Nursing Care Plan - Diabetes - Case Study Example

Nursing Care Plan - Diabetes Epidemiology Diabetes Mellitus is a “metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action or both” (Canadian Pharmacists Journal, 2009). The three types of diabetes are classified as: (1) Type I, insulin dependent diabetes or juvenile diabetes is characterised by body’s inability to produce insulin; (2) Type II, non-insulin dependent diabetes or onset diabetes is characterised by a health condition wherein the cells is not capable of using insulin properly; and (3) gestational diabetes which occurs in pregnant women with high levels of blood sugar during pregnancy (DHSS, 2009; Eisenmann, DuBose, & Donnelly, 2007; Heron, 2007; Al-Delaimy et al., 2002). In line with the health consequences of diabetes, the US trend, risk factors, risk reduction strategy, and pathophysiology will be briefly discussed followed by developing a proposed nursing care plan which is effective in preventing and treating diabetes mellitus will be provided in details. US Trend: Diabetes The US trend for deaths caused by diabetes has been declining from 1980 to 1995. However, a slight increase was seen during the early 2000s. Between the years 2003 – 2004, diabetes dropped from top five to rank six to seventh respectively (Heron, 2007). In 2007, approximately 1.6 million people ages 20 and above were diagnosed with diabetes (National Diabetes Statistics, 2007). (See Figure I – Percentage of Total Deaths for the Top Five Causes of Death among Females: 1980 – 2004 on page 7) Risk Factors of Diabetes Risk factors of diabetes includes the following: (1) human genetic variability (MSNBC, 2007); (2) smoking or smoking history, snoring, and poor diet (Al-Delaimy et al., 2002; Hu et al., 2001); (3) overweight or obesity; (4) impaired fasting glucose (≥ 100 mg/dl); (5) hyperinsulinism or insulin resistance (fasting insulin ≥ 30 µU/ml) which increases risk for type II diabetes (Hirst, 2006); and (6) the lack of physical exercise due to amputated lower-extremity (Eisenmann et al., 2007; Speckman et al., 2004). With regards to pregnancy and new born babies, Pettitt & Jovanovic (2007) revealed that low birth weight which increases the risk for gestational diabetes among the pregnany women whereas not breastfeeding to newly born infants could increase the incidence of having a type II diabetes (Stuebe et al., 2005). Risk Reduction Strategy for Diabetes Health care practitioners should encourage and educate the Americans with regards to the importance of participating in regular physical activities (DOHHS, 1986) aside from promoting changes in their lifestyle such as being more conscious with their diet and changing their personal point-of-view with regards to smoking habit. For pregnant women, they should prepare themselves to breastfeed their new born infants. Pathophysiology Diabetes is a chronic metabolic disorder in which the body is unable to metabolize carbohydrates, fats and proteins due to lack of insulin. (DHSS, 2009; Harris, 1995) In the presence of sufficient insulin produced by the pancreas, the stomach will be able to digest carbohydrates, fats, and proteins (Marieb, 2004, p. 296). Therefore, a normal blood sugar level of 90mg/100ml is maintained. The impaired glucose tolerance, formerly known as “borderline diabetes” is a case of hyperglycemia or high blood sugar level which may lead to the development of type 2 diabetes. (DHSS, 2009) Source: Derived from Marieb, 2004, pp. 294 – 295. Current Trends in Care / Treatment In the case of hyperglycemia, treatment and care for patients includes having a balance diet, proper meal planning, self-monitoring of blood glucose, administration of insulin or oral glucose-lowering medicine like Troglitazone which is specifically designed to control hyperglycemia-induced insulin resistance but not the glycosamine-induced insulin resistance for Type I diabetes, and reduce strenuous physical activities (Miles et al., 2009; Boucher, et al., 2007). Immediate or emergency care for hypoglycaemia is the intake of simple sugar such as candy for easy digestion in the body. (Deitel, 2008) In treating hypoglycaemia caused by impaired or insufficient glucagon secretion, the administration of epinephrine and cortisol could enable the patient to recover from the health consequences of hypoglycaemia (Chan et al., 2002). Cultural Sensitive Care Ramadan fasting is being observed by the Muslims during the 9th month in the Islamic lunar calendar. (Islam 101, 2009) Medical professionals advice Muslim diabetic patients not to fast since the complications of Type I diabetes can be hazardous to the health of the patient which often could lead to morbidity. (Elhadd & Al-Amoudi, 2006) In line with this, nurses should advice the patients to observe safe fasting. In the case of Hinduism, people who observe this religion often join a lot of festivals that observe fasting and feasting for up to 9 days. The same recommendation is given to Hindu diabetic patients during the entire fasting period of the Raksha-bandhan among otheres. In case of feasting, Hindu patients should be advice to eat moderately so as not to trigger the health consequences of too much glucose in the body (hyperglycemia) (Patel et al., 2001). NURSING DIAGNOSIS EXPECTED OUTCOME NURSING INTERVENTIONS RATIONALE Risk for infection related to high glucose levels decreased leukocyte function. (Doenges, Moorhouse, & Murr, 2006, p. 673) After 30 minutes of nurse-patient interaction, the patient is expected to understand the importance of proper nutrition and hand washing in terms of reducing risk of infection caused by prolonged wound healing due to the presence of diabetes. Independent: 1. Promote the importance of hand washing by nurse and patient. 2. Always cover wound with dressing. 3. Teach patient the importance of proper nutrition. 1. Reduces the risk of cross-contamination. 2. To prevent infection. 3. To promote patient’s wellness and hasten wound healing. Source: Doenges, Moorhouse, & Murr (2006) pp.322 - 324 Figure I – Percentage of Total Deaths for the Top Five Causes of Death among Females: 1980 – 2004 Source: Heron, 2007 References Al-Delaimy, W., et al. (2002). Snoring as a Risk Factor for Type II Diabetes Mellitus: A Prospective Study. American Journal of Epidemiology , 155(5):387 - 393. DOHHS, U. (1986). Physical Activity and Health: A report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Eisenmann, J. C., DuBose, K. D., & Donnelly, J. E. (2007). Fatness, Fitness and Insulin Sensitivity Among 7- to 9-Year-Old Children. Obesity , 15:2135 - 2144. Hirst, K. (2006). Presence of Diabetes Risk Factors in a Large U.S. Eighth-Grade Cohort. Diabetes Care , 29:212 - 217. Hu, F. B., et al. (2001). Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women. The New England Journal of Medicine , 345:790 - 797. MSNBC. (2007, April 27). Retrieved September 17, 2009, from New Genetic Risk Factors for Diabetes Found: Scientists Scanned DNA of 32,000 People in 5 Countries: http://www.msnbc.msn.com/id/18334731/ Pettitt, D. J., & Jovanovic, L. (2007). Low Birth Weight as a Risk Factor for Gestational Diabetes, Diabetes, and Impaired Glucose Tolerance During Pregnanvy. Diabetes Care , 30:S147 - S149. Speckman, R. A., et al. (2004). Diabetes is the Strongest Risk Factor for Lower-Extremity Amputation in New Hemodialysis Patients. Diabetes Care , 27:2198 - 2203. Stuebe, A. M., et al. (2005). Duration of Lactation and Incidence of Type 2 Diabetes. JAMA , 294:2601 - 2610. Read More