Nursing Care Plan for Patients with Hypoglycemia - Assignment Example

Case Study: Hypoglycemia The essay aims to address a two-fold objective to wit to identify three nursing diagnosis based on the assessment; and (2) to prioritize three nursing diagnosis and formulate nursing care plan. Case Study: Hypoglycemia Introduction Hypoglycemia is defined as a condition in which the blood glucose level of a person falls below 2.7-3.3 mmol/L and where too much insulin or hypoglycemic agents, too little food, and excessive physical activity precipitates the occurrence of a hypoglycemic attack (Day, Paul & Williams, 2009, p. 1326). Hypoglycemic episodes may happen anytime and the severity and fatality of an attack depends upon the emergence of interventions. Older adults with diabetes are at increased risk for hypoglycemic episodes. Due to physiologic effects of aging such as poor dentition, decreased appetite, decreased taste sensation, and presence of chronic illness, older adults are more likely to be nutritionally deficient, which put them at risk for hypoglycemic episodes (Roach, 2001, p. 321). Likewise, older adults frequently live alone and the non-recognition of the symptoms of hypoglycemia may lead to incidences of injury (Surrena, 2009, p. 387). Mr. Adams Douglas, 51 year-old male, was admitted to the hospital due to confusion. Assessment revealed a blood sugar of 2.1 mmol/L, a marked hypoglycemia. In addition, Mr. Douglas is receiving medication for diabetes and hypertension and stated that he administered full dose (26 units) of insulin in the morning although Mr. Douglas had not eaten anything prior to administration of insulin. Further assessment also revealed that Mr. Douglas smokes 1 pack of cigarette/day and has been living alone in a single bed unit. Upon admission to the hospital, Mr. Douglas’ current conditions include slurred speech, inability to remain still in the bed, feeling of weakness and lack of energy, and Glasgow Coma Scale of 13/15. Initial medical interventions were implemented in order to rule out hypoglycemic episodes. Nursing Care Plan Within 2 hours, the priority nursing diagnoses are risk for injury, acute confusion, and imbalanced nutrition less than body requirements. The first nursing diagnosis is the Risk for Injury related to decreased blood sugar level, secondary to insulin therapy. After two hours of nursing intervention, Mr. Douglas’ will be free from any form of injury by maintaining blood glucose levels between 2.7-3.3 mmol/L and identifying signs and symptoms of hypoglycemia. Nursing interventions include the following: assessment of serum glucose levels at bedside before administering oral hypoglycemic agents, before meals, and before going to sleep because serum glucose levels are more accurate parameters than urine glucose, which is affected by renal threshold and function of aging (Moyet, 2008, p. 856); assessment of signs and symptoms of hypoglycemia such as irritability, confusion, fatigue, weakness, sweating, shakiness, palpitation, and slurred speech because identifying the early signs of hypoglycemia will prevent further complications (Schilling et al, 2003, p. 160); checking institutional protocol for hypoglycemia treatment because treatment depends on the ability of the patient to swallow or to the level of consciousness; letting the patient rest or lie down and institute seizure precautions because severe hypoglycemia may lead to unconsciousness and seizures (Schilling et al, 2003, p. 160); allowing the conscious patient to consume 10-15 mg of simple carbohydrate and if unconscious, administering 1 mg of glucagon SC or IV bolus of dextrose 50% is necessary because simple carbohydrates are metabolized quickly and glucagon raises blood glucose level by stimulating the liver to release glycogen (Schilling et al, 2003, p. 160); assessment of patient’s eating habits because physiological effects of aging may cause the patient to skip meals, which contribute to hypoglycemia (Schilling et al, 2003, p. 160); and rechecking of blood glucose after 1 hour because regular monitoring detects early signs of hypoglycemia or hyperglycemia (Moyet, 2008, p. 856). After evaluation, Mr. Douglas will be free from any form of injury, manifests normal blood glucose level, and identifies early signs of hypoglycemia after two hours of nursing interventions. The second nursing diagnosis is Acute Confusion related to decreased