing of the face and palpitation.
8) Respiratory: It includes difficulty in breathing, cough with or without sputum. The signs are increased rate of respiration.
9) Security: It includes itching, skin ulcers, and lots of dryness in the skin. The signs are paralysis, decreased motion of limbs, and decrease in body strength.
10) Sexuality: It varies in males and females. Impotency problem occurs in males. In females, the problem with sexual intercourse and vaginal discharge due to infection (Kenealy et al, 2014).
Nursing goal
The nursing goals are planned in a way to make the patient health and mental status perfectly fine. It includes educating the patient and his/her family about how to manage diabetes and how to improve their health. The nursing goals that are to be achieved are as follows:
Reducing all the discomfort or pain the patient is suffering from. It includes reducing pain or swelling in any part of the body.
Maintaining the serum glucose level between 70-200 mg/dl.
Resuming the usual mental status. Anxiety, fear, and nervousness would be addressed.
Reaching the patient’s satisfaction level. This is making the patient understand that his health is managed in the best way and he/she is absolutely fine. The fears in the patient’s mind regarding the medical treatment would be abolished.
Absence of any condition like polydipsia, polyuria, and polyphagia.
Achieving homeostasis.
Educating the patient on how to manage his/her health and follow a specific diabetic regime.
Raising the confidence of the patient as well as his/her family members by providing excellent nursing facilities.
Patiently listening, addressing and fulfilling all the needs and requirements of the patients.
Maintaining a healthy weight with proper light exercises and healthy diet.
Nursing Interventions
Nursing interventions are the actions and orders that are to be taken to reach the nursing goals and outcomes:
1) Assessing the signs of hyperglycemia. It includes assessing frequent hunger, frequent urination and frequent sweating (polydipsia, polyuria, and polyphagia). The rationale is to assess the problems the patient is facing and reducing it in a certain amount of time.
2) Assessing the mental status of the patient. The rationale is to calm the patient down and bring down his/her nervousness and anxiety level.
3) Performing actions to reduce pancreatic stimulation (Mackinnon, 2012). The rationale is to prevent the body and the pancreatic islet cells from any further damage.
4) Performing actions to relieve discomfort, detailing all the tests and methods. The rationale is to make the patient satisfy and make him/her understand that he/she is in the right hand and appropriate measures are carrying on.
5) Performing actions to decrease stress. The rationale for it is that increase in stress levels causes increase in hormones like epinephrine, norepinephrine, glucagon, and cortisol. This further increases the blood glucose levels.
6) Administering insulin or oral hypoglycemic agents. Checking Blood glucose level after every four hours and after meals. The rationale is to reduce the increased blood glucose level. Checking in every hour will help to know the status of glucose level in the patient’s body. It will also tell how much patient health is improved.
7) Assessing for the signs and symptoms of ketoacidosis. It consists of signs like warm, thirst, weakness, hypotension, pain in abdomen, ketones in blood and urine, low serum pH and carbon dioxide content.
8) Educating the patient about the diabetes. The rationale is to protect the patient’s health at present and future. The diet regimen, the instructions and knowledge given to the patient will help him/her to manage diabetes in future (Bethel & Angelyn, 2013). It would also help the patient to be precautions and preventive about any future fatal conditions. The education and knowledge given to the patient are as follows:
The patient would be demonstrated on how to measure his/her blood sugar level. The general information like what is the normal sugar level and are the higher and lower limits of blood sugar level shall also be explained.
The patient would be physically explained in how to take insulin injections with the help of sliding scale. The level of insulin to be taken and the appropriate time when it is to be taken will also be explained to the patient (Davidson, 2013).
The patient would be educated verbally when to check his/her blood sugar level. It includes the time and the period of checking the blood sugar level again (Wilkinson, Carryer & Adams, 2014).
The patient would be explained how to successfully mix NPH and regular insulin together.
The patient would be explained about the diet regime that is to be followed. It would include telling the quantity and the type of food the patient can eat. A strict and nutritious diet that includes leafy vegetable, fruits, salads and lots of fluid would be recommended. The time when the food is to be consumed would also be explained (Daly, 2012). All the food would be according to the diabetic needs. The do’s and Don’ts related to food habits would also be dealt with.
The patient would be provided with testing strips, lancets, one free glucometer, and insulin syringes. It would help him/her to take care of health on their own. It would also include teaching on how to dispose the insulin syringes and lancets carefully.
