To create a trusting relationship between the parties, the nurse must sensitize the responsibility of the family member in helping Rohan with his medication. Having diagnosed Rohan with 1 diabetes mellitus, it is vital to ensure an appropriate care that will help in monitoring and regulating the level of blood sugar. This is because of the random changes that come as a result of the disease.
The care needs of Rohan should include;
Provision of emotional support to help him cop up with the depression that may come along with the disease. Research studies indicate that diabetes can be stressful to both the child and the family members which may result into family dysfunctions. The caregiver should emphasize anxiety distraction, for example, singing favorite songs, watching TV and other activities that may attract pleasure. The health team should demonstrate a high level of emotional support to Rohan and the family. This could be done by organizing a meeting with the household members, emphasizing parental care and guidance for the child to help improve the working and social relationship (American Diabetes Association, 2013, p.S10)
Right nutritional balance. Administering the right nutritional balance can help in controlling type 1 diabetes. This should focus on controlling the level of carbohydrates consumed by the child and managing the child’s weight. This, therefore, implies that nutritional plan for Rohan should be drafted and reviewed periodically to monitor the changes in blood sugar. Cases may come of eating disorders, but the caregiver should always encourage Rohan to follow the nutritional plan. More food should also be availed. However, this should be accompanied by more exercise as
Routine controlled Exercise, Rohan needs to have at least an hour of aerobic exercise daily that should be accompanied by muscle and bone fitness exercise at least four times in a week. The process of doing the exercise, the child’s insulin level may change implying that any form of exercise should be accompanied by the regular checks to monitor insulin needs. The primary purpose of doing the exercise is to improve on glucose utilization which as a result, lowers its concentration in the blood. Most importantly, exercise should not be used as the main control, however as a way of promoting physical health growth.
The priorities for nursing care of children suffering from diabetes.
Plan of care. The nurse and the family of Rohan should be able to consider a plan of care upon diagnosing him with type 1 diabetes. The nurse should consider the admission history background and information of the child to develop the most relevant and applicable form of care for the child/ infant. However, in the plan, the nurse should demonstrate a high degree of adherence support.
Patient and family centred communication. The nursing care personnel should consider creating an effective and friendly relation to the patient and the family as well. This is important because the nurse will be able to obtain the relevant information concerning the patient with a lot of ease. A good relationship between the nurse and the family also helps the child to develop the confidence of expressing their problems. As demonstrated in family-centred treatment, better results are expected when there is collaboration of the child, parents and the nurse (Handelsman et al p.287)
Pain assessment and management. The nursing personnel should be able to ascertain the type of pain Rohan undergoes. This will be a base of treatment is going through in relation to the pain history and seeking possible strategies of reducing/ cooling down the pain. Some of the pain assessment criteria that can be used by the nurses may include; behavioural manifestation, past experience as explained by the family members, physiologic parameters, and the use of environment factors
As it can be witnessed from the scenario, Rohan does not have enough time with his family members. His father leaves very early in the morning for work, and the mother is suffering from depression and nephritic syndrome. In this case, the nurse has to apply theoretical and ethical support to help improve on Rohan’s relationship with his family members. The nurse should request Rohan’s teacher to help her organize a counselling session with Rohan’s family. This will be aiming at having a personalized interview with the family which may later provide a base health, physical, social and emotional support.
