T1DM is a chronic disorder resulting from the immune system destruction of cells producing insulin in the pancreas (AIHW, 2013). According to Cheah, Kasim5, Hong, Hassan and Jalaludin (2018), Type 1 Diabetes Mellitus is the most prevalent type of DM and can affect all ages but is more pronounced among children and adolescents (Leclair, 2013; Millette, Mok, & Legault, 2013). In 2013, 19 % of the Australian population was for children between 1-14 years but they produce 44% rate of all cases of T1DM (AIHW 2015). The aetiology of Type1 Diabetes is not known but is thought to be the interaction of genetic susceptibility and factors in the environment. The disorder is unpreventable and incurable and when poorly managed, it results into various short and long term health problems and ultimately death. The disorder is closely connected to DKA (diabetic ketoacidosis) (AIHW, 2013).
This study is going to provide a C&FCC for Sarah and her family. Sarah is 12 and lives in a remote area where accessing medical health is very difficult. She has been diagnosed with T1DM and has a history of abdominal pain, hyperglycaemia and mild ketoacidosis. She is distressed and loathes needles. The study will develop a management plan for Sarah and her mother in the time she spends in the hospital and post discharge at her remote home.
The initial nursing assessment within 24 hours should be on Sarah’s blood glucose level. According to diabetes guidelines by the America Diabetes Association, management of T1DM in children requires that the health care team emphasize on checking the BGL of the children. The blood glucose assessment should be frequent (4 times a day) to ensure that the level is between 100-200 mg/dl and HbA1c levels of less than 8.5%. That for Sarah should equate to an estimated average glucose (EAG) of less than 197mg/dl (Streisand & Monaghan, 2014).
It is recommended that, when assessing a young child, one should kneed or bend to the child’s height (Cobert, 2013). The nurse should introduce himself to the child and not just speak to the parent and for this case Sarah’s mother (Cobert, 2013). The nurse should conduct an interview that seeks to understand Sarah’s health history by use of open ended questions both to Sarah and the mother (Estes, 2013). Since T1DM is thought to be a genetic disorder, the nurse should ask a family history question with T1DM. This assessment should aim at seeking knowledge of when the disorder began, duration of illness, characteristics of illness, location of pain and any other symptoms that relate to a body part involved (Estes, 2013).
Pain assessment is particularly very important in a move to provide the best management against it (Weber & Kelley, 2013). Factors that influence pain experience like onset, frequency and duration are very important. Both the relieving and aggravating factors that reduce the effect of the illness on Sarah should also be assessed. It is the duty of the assessor to understand the past treatment and medication applied in the past to treat the T1DM (Weber & Kelley, 2013).
Physical examination is an important aspect of nursing assessment (Toney-Butler; & Unison-Pace, 2018). Nursing assessment should also include physical examination apart from interviewing. The nurse should observe and measure the observable signs like the severity of pain, general weakness. Physical examination includes looking at Saran’s body temperature, blood pressure, height and weight as well as pulse and respiratory rate (Toney-Butler; & Unison-Pace, 2018). These factors should then be matched with the normal values (Estes, 2013). For example the optimum body temperature is 37.0 0C, but Sarah’s is 37.8 0C meaning she has high body temperature.
Some of the assessment tools that might be involved for T1DM include the baseline assessment tool, glucose monitoring equipment, symptoms checklist and various pain scales among others. The pain scales are used even in assessing pain in people who cannot experess themselves (McGuire, Kaiser, Haisfield-Wolfe & Iyamu, 2016)
The primary nursing diagnosis within 24 hours is preforming activities that ensures that Sarah’s BGL is stable. After assessment it is the role of the healthcare time and the specific practitioners to ensure that Sarah’s BGL is EAG is less than 197 mg/dl (Streisand & Monaghan, 2014). This is performed by insulin therapy following the diabetes management guidelines. Within the same period of 24 hours, the nursing team should ensure that Sarah’s diet is monitored as well as her physical activities to ensure that there is maintenance of a tight glycemic control. The providers must consider the sensitivity of insulin in children that put them at a hypoglycemia. The dosage of insulin for Sarah should consider the food consumption rate, which is not easily predicted. For Sarah, insulin should be provided once she has eaten to avoid hypoglycemia when she has eaten too little. Sarah should not engage in vigorous physical activity as that may decline the recovery process for children with T1DM (Streisand & Monaghan, 2014)
The main causes for health concern in Sarah’s case are ketoacidosis, hyperglycaemia and the slightly elevated body temperature. Ketoacidosis, a situation where the body produces high levels of blood acids called ketones, develops when the body cannot produce enough insulin (McCarvill & Weaver, 2014). Since Sarah’s body is unable to utilise glucose in the blood for energy, fats are broken down instead to release the energy needed. Burning of these fats releases these acids (ketones). Excessive glucose amount in the blood plasma, hyperglycaemia, is evident in Sarah’s case from the elevated blood sugar levels of 16.1 mols. According to Bowen, Xuan, Lingvay and Halm (2015), the normal blood sugar level ranges from 5.6–11.0 mmol/L
It is noted that Sarah is afraid of needles as revealed by her mother and the discomfort with the child as much as possible making her feel comfortable in that state by employing a number of distractions(Nally & Mueller, 2018).
