Nutritional Deficit and Fruit Imbalance - Assignment Example

? Nursing Practice in Context 4 Nursing Practice in Context 4 Question The patient is a 74years old woman called Mrs. Douglas admitted in the ward to undergo surgery to create Arterio-venous fistula in her left forearm. She is a diabetic type 2, obese and she has bone diseases instigated by her chronic kidney failure. Chronic Kidney diseases are caused by failure to remove waste products and excess body fluid. Concurrently, Diabetes mellitus is one of the major causes of the chronic kidney disease (Bruce & Paxton, 2008). This is because the high sugar quantity in the body overworks the kidneys causing them to cease functioning properly. When the body digests proteins, there is usually the generation of waste products. These wastes become part of urine. Diabetes destroys the tiny blood vessels and holes, which act as filters when they are overburdened (Bruce & Paxton, 2008). After some years, the filters will stop functioning properly and some of the important proteins will leak into urine causing a condition called micro albunuria (American Diabetes Association, 2006). The initial symptom of the chronic diseases is the buildup of fluids at various body parts. Other signs entail insomnia, loss of appetite, and lack of concentration (American Diabetes Association, 2012).Chronic kidney disease (CKD) leads to premature mortality, low quality of life, and high life expenditures. Different diseases such as diabetes, hypertension and obesity have played greater roles in the increase of chronic kidney diseases (Bruce & Paxton, 2008). The research indicated that obesity relates with diabetes and hypertension and the three are the major leading causes of chronic kidney diseases. In U.S, the numbers of adults with obesity have been doubling for the past three-decade (Bruce & Paxton, 2008). Obesity posses risks to individuals because it affects the development and progression of kidney injury beyond blood pressure and glycerin status as well as the key player in renal injuries. There are different mechanisms explaining the relationship that exist between obesity and chronic kidney disease. These mechanisms include the effects on the body mass and the subsequent increased glomerular filtration rate per intact nephron. Targeting obesity in U.S will lead to the maintenance and preservation of kidney functions (Hoy & Feigenbaum, 2006). It will not rely on whether an individual looses weight through maintaining diet, exercising or undergoing bariatric surgery. The conducted studies reveals that weight loss reduces the rates of hypertension, type 2 diabetes and obesity. People should ensure that they maintain their diet and exercise in order to lose weight as it will help them in reducing the rates of obesity, hypertension, and diabetes (McBride & Korczak, 2007). Question 2 (B) The paper highlights the nursing care of Mrs. Mrs. Douglas Douglas who is 74 years old. She is a diabetic with many complications and she is admitted for surgery tomorrow. The two nursing problems that Mrs. Douglas has are nutritional deficit and electrolyte imbalance. She also has impaired skin integrity. The two nursing interventions explained in the paper are the acute and community care focus. Two evaluation criteria for each intervention will also be explained Priority Problem 1 Nutritional deficit and fruit imbalance One of the identified medical problems entails nutritional deficit and fluid imbalance. Mrs. Douglas is experiencing these problems because of her poor nutritional habits and she does not know about the illness processes. The assessment data used to support this diagnosis is the subjective data of the patients’ nutritional habits. Mrs. Douglas stated that she takes 1-2 glasses of juice and water per day, lack of knowledge of what to eat or drink, and sometimes she lacks appetite because of the bad taste in her mouth. The objective data that supports the diagnosis entail obesity and kidney disease. These are caused by taking food with high cholesterol, not doing enough exercises, and failure to take enough water daily. Acute focus The initial priority intervention for this condition is nutritional therapy. This therapy is vital because it prevents and manages the existing diabetes. The goal of nutritional therapy for diabetics is to achieve and sustain the most favorable metabolic results (American Diabetes Association, 2006). Nurses and nutritionist should collaborate in performing this intervention. Nurses should address the patients’ nutritional needs while considering their personal and cultural aspects (Boord, Braber, Christman et al, 2011). The nurse and nutritionists have to identify Mrs. Douglas’s food preferences, insulin characteristics, her cultural and ethics needs when recommending the food types. The nurse should then incorporate the patient’s food preferences into the hospital meal plan (Medical Patent Business Week, 2011). Mrs. Douglas is overweight making her condition dire since it is associated with diabetes. Researches prove that overweight diabetic patients have