9) Listening to patient discomfort and comforting him with soothing talks, touch and healthy environment. The rationale is to calm the patient’s mind, decrease his/her nervousness and anxiety levels.
10) Providing diet that has 60% carbohydrates, 20% protein, 20% fats. It should be incorporated in a number of meals and snacks. Carbohydrates are present in apples, broccoli, peas, dried beads, carrots, peas, oats. The rationale for giving carbohydrate is that it decreases glucose levels, insulin needs, reduces the serum cholesterol levels, and promotes satiation (Ackley et al., 2010). The quantity of food to be consumed is according to individual insulin characteristics and is specific to patients. A light meal at bedtime consisting complex carbohydrates is important to be given as it prevents hypoglycemia during sleep.
11) Giving all the medications properly, on time. The rationale is that the drugs will help to maintain the glucose level of the patient and would help to reduce the discomfort and pain the patient is having.
Nursing evaluation
The nursing evaluation consisting of assessing the patient health status. It is a very essential step as it gives the idea of how well the medical treatment is carried out. It is to track the goals that are achieved and to check whether the nursing care plan have been carried out effectively and efficiently or not. The evaluation has to be made on certain tests like blood glucose tests to determine the state of glucose in the body (Clendon et al, 2013). It also checks the mental and physical health status of the patient. It also checks the discomfort and pain the patient was having earlier like abdominal tenderness, red and itchy skin. The nursing evaluation decides whether the nursing care plan has to be carried out the same way, or it has to be terminated or it is to be continued. For hyperglycemia patients, checking the blood glucose level, body weight, frequency of hunger, sweat and urine. The nursing plan above should be carried out and evaluated to see the effectiveness.
Conclusion
Hyperglycemia and Hypoglycemia are deadly and fatal complications. It is very important to take appropriate steps and actions to treat the patient. It also includes educating the patients to reduce future complications. To reduce the morbidity and mortality associated with these conditions the patient has to follow the strict diet and medical regimen given. The care plan is to be followed strictly so as to attain health and normal status of the patient. To provide lots of fluid and healthy food is the key to success to fight with hyperglycemia at present and also in future. Nursing along with medical treatment is sure to produce the best results in the patient’s health. Care plan effectiveness depends on the level it has been carried out.
References
Ackley, Betty; Ladwig, Gail B.; Kelley, Helen (2010). Nursing diagnosis handbook: an evidence-based guide to planning care (9th ed.). Maryland Heights, MO.: Mosby
Armstrong MJ, Gronseth G, Anderson DC, Biller J, Cucchiara B, Dafer R, Goldstein LB, Schneck M, Messé SR (May 28, 2013). “Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease: Report of the Guideline Development Subcommittee of the American Academy of Neurology”. Neurology 80 (22): 2065–2069
Australian Diabetes Society (2011), Clinical Guidelines for children, adolescents and adults.
Bethel, edited by Mark N. Feinglos, M. Angelyn (2013). Type 2 diabetes mellitus: an evidence-based approach to practical management. Totowa, NJ: Humana Press. p. 462.
Clendon J, Carryer J, Walker L, Noble V, Minto R, Calverley R, et al. Nurse perceptions of the Diabetes Get Checked programme. Nurs Prax N Z. 2013;29(3):18–30
Daly B. Diabetes management by primary health care nurses in Auckland—a cross-sectional study [PhD thesis]. Auckland: University of Auckland; 2012
Davidson MB. Effect of Nurse-Directed Diabetes Care in a Minority Population. Diabetes care 2013; 26: 2281-87.
Goolsby MJ. 2012 American Academy of Nurse Practitioners diabetes management survey. J Am Acad Nurse Pract.19(9):496–8
Kenealy T, Arroll B, Kenealy H, Docherty B, Scott D, Scragg R, et al. Diabetes care: practice nurse roles, attitudes and concerns. J Adv Nurs. 2014;48(1):68–75
Mackinnon M. Diabetes nursing: a personal perspective of the last 50 years. Br J Diabetes Vasc Dis. 2012;2(6):464–7.
Raina Elley C, Kenealy T (December 2011). “Lifestyle interventions reduced the long-term risk of diabetes in adults with impaired glucose tolerance”. Evid Based Med 13 (6): 173
Wilkinson J, Carryer J, Adams J. Evaluation of a diabetes nurse specialist prescribing project. J Clin Nurs. 2014;23(15– 16):2355-66.
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