This stage of the nursing procedure involves coming up with a schedule for Sarah’s treatment pattern based on the assessments done and diagnosis made. This plan is specific, measureable, achievable, realistic and within a time frame as required. According to Keenan, Mandeville, Yakel and Tschannen (2018), planning in health involves facilitating the flow of information from one provider to the other.
The main aim is to prepare Sarah and her family for a life-time management of the type one diabetes. Since they are from a remote community, the family may have little or no knowledge concerning the pathology of the disease and treatment. People from rural and remote areas have little knowledge on pathology service (Jones, McAllister & Lyle, 2017) The nurse should therefore aim at providing Child and Family Centred Care support framework. Where the family may not be able to understand the nurse due to a language barrier, assistance of an impetrator should be invoked.
The nurse should regularly check on Sarah’s diet to ensure meals are taken at consistent times a day, a balance diet is administered, enough calorie intake is administered and so on (Palladino & Helgeson, 2013)
The long term goal is to develop a strong Child and Family Centred Care support framework for Sarah’s lifetime management of the disease. This will involve talking with the child concerning her condition and encouraging her to speak out whenever she feels overwhelmed or socially stigmatized (Rechenberg, Sadler & Grey,2018).She should also be encouraged to ask as many questions as possible regarding her condition.
Her family, mother, in Sarah’s case should be familiarized with Sarah’s condition and trained on how to administer insulin to Sarah as well as the time duration. Her mother should also be educated on the type of diet consistent with Sarah’s condition and the frequency of meal intakes (Reddy, Rilstone, Cooper & Oliver, 2016). Sarah should also be familiar with the insulin administration so as to take charge in absence of her mother.
The nurse should emphasize that Sarah’s mother educate the rest of her family and her community especially at Sarah’s school on the nature of her condition and how it should be managed to prevent any external interference with her treatment pattern (National Collaborating Centre for Women’s and Children’s Health (UK), 2015). The nurse should also advice Sarah’s mother on a regular exercise plan to aid Sarah’s body utilise more food thus reducing insulin requirements (National Collaborating Centre for Women’s and Children’s Health (UK), 2015).
A number of interventions need to be considered so as to meet the desired outcome of Sarah’s eventual blood sugar management at normal levels. This may require the involvement of a multidisciplinary team.
The nurse should ensure that Sarah’s blood sugar level is maintained at normal range of 3.9- 7.1 mols, by frequently administering insulin up to 4 times a day especially before meal times. Frequent monitoring of her temperature, blood pressure, height and weight should also be done (Chaney, 2013). Sarah’s diet should be monitored to ensure that she is having a balanced diet intake. Enough calories should be administered to Sarah to balance energy expenditure (Delamater et al., 2018). Meals should be administered at consistent times each day to balance energy requirements.
Immediately after admission, the nurse should work on creating a conducive environment for Sarah’s treatment. This could include regular tours around the hospital wards, to familiarize Sarah with the hospital environment. Music therapy and distraction can also be offered as the child is afraid of needles (Estes, 2013).
Sarah’s mother should be educated on the treatment and management of her child post discharge (National Collaborating Centre for Women’s and Children’s Health (UK), 2015). This involves regular administration of insulin of up to 4 times a day around meal times, a balanced diet intake plan and an exercise plan. This will require involvement of a dietician, physical therapist and the remote nurse at the local community for monitoring of Sarah’s condition. Regular hospital visits should be encouraged to monitor the child’s blood sugar levels, body mass index and general well-being.
Evaluation is the final stage in this nursing procedure (Bulechek, 2013). The goal is to ensure Sarah is within normal body functioning parameters with a blood sugar level of 3.9- 7.1 mols. Weight, temperature and blood pressure are also to be constantly monitored within the recommended ranges to prevent a deteriorating condition. The blood sugar levels will have stabilised within the first week of admission. On discharge, Sarah’s mother should be educated on monitoring her child’s condition.