low insulin resistance (American Diabetes Association, 2008). Mrs. Douglas should lose weight by taking foods that have low carbohydrates and calories. Additionally she can lose weight through physical activities and behavior modification. The nurse has to check and record her weight daily to assess the adequacy of nutritional intake (Wilkerson, 2010). People with diabetes should take foods with more fibers such as legumes, fruits, vegetable, and fiber-rich cereals. Research outcomes show that high-fiber foods can lower glycemia for individuals with type 1 diabetes. Additionally, they can lower glycemia, hyperinsulinemia, and lipemia for those with type 2 diabetes (Matthew, 2011). People with diabetes are usually dehydrated and they need water or foods with fluids. Mrs. Douglas should take at least eight glasses of water as part of the nutritional therapy (America Diabetes Association, 2007). This intervention should be performed daily based on nutritional plan during the acute care. The nurse will have to check Mrs. Douglas’s weight regularly and her body fluid quantity through regular urine tests. The nutritional therapy does not have side effects, however; various things like palatability, restricted food preferences, and gastrointestinal effects can hinder some food intake (Lindsay, 2009). Community focus The nurses can also address Mrs. Douglas’s deficit through community care focus. The acute care focus is usually short-term. It should be combined with the community care focus for long-term treatment (American Diabetes Association, 2008). An example of the community care focus entails the outpatient care. Nurses should advice Mrs. Douglas and her home caregiver to continue with the therapy at home after discharging her and she should go for regular hospital checkups (Business Wire, 2010). Mrs. Douglas should take foods that have resistant starch like the starch found in raw potatoes and some legumes. The patient can also take high-amylose foods like the formulated cornstarch(American Diabetes Association, 2008). The resistant-starch/ high-amylose foods can help in the modification of postprandial glycemic response, prevention of hypoglycemia, and the reduction of hyperglycemia (American Diabetes Association, 2008). Studies prove that dietary sucrose does not escalate the level of glycemia like isocaloric amounts of starch (American Diabetes Association, 2008). Taking of sucrose or the foods containing sucrose by the diabetic individuals not worsen their conditions. Intake of sucrose should not be restricted because of concern about aggravating hyperglycemia. However, if Mrs. Douglas should continue taking sweets at home, she should also take insulin or other glucose lowering medicine (American Diabetes Association, 2006). Furthermore, Mrs. Douglas should continue doing the physical exercises and taking more water at home. She should walk for two kilometers every day in the evenings. This will help her to lose more weight. Her home caretaker should always remind her to take more eight glasses of water daily (American Diabetes Association, 2006). Additionally, the nurses can create awareness through various community programs that touch on the ways of preventing and controlling diabetes effects through nutritional therapies. Mrs. Douglas’s family should be educated about the nutritional therapy so that they can help Mrs. Douglas at home (American Diabetes Association, 2008). Priority Problem 2 Impaired skin integrity Mrs. Mrs. Douglas has been identified with an impaired skin medical integrity. As apparent in the case study, Mrs. Douglas has impaired skin integrity because she lacks adequate knowledge on how to manage her skin. The assessment data used to support the diagnosis is the subjective data that the patient stated in her case scenario. Mrs. Douglas says that her skin usually becomes dry and itchy. She gets bruises and does not understand why her skin is bruised. Mrs. Douglas should take different measures in her acute and community care to maintain her skin integrity. She needs to continue with such measures throughout the rehabilitation (Wurster, 2007). The research conducted by the National Survey of Kidney indicated that 14.5% of patients’ kidney complications develop pressure sores. The situation is also common among varied classes of patients who are comatose, severely paralyzed, obese, have inconsistent bladder and persons suffering from muscle spasticity. The objective data that support the diagnosis bases on the fact that Mrs. Douglas has diabetes type 2 that is attributable to Chronic Kidney Failure. Acute focus The major intervention that the doctors should conduct on this condition is to perform acute care because it is vital in maintaining Mrs. Douglas’s skin integrity (Medical Patent Business Week, 2011). Nurses should conduct systematic daily inspection of her skin condition to detect areas of incipient breakdowns as they draw attention to areas over bony prominences. Healthy skin varies among individuals; however, it should have good turgor, feel warm, dry and be free of impairments. Nurses