Diabetes and Evidence-Based Nursing - Research Paper Example

?Running head: Diabetes and Evidence-based Nursing Diabetes and Evidence based Nursing (school) Diabetes and Evidence based Nursing A. Introduction of patient and situation This study will focus on Tony, a diabetic patient who was admitted to my unit, the Emergency Unit, for high blood sugar and dehydration. His tests indicated extremely high blood sugar levels, but he was only put on oral diabetes medications by the PCP. The patient has been feeling the symptoms of diabetes, including polyuria, polydipsia, and lethargy among others. He is 38 years old, African American, and is relatively active in his lifestyle. The day following his admission, his blood sugar level was more than 999. As a patient advocate, I was concerned for the patient’s treatment and I approached the patient and his wife about seeking a second opinion from an Endocrinologist. I recommended this with the hope of ensuring that they would gain the best possible care for the patient’s condition. The couple agreed and several weeks later returned to thank me for making the recommendation. The patient was diagnosed by the Endocrinologist with Flatbush Diabetes which is a rare form of diabetes presenting among African-American males. It calls for insulin administration for a short period of time and later to be shifted to oral diabetic medications. When untreated, it can lead to diabetic ketoacidosis. The nursing situation in this case is based on the appropriate care of the diabetic patient, on the assistance given in the administration of the patient medications, and on the monitoring of the patient’s vital signs, diet, blood sugar levels, and blood pressure. Since the patient’s blood sugar levels were not sufficiently being lowered by the oral medications, the nursing role extends to patient advocacy – helping protect the rights of patients and ensuring that they receive the best possible care. Since the PCP was not giving enough medical attention to the patient and with the knowledge that the patient may need more medical care, it is proper for the nurse to advice the patient to seek specialist care. This situation may be considered unethical between health professionals, but weighing between the patient’s needs and cordial relations between myself and the PCP, catering to the patient’s needs is still an ethical choice (Johnson and Jacobson, 2007). B. Description of Medical/health Condition Insulin is the hormone which regulates the uptake of glucose from the blood into the cells of the body (Medical News 2011). Deficient insulin or issues with its receptors therefore play a crucial role in the manifestation and development of diabetes mellitus. Most carbohydrates in food are broken down into monosaccharide glucose, which is the main carbohydrate which is found in the blood and used as fuel by the body (Medical News, 2011). When blood glucose levels in the body are high, insulin is released in the blood by the beta cells in the Islets of Langerhans in the pancreas. Insulin is then utilized by the body’s cells in order to absorb glucose from the blood and use as fuel, and later for conversion to other molecules, and for storage (Medical News, 2011). Insulin also serves as the control signal for the conversion of glucose to glycogen for internal storage in the liver and the muscle cells. Decreased glucose level leads to reduced release of insulin. This then leads to the reverse conversion of glycogen to glucose. Glucose is mostly managed by the glucagon which then acts in opposition to insulin. Glucose recovered by the liver is re-introduced into the bloodstream; the muscle cells do not have the necessary capacity for export (Medical News, 2011). Significant insulin levels highlight the anabolic processes, including cell growth and duplication, protein synthesis, and fat storage. Insulin serves as the main signal in the conversion of bidirectional processes of metabolism from the catabolic to the anabolic direction, and vice versa (Medical News, 2011). In effect, low insulin levels trigger the onset of ketosis. In instances when insulin is insufficient, glucose would not be absorbed by the cells which require it; moreover, it would also not be stored properly in the liver and the muscles. The overall effect would be high levels of blood glucose, poor protein synthesis, and acidosis (Medical News, 2011). (Khardori, 2011) Diabetes mellitus mostly manifests when a diabetogenic lifestyle is carried out by one which already has a genetic predisposition to the disease. A diabetogenic lifestyle includes one which is excessive in caloric intake, has inadequate caloric expenditure, and has resulting obesity. The BMI at which the excess weight would increase a person’s risk to acquiring diabetes is different for each racial group (Khardori, 2011). Those with European and Asian ancestry usually have a higher risk for diabetes. Hypertension is one of the risks associated with the development of this disease in whites, not so much among African-Americans (Wei, et.al., 2011). However, Flatbush Diabetes has emerged to be a major, but rare health threat among African-Americans. This disease has been classified as Type 1b diabetes mellitus. About 90% of diabetic patients have a history of obesity and their obesity also predisposes them to the development of other conditions, such as coronary heart disease, and hypertension. Other risk factors for this disease include: age greater than 45 years, weight greater than 120% of ideal body weight, family history of diabetes within the first degree relation, history of previous impaired glucose tolerance or impaired fasting glucose, and hypertension (Khardori, 2011). Medical Diagnosis: Flatbush Diabetes The goal for this disease is to immediately decrease his blood sugar levels through the administration