In addition to Child and Family Centred Care, members of the interdisciplinary committee are also essential for Sarah’s effective treatment pattern. The health providers involved in Sarah’s treatment include; her doctor, ward nurses, medical team, physiotherapist and a dietician (Bansal, Cuttler, O’Riordan & Koontz, 2013).
The doctor is in charge of the general monitoring of the child’s condition and issuing of directives as to what procedures and treatment should be done. The nurses are actively involved in the daily monitoring of Sarah and providing education on her treatment pattern post discharge.
The physiotherapist is in charge of the general recommendations on the type of physical exercise Sarah should engage in and the frequency so as to utilise food thus reducing insulin requirements. The dietician on the other hand is to recommend the appropriate diet for Sarah’s condition which should consist a balanced diet and regular calorie intake to balance energy expenditure.
Furthermore, a nurse from the remote community and a doctor should be involved to monitor Sarah’s condition post discharge. This is to ensure regular hospital visits to monitor her condition while in her home community.
Sarah’s family and community in general are instrumental in the implementation of the care plan. They are to make sure insulin is administered up to four times a day before meals while also ensuring a balanced diet is administered. Regular exercise patterns as recommended should be followed.
The nurse is to ensure Sarah’s mother is well conversant with the disease and the treatment pattern. This includes training on injection of insulin and the different types of insulin (Noco?-Bohusz & Noczy?ska, 2015).
Sarah’s mother should be encouraged to enlighten members of her community as well so as to avoid any social stigma that may arise. She should also be encouraged to have open communication with her daughter so as to be a source of encouragement and to answer any questions she may have regarding her condition (Wherrett et al., 2018).
The community’s ignorance on Sarah’s condition may be a course for her deteriorating condition, due to social stigma. They should be therefore encouraged to support the mother in this, to avoid any instances of a deteriorating condition.
Conclusion:
This study has reviewed type one diabetes mellitus in adolescents focusing on Sarah, a 12-year old type one diabetic. It has analysed the initial assessments, nursing diagnosis, planning implementation and evaluation of Sarah’s condition. The main goal is to provide an effective care and treatment plan for Sarah. The paper has analysed a care pattern during admission and post discharge. More focus placed on post discharge treatment which involves Child and Family Centred Care support.
To achieve an effective treatment pattern, there is need to involve an interdisciplinary team which consists of Sarah’s doctor, ward nurses, the medical team, a physiotherapist and a dietician. All these personalities are important for the holistic well-being of Sarah. A remote nurse and doctor are also to be involved to continue with Sarah’ treatment post discharge. Sarah’s family and community are to also be educated on the roles they are to play in Sarah’s recovery.
References:
AIHW. (2013). Prevalence of type 1 diabetes among children aged 0–14 in Australia 2013, Table of contents – Australian Institute of Health and Welfare. Retrieved 28 Aug. 2018 from https://www.aihw.gov.au/reports/diabetes/type1-diabetes-among-children-aged-0-14-2013/contents/table-of-contents
AIHW. (2015). Diabetes Overview – Australian Institute of Health and Welfare. Retrieved 28 Aug. 2018 from https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/diabetes/overview
Bansal, N., Cuttler, L., O’Riordan, M., & Koontz, M. (2013). Dietary Quality in Adolescents With Type 1 Diabetes. Diabetes Care, 36(8), e113-e113. doi: 10.2337/dc13-0436
Bowen, M., Xuan, L., Lingvay, I., & Halm, E. (2015). Random Blood Glucose: A Robust Risk Factor For Type 2 Diabetes. The Journal Of Clinical Endocrinology & Metabolism, 100(4), 1503-1510. doi: 10.1210/jc.2014-4116
Bulechek, G. (2013). Nursing Interventions Classification (NIC). St. Louis: Mosby Elsevier.
Chaney, D. (2013). Evaluation of the Effectiveness of a Structured Diabetes Education Programme (CHOICE) on Clinical Outcomes for Adolescents with Type 1 Diabetes: A Randomised Controlled Trial. Journal Of Diabetes & Metabolism, 04(06). doi: 10.4172/2155-6156.1000280
Cheah, Y., Kasim5, Z., Hong, Y., Hassan, N., & Jalaludin, M. (2018). Management of T1DM in children and adolescents in primary care. Malays Family Physician., 12(2), 18-22. Retrieved 28 Aug. 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802777/
Cobert, J. (2013). Tarascon pediatric psychiatrica (p. 31). Sudbury, Mass.: Jones & Bartlett Learning.