should conduct gentle skin cleansing on a daily basis and should not expose the skin to moisture. Additionally, Mrs. Douglas should avoid all forms of skin injury resulting from excessive pressure. This is achievable by proper positioning, turning and transferring techniques. The use of barrier sprays, lubricants, padding, protective clothing and special mattresses are equally instrumental. Nurses should pay attention to how Mrs. Douglas maintains adequate hydration and nutrition because it helps in maintaining skin turgor, moisture and suppleness. These approaches make the skin resilient to skin damages caused by pressure (Stevermuer, Owen, Williams & Masso, 2007). During acute care, the doctors need to refine Mrs. Douglas’s skin therapy. They can analyze the causes Mrs. Douglas’s itchy and dry skin. After determining the major causes, they can offer Mrs. Douglas with a new dry skin regime. Additionally, the doctors can prescribe and recommend treatment for dry and itchy skin until Mrs. Douglas’s skin gets better (Brown & Edwards 2012, p. 76). Acute care treatment may include the application of Antihistamines used to reduce itching. Additionally, doctors should apply creams and medicine to suppress the response of immune system because they are the main cause of irritation (Brown & Edwards 2012, p. 76). The nurses should apply Corticosteroid cream and ointment on the patient’s skin. This should be her first hospital skin treatment. This cream helps in treating dry and itchy skin. Dry and itchy skin may begin to crack and bleeding may follow. Additionally, the nurse should apply the topical antibiotic creams to prevent the skin from being infected by bacteria. The bacteria that mostly affect dry skin especially after cracking are the staphylococcus bacteria. The patient is vulnerable to the infections because of the bruises she usually gets (Brown & Edwards, 2012, p. 76). Moreover, the application of the lactic acid oil on her skin may be helpful in removing the peeling skin. The application of each cream should be initiated once or twice a day depending on her skin condition (Brown & Edwards, 2012, p. 76). Nurses should encourage Mrs. Douglas to maintain functional body alignment because misalignment results into discomfort and injury to joints, nerves and limbs that can impair the skin. Mrs. Douglas should change chair-bound position after every one hour and shift her weight every 15 minutes. This is because excess pressure over the sacrum closes the skin capillaries resulting into skin ischemia. Nurses should encourage ambulation because they reduce the pressure on the skin from moving. Additionally, Mrs. Douglas needs a massage to increase tissue perfusion. The massage should avoid reddened areas as it damages the skin (Sanders, 2012). The nurse should ensure that they conduct all the recommended acute care on a daily basis in order to facilitate the healing process. The nurses should be checking the patients’ skin regularly to see whether there are some improvements and in case not, they should consider changing the processes involved in acute focus. Community based focused intervention The major interventions that the community based focus should undertake during such incidence entail performing all processes recommended by the doctors, as they can help Mrs. Douglas fully recover from the skin impairment. The aim of the community care is to offer ongoing support so Mrs. Douglas can remain in her neighborhood and stay in her home instead of experiencing institutional or residential care. Based on Mrs. Douglas’s case, the caregiver should consult an appropriate dietitian to assist Mrs. Douglas and the family in choosing the foods that can meet nutritional and hydration goals (Brown & Edwards, 2012, p. 76). The nurse should teach Mrs. Douglas and the caregiver about the causes of pressure on the skin so that they create methods to prevent skin breakdown. The nurses should reinforce the importance of mobility, turning and ambulation that will help Mrs. Douglas and the caregiver to understand the required methods for them to prevent pressure ulcers (Felix, Mays, Stewart, Cottoms & Olson, 2011). The caregiver in the community care should assess Mrs. Douglas’s ability to move. This is because the research conducted by the American health centers indicated that immobility is the greatest risk factor in skin breakdown (Hoy & Feigenbaum, 2005). Finally, the nurse should teach both Mrs. Douglas and the caregiver on how to assess the history of radiation therapy because radiated skin is thin and friable. This is attributable to lack of enough blood supply that increases skin breakdown. The caretaker and the nurse in charge should ensure that they carry out the practices needed in community focus accordingly so that Mrs. Douglas’s skin condition gets to improve. The caregiver should check Mrs. Douglas’s skin on a daily basis to confirm whether there are improvements and in case these is not, the caregiver should consider changing the processes involved in community focus. Douglas should reduce the number of hot showers and avoid