of insulin. The primary goal is to eliminate symptoms and prevent the manifestation of complications (Umpierrez, 2006). In order to implement microvascular risks, the control of glycemia and blood pressure is sought; and in macrovascular risk reduction the control of lipids and high blood pressure, cessation of smoking, and implementation of aspirin therapy are some of the main concerns. Microvascular concerns include eye and kidney diseases; whereas macrovascular concerns include coronary, cerebrovascular, and peripheral vascular issues (Khardori, 2011). Goal setting is an important part of diabetes treatment, the primary goal being to reduce the blood sugar levels to acceptable levels. Nursing concepts: Reduce weight through health education Another goal would be to reduce the weight for the obese patients. Exercise medications as well as diet adjustments are an important part of the weight-reduction process. The nurse’s role would be to encourage the patient to participate in these weight reduction activities and to recommend modifications and adjustments in the patient’s diet (Khardori, 2011). A diet recommendation for each meal can also be planned with the patient, with due consideration given based on appropriate carbohydrate, protein, fat, vitamins, mineral, and fiber content of each meal. The nurse has to educate the patient on proper foods which can be consumed by the patient, and the recommended portions for these foods. The nurse’s role is also to educate the patient on the importance of the maintenance of reaching ideal blood sugar levels, meaning, such levels must not reach extreme highs and lows because these highs and lows would trigger the onset of various complications (Hegner, et.al., 2007). The nurse must teach the patient that he cannot go hungry and that he must bring a piece of candy, a bar of chocolate, or any sugary treat with him at all times in order to avoid hypoglycemia. The nurse can also instruct the patient that he does not have to avoid eating any foods, for as long as practices moderation in his diet. For example, during celebratory meals with friends or family where he may be tempted to eat a lot of food, he can make trade-offs in his intake. He may eat a bowl of ice cream, but skip the cake, or he may eat a bowl of pasta but skip the mashed potatoes or other carbohydrates (Hegner, et.al., 2007). These are essential lifestyle choices which the patient has to make in order to improve his chances of fighting the disease and of reducing his blood sugar levels to relatively normal or acceptable levels. Nursing concept: Patient monitoring The nurse’s role is also to monitor the patient’s blood pressure, kidney functions, and blood sugar levels. During the patient’s stay in the hospital, the monitoring would be carried out by the nurse, and before discharge, the patient can be taught self-monitoring options (Kitabchi, 2003). Monitoring of kidney functions involve the performance of urinalysis and assessment of creatinine levels. Any significant changes in these areas require referral to the physician for necessary actions. Since the PCP in this case was not recommending the appropriate medications and interventions for the patient, it is the nurse’s function to be a patient advocate. Patient advocacy is about empowering the patient and acting in his behalf and for the promotion of his health. The management of complications is also important in the nursing care of the diabetic patient. The nurse has to teach and instruct the patient that he would have to undergo regular eye examinations, yearly microalbumin checks, foot examinations, and kidney function monitoring (Khardori, 2011). Monitoring these areas help prevent and promote early management of ophthalmic complications, gangrene, and kidney failure. Conclusion The preferred outcome for this patient is for the patient to reach normal or near to normal blood (normal for diabetics) glucose levels. The decision of the nurse which might have improved this situation is on the recommendation given to the patient to seek further consult with an Endocrinologist. If the decision of the PCP would have been followed and the nurse would have allowed the patient to be discharged without making the proper recommendations, the patient would have become ketoacidotic and probably would have slipped into a coma. The actions taken by the nurse independently in informing the patient that another option is available to them may have improved the patient’s outcomes. It allowed the patient to consider the seriousness of his condition and the need for him to seek a second opinion. By reaching such point, the patient was able to establish his true diagnosis and his need for appropriate medications to address his disease. Works Cited Hegner, B., Acello, B., & Caldwell, E. (2007). Nursing Assistant: A Nursing Process Approach. California: Cengage Learning. Johnson, A. & Jacobson, B. (2007). Medical speech-language pathology: a practitioner's guide. New York: Thieme. Khardori, R. (2011). Type 2 Diabetes Mellitus Treatment & Management. eMedicine. Retrieved 12 October 2011 from http://emedicine.medscape.com/article/117853-treatment#aw2aab6b6b7 Kitabchi, A. (2003). Ketosis-prone diabetes: a new subgroup of patients with atypical type 1 and type 2 diabetes? J Clin Endocrinol Metab, volume 88: pp. 5087–5089. Medical News (2011). Diabetes Pathophysiology. Retrieved 12 October 2011 from http://www.news-medical.net/health/Diabetes-Pathophysiology.aspx Umpierrez, G. (2006). Ketosis-Prone Type 2 Diabetes: Time to revise the classification of diabetes. Diabetes Care, volume 29(12), pp. 2755-2757. Wei, G. Coady, S., & Goff, D. Jr, (2011). Blood Pressure and the Risk of Developing Diabetes in African Americans and Whites: ARIC, CARDIA, and the Framingham Heart Study. Diabetes Care, volume 34(4): pp. 873-9. Read More