When a counselling session has been organized, the nurse should consider using the most relevant theory during the session to ensure best results/ outcomes are obtained. In this case, one of the general strategies that the nurse can use is adopting a family-centred theory. According to the theory, there is a collaboration of the patient, family members, the nurse and the physicians. In other words, they all work towards achieving a common goal. Therefore if a nurse is to adopt this there theory, she must adhere to the principles of the theory
The nurse should consider shifting from not only apply professional and organizational strict law to diagnosis, treatment and learning to help I obtaining the needs, cultural values, beliefs, and ethics of the family or simply to attain accurate relevant information. The nurse should have in mind that all people are different in their way and therefore treating all the family member and Rohan with dignity. During the interview, the nurse should mostly use open-ended questions except whining seeking clarity. During the process of developing a rapport aimed at achieving a trustable relationship, the nurse may follow the following logical procedures
Making an introduction as the very first phase I the session. (Name, position, title, and their responsibility in caring for the child/ Rohan). To demonstrate respect, the nurse should ask all the available family members what names they would prefer to be called with. Explaining the purpose of the interview and the relationship and how relevant the information they provide matters. Involving the child in the interview by asking questions that he thinks is the reason why his family is not taking much care about him; however, these questions should cater for the age and understanding level of the child. During the interview, the nurse should build on the strengths and weaknesses of the family to help them adjust accordingly. The nurse should ensure delivering completely honest of the information concerning the child and the family. Using a language that can be understood by both the child and the family members during the interview will help in delivering most significant results. Providing privacy and clarifying any unclear information that would cause doubt and mistrust amongst the parties. This can be done by assuring the family members and the child/ youth that the information collected from them is basically under health insurance portability and accountability act (HIPAA). Interview the mother of the child about her illness and depression to help establish a valid solution in improving the relationship with Rohan. If the nurse has managed (American Diabetes Association 2016, p3)
A sample plan of care to address Rohan’s type 1 diabetes
The best care plan for type 1 diabetes management primarily involves efficient blood glucose monitoring through the use of insulin, avoiding extremely high and low concentration of blood sugar. Actually, the control should be regulated between the glucose level of (90-170) before the meals and (100-180) after meals. In the care plan,
Nutritional balance should be developed to manage the type of food the child eats. The main nutritional content to consider should be carbohydrates, proteins, and fats
The table below provides the methods of insulin nutritional dosing
|
Dosing method |
Meal planning |
|
Fixed dose for rapid acting and intermediate insulin |
Rohan should eat at a time when the insulin peak is at the highest level. The meals should be well timed on daily basis and the nutrient concentration of fats, proteins, and carbohydrates should be maintained |
|
Long acting-basal |
This form allows certain degree of meal scheduling. The rapidness of the insulin is as a result of the concentration of carbohydrates in the food eaten |
|
Insulin pumps |
Pumps also give chance in flexibility in meal planning. Carbohydrates content of the body determines the rapid action of the insulin |
As from the table, the evaluation should be based on how well the instructions are followed. Failure to follow the nutritional instruction will lead to a failure in the plan.
References
American Diabetes Association, 2013. Executive summary: Standards of medical care in diabetes—2013. Diabetes care, 36(Supplement 1), pp.S4-S10.
American Diabetes Association, 2014. Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), pp.S81-S90.
American Diabetes Association, 2015. Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association, 33(2), p.97.
American Diabetes Association, 2016. Standards of medical care in diabetes—2016 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association, 34(1), p.3.
Buckley, B.S., Harreiter, J., Damm, P., Corcoy, R., Chico, A., Simmons, D., Vellinga, A. and Dunne, F., 2012. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review. Diabetic medicine, 29(7), pp.844-854.
Copeland, K.C., Silverstein, J., Moore, K.R., Prazar, G.E., Raymer, T., Shiffman, R.N., Springer, S.C., Thaker, V.V., Anderson, M., Spann, S.J. and Flinn, S.K., 2013. Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents. Pediatrics, 131(2), pp.364-382.
De Belvis, A.G., Pelone, F., Biasco, A.M.A.L.I.A., Ricciardi, W. and Volpe, M.A.S.S.I.M.O., 2009. Can primary care professionals’ adherence to Evidence Based Medicine tools improve quality of care in type 2 diabetes mellitus? A systematic review. Diabetes research and clinical practice, 85(2), pp.119-131.
Handelsman, Y., Bloomgarden, Z.T., Grunberger, G., Umpierrez, G., Zimmerman, R.S., Bailey, T.S., Blonde, L., Bray, G.A., Cohen, A.J., Dagogo-Jack, S. and Davidson, J.A., 2015. American Association of Clinical Endocrinologists and American College of Endocrinology–clinical practice guidelines for developing a diabetes mellitus comprehensive care plan–2015. Endocrine Practice, 21(s1), pp.1-87.
Handelsman, Y., Mechanick, J., Blonde, L., Grunberger, G., Bloomgarden, Z., Bray, G., Dagogo-Jack, S., Davidson, J., Einhorn, D., Ganda, O. and Garber, A., 2011. American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for developing a diabetes mellitus comprehensive care plan: executive summary. Endocrine Practice, 17(2), pp.287-302.
Merkel, R.M. and Wright, T., 2012. Parental self-efficacy and online support among parents of children diagnosed with type 1 diabetes mellitus. Pediatric nursing, 38(6), p.303.
Nakhla, M., Daneman, D., To, T., Paradis, G. and Guttmann, A., 2009. Transition to adult care for youths with diabetes mellitus: findings from a Universal Health Care System. Pediatrics, 124(6), pp.e1134-e1141.
Peters, A., Laffel, L. and American Diabetes Association Transitions Working Group, 2011. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems. Diabetes care, 34(11), pp.2477-2485.
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