soaking herself in the bathtub to reduce the cases of dry and itchy skin. This is because excessive showering removes natural oil on the skin contributing to the dry skin. The caregiver should advice Mrs. Douglas to avoid using soaps and compounds with irritating agents. She should start using milder soaps and detergents. Additionally, applying moisturizer immediately after a bath will relieve Mrs. Douglas’s itchy and dry skin. It is advisable for Mrs. Douglas to take a lot of water and other liquids to keep her skin moist. Finally, she should apply sunscreen daily to protect her skin from the harmful ultra violet rays (Bayliss, Edwards, Steiner & Main 2008, p 289). The patient should use the medical creams such as the corticosteroid creams, ointments, and the lactic acid lotion at home to further treat, prevent dry and itchy skin. She should also use the cream twice every-day day for weeks or months until her skin heals. Moreover, she may use kitchen oil especially the olive to moisturise her skin (Brown & Edwards, 2012, p. 76). After washing or touching water, she should always use petroleum jelly to prevent her skin from drying and cracking. Soaking her skin in dilute bleach solution can also be helpful. Researches prove that the diluted solution can help in reducing and preventing the staphylococcus infections. This should be repeated after one month (Brown & Edwards 2012, p. 76). Question 2(C) Evaluation criteria for acute care nursing interventions The evaluation procedure for acute care intervention will be dependent on the level of compliance. Consequently, nurses will determine the level of compliance during acute. This concept can be proven by checking the weight of the patient when she is at the hospital (PR Newswire, 2007). A patient who records significant health improvement during the acute care intervention implies that the level of compliance during the acute care interventions is high. An additional evaluation criterion is quality. The quality of care of the acute care interventions will also be determined based on the level of health improvement based on objective evaluation. Higher levels of health improvement during the acute intervention will indicate an elevated quality of acute care (PR Newswire, 2007). Evaluation criteria for community care nursing interventions One evaluation criterion for community care focus entails the ability to walk longer distance after doing exercises regularly. Ability to walk two Km without easily getting tired will indicate the effectiveness of the intervention. Another evaluation criterion for community care intervention entails Mrs. Douglas’s ability to control her sugar level. The control of her sugar amount will prove the effectiveness to this intervention. Skin Impaired integrity Evaluation criteria for community care focused It is fundamental to focus on several concepts for one to acknowledge the effectiveness of community care offered by the nurse to the patient and the caregiver (Everett, 2001). The analysis of a patient’s access to the community resources could be instrumental in evaluating the effectiveness of community-based care. Consequently, a patient who accesses community resources to improve his or her health status presents a positive outcome to community care (Hicks, O'Malley, Lieu & Keegan, 2006). The evaluation process could also focus on the ability of the patient to understand and identify the methods that would help him or her meet self-care needs in improving the integrity of her skin. Douglas would be responding to community care accordingly when she identifies the needed methods to enhance the recovery of her skin, she. Evaluation criteria for acute care focused The evaluation criteria used to ascertain the effectiveness of this therapy include subjective evaluation of how Mrs. Douglas’s skin is recovering by checking whether the bruises are getting better. This can be observable by the nurses analysing where there are some changes to Mrs. Douglas’s skin since she started the treatment or not. The feedback will show whether Mrs. Douglas is responding positively to medication. The second evaluation criteria for acute focus intervention entail Mrs. Douglas’s ability to observe and understand what is happening to her skin. Mrs. Douglas stated in her case scenario that she does not understand whatever happens to her skin. This implies that by understanding her skin condition, she will be in a better position of preventing future harm to her skin (Bayliss, Edwards, Steiner & Main, 2008, p 289). Conclusion The essay focused on nursing care of Mrs. Douglas a 74 years old woman admitted in the wards for Arterio-venous fistula surgery on her left forearm. According to her case scenario, Mrs. Douglas has two major medical problems including impaired skin integrity related with lack of skin management knowledge as well as nutritional deficit and fluid imbalance related to inadequate knowledge on disease processes. It also highlights the nursing interventions to both the identified nursing problems. 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