blood sugar level as manifested by time and place disorientation. After two hours of nursing intervention, Mr. Douglas’ confusion will subside as manifested by improved orientation to place and time, GCS of 15, coherent speech, alertness, and increased level of consciousness. The nurse will implement the following practice: assess LOC, breathing pattern, and patency of veins in preparation for medical treatment. Confusion may signal a critical emergency, such as hypoglycemia, that threatens permanent brain damage (Hales, 2008, p. 1451); institute delirium and seizure management. Safety is the priority for patients with hypoglycemia and delirium and seizures are severe effects of hypoglycemia (Larrabee, 2009, p. 72); have a staff member stay at patient’s bedside to protect patient from harm (Ralph & Taylor, 2005, p. 56); Monitor neurologic status, such as GCS, on a regular basis to detect improvement or decline in neurologic status (Ralph & Taylor, 2005, p. 56); orient the patient to time, place and date. Reality orientation such as date, place, and time of the day decreases confusion and enhances memory (Roach, S.S. , 2001, p. 161); and inform the client of the cause of confusion and disorientation because knowledge of the cause of confusion signals the client to seek early treatment for future incidence (Schultz & Videbeck, 2009, p. 114). After thorough evaluation, Mr. Douglas’ confusion will subside, and will be coherent, alert, conscious, oriented, and GCS will be 15 after two hours of nursing interventions. The third nursing diagnosis is Imbalanced Nutrition less than body requirements related to decrease caloric intake as manifested by verbalization of skipped meal. After two hours of nursing intervention, Mr. Douglas will have enough caloric intake as manifested by eating on a regular basis. The nurse perform the following nursing care: assess normal pattern of eating. Older adults are particularly at risk for hypoglycemia due to nutritional deficit. Nutrition is an essential factor in recovery and pre-administration of insulin (Almeida et al, 2008, n.p.); assess medications taken by the patient. Numerous pharmacological treatments for diabetes may indirectly or directly inhibit glucagon secretion which is responsible for increasing blood sugar levels (Rosenstock et al, 2007, p. 175; Juhl et al, 2002, p. 424; Degn et al, 2004, p. 2397); assess intravenous infusion of Dextrose 50% and avoid abrupt discontinuation. Ensure that appropriate amount of needed glucose or calories were delivered and avoid relapse of hypoglycemia due to abrupt discontinuation of running concentrated dextrose infusions (Elamin & Norri, 2010, n.p.). After thorough evaluation, Mr. Douglas will demonstrate increased in appetite to compensate for the increase caloric intake after 2 hours of nursing interventions. Conclusion Hypoglycemia happens when blood glucose levels falls between 2.7-3.3 mmol/L. Insulin, meal pattern, and stress may precipitate hypoglycemic attack. Mr. Douglas is particularly at risk to hypoglycemia because of the physiologic effects of aging and social history of living alone. In patient with hypoglycemia, safety is always the priority; thus, risk for injury would be the priority nursing diagnosis, followed by acute confusion, and last is imbalance nutrition. Although the first priority is a risk nursing diagnosis, chances of injury are increased in patient with hypoglycemia. Following nursing standard procedures, if there is no problem in ABC, safety of the patient becomes the priority. References Almeida, M.A. et al. (2008). Prevalent nursing diagnoses and interventions in the hospitalized elder care. Revista Latino-Americana de Enfermagem, 16(4): n.p. doi.org/10.1590/S0104-11692008000400008. Day, R.A., Paul, P. & Williams B. (2009). Assessment and Management of Patients with Diabetes Mellitus. Brunner and Suddarths Textbook of Canadian Medical-Surgical Nursing (2nd ed.) (p. 1301-1353). Philadelphia: Lippincott Williams & Wilkins. Degn, K.B. et al. (2004). Effect of intravenous infusion of exenatide (synthetic exendin-4) on glucose-dependent insulin secretion and counterregulation during hypoglycemia. Diabetes, 53: 2397–2403. Elamin, A. & Norri, A. (2010). Essentials of Total Parenteral Nutrition: A review. Sudan Journal of Medical Sciences, 5(1):n.p. Hales, R.E. (2008). Treatment of Seniors. 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