Delamater, A., de Wit, M., McDarby, V., Malik, J., Hilliard, M., Northam, E., & Acerini, C. (2018). Psychological Care of Children and Adolescents with Type 1 Diabetes. Pediatric Diabetes. doi: 10.1111/pedi.12736
Estes, M. (2013). Health assessment & physical examination (5th ed., pp. 20-35). Cengage Learning.
Grey, M., & Rechenberg, K. (2018). Sleep and Glycemia in Adolescents with Type 1 Diabetes. Diabetes, 67(Supplement 1), 814-P. doi: 10.2337/db18-814-p
Jones, D., McAllister, L., & Lyle, D. (2017). Rural and remote speech-language pathology service inequities: An Australian human rights dilemma. International Journal Of Speech-Language Pathology, 20(1), 98-101. doi: 10.1080/17549507.2018.1400103
Keenan, G., Mandeville, M., Yakel, E., & Tschannen;, D. (2018). Chapter 49Documentation and the Nurse Care Planning Process. In R. Hughes, Patient Safety and Quality: An Evidence-Based Handbook for Nurses. National Center for Biotechnology Information, U.S. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2674/
Leclair, E., (2013). Type 1 Diabetes and Physical Activity in Children and Adolescents. Journal Of Diabetes & Metabolism, 01(S10). doi: 10.4172/2155-6156.s10-004
McCarvill, R., & Weaver, K. (2014). Primary care of female adolescents with type 1 diabetes mellitus and disordered eating. Journal Of Advanced Nursing, 70(9), 2005-2018. doi: 10.1111/jan.12384
McGuire, D., Kaiser, K., Haisfield-Wolfe, M., & Iyamu, F. (2016). Pain Assessment in Noncommunicative Adult Palliative Care Patients. Nursing Clinics Of North America, 51(3), 397-431. doi: 10.1016/j.cnur.2016.05.009
Millette, M., Mok, E., & Legault, L. (2013). Impact of elective hospital admissions on glycaemic control in adolescents with poorly controlled type 1 diabetes. Diabetes & Metabolism, 39(6), 505-510. doi: 10.1016/j.diabet.2013.04.003
Nally, L., & Mueller, C. (2018). Health Mindset and Health Outcomes for Adolescents with Type 1 Diabetes. Diabetes, 67(Supplement 1), 830-P. doi: 10.2337/db18-830-p
National Collaborating Centre for Women’s and Children’s Health (UK). (2015). Diabetes (Type 1 and Type 2) in Children and Young People: Diagnosis and Management.;Education for children and young people with type 1 diabetes. Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0084611/
Noco?-Bohusz, J., & Noczy?ska, A. (2015). Postprandial sRAGE levels in type 1 diabetes mellitus in children and adolescents. Pediatric Endocrinology Diabetes And Metabolism, 21(4), 162-170. doi: 10.18544/pedm-21.04.0038
Palladino, D., & Helgeson, V. (2013). Adolescents, Parents and Physicians: A Comparison of Perspectives on Type 1 Diabetes Self-Care. Canadian Journal Of Diabetes, 37(3), 175-181. doi: 10.1016/j.jcjd.2013.02.057
Rechenberg, K., Sadler, L., & Grey, M. (2018). Anxiety in Adolescents with Type 1 Diabetes. Diabetes, 67(Supplement 1), 815-P. doi: 10.2337/db18-815-p
Reddy, M., Rilstone, S., Cooper, P., & Oliver, N. (2016). Type 1 diabetes in adults: supporting self management. BMJ, i998. doi: 10.1136/bmj.i998
Streisand, R., & Monaghan, M. (2014). Young children with type 1 diabetes: challenges, research, and future directions. Current diabetes reports, 14(9), 520. doi: 10.1007/s11892-014-0520-2
Toney-Butler;, T., & Unison-Pace, W. (2018). Nursing, Admission Assessment and Examination. 2018, StatPearls Publishing LLC.
Weber, J., & Kelley, J. (2013). Health assessment in nursing (pp. 146-154). Lippincott Williams & Wilkins.
Wherrett, D., Ho, J., Huot, C., Legault, L., Nakhla, M., & Rosolowsky, E. (2018). Type 1 Diabetes in Children and Adolescents. Canadian Journal Of Diabetes, 42, S234-S246. doi: 10.1016/j.jcjd.2017.10.036
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download