Nursing Management of Patient's Complications because of Diabetes Type 2 - Case Study Example

NURSING CASE CONFERENCE REPOT by Student’s name Code+ course name Professor’s name University name City, State Date Introduction Mr. X is a male aged eighty-four years. He was born in Italy but he currently lives in Adelaide, Australia. He immigrated to Australia in 1945 and he speaks English. He has a daughter and two sons who live in Adelaide. The daughter is married but the father lives with them where they take care of him. His wife died two years ago in 2012. He had been working in car manufacturing but has retired for a long time now. He is self-sufficient and can do activities of daily living. He has a medical insurance that cover which caters for his medical bills. Although he had been smoking, he quitted the habit when he was thirty-five years old. However, before he was admitted, he takes two glasses of wine. He can drive personally and carry out his shopping without need of extra help from his relatives. He is therefore not disabled by his medical state (MedicineNet 2012). He was admitted to the current hospital on October 3, 2014. He had a pleural effusion from his rib cage cavity. He had been admitted for three weeks in Ashford Hospital the previous month. He is alert and oriented. During admission, he was coughing and had breath shortness. He had no chest pains though. His ankles were swollen and he had a low blood pressure. His systolic pressure was between 90mmHg and 110mmHg while diastolic pressure was 50mmHg and 60mmHg. Other Observations were stable. His cough improved during the night of admission. Before admission, he had Diabetes Type 2 for four years. He also had Congestive Heart Failure, pneumonia, Arial Fibrillation and Left Ventricle Failure. In addition, he had Gout, low blood pressure, high cholesterol level, osteoporosis and constipation. These medical complications might have led to the current medical state. Anatomy of Chest Cavity Thoracic cavity is one of the largest cavities in human body. Ribs and sternum surround it. It is partitioned from the cavity of the abdomen by a diaphragm. This chest cavity holds heart, lungs, blood vessels connecting lungs and heart and other major blood vessels. The cavity also holds esophagus, which is the duct that connect mouth and stomach. Pleura membrane covers chest cavity and normally secrets a serum (“Thoracic Cavity” 2014). Physiology Pleurae are slim tissues that are enclosed by cells, which encircle lungs and inner side of wall of the chest (Tidy 2013). These membranes have a gap between them, which separates chest walls, and lungs. This gap between wall of the chest and the lungs is known as the pleura cavity (McGing & O’Kelly 2009, p. 11). Little fluid exists in this cavity. The purpose of the fluid is to lubricate regular movements of lungs during gaseous exchange as the lung moves in and out of the cavity. This reduces friction during the breathing making gaseous exchange comfortable. There are a number of pleurae found in the thoracic cavity. These include pleura of the mediastinum, which is the tissues and gap between the lungs, and visceral pleura, which covers the lungs. There is also a pleura lining the chest cavity. This is called parietal pleura (“Pleura” 2014). In a healthy person, parietal and visceral pleurae are joined. Pathology Pleura effusion happens when there excess formation of the serum (Hajiliadis 2014). This leads to building up of surplus serum in pleural cavity. This build up could be due to increase of serum production or decline in serum removal. It can also be because of increased permeability of pleural membrane or oncotic pressure (McGrath & Anderson 2011, p. 120). For instance, Congestive Heart Failure leads increase in production of serum. This is due to high level of gradient of hydrostatic pressure. Pathophysiology Congestive Heart Failure is a medical condition where the heart is unable to supply blood at a rate that is required by metabolic needs of the body. These needs may be during working or at rest (McMurray 2012, p. 1793). During the activities of the heart, there is pressure build up. During preload, pressure builds at the base of the heart. This pressure is used during the heart’s workload. At workload, the blood moves to the left ventricle. During afterload, the cardiac muscles build pressure, which is used to pump blood out of the heart (Drager & Hoffmann 2012, p. 7). When the heart has Congestive Heart Failure, the afterload pressure is reduced. Blood entering the heart becomes more than the one leaving it. The heart becomes unable to meet the pace of blood pumping. This leads to backload of blood in the blood vessels. Some of the blood serum may seep through the capillaries leading to congestion of serum in the pleura cavity (Huntsville Hospital 2013, p. 4). This results to pleura effusion. In addition, the heart failure can lead to congestion of serum in capillaries of the heart. This leads to seepage into the surrounding cells. This leads to blockage of these alveoli, which are responsible for gaseous exchange. The resulting effect is that the lungs are not able to take in oxygen leading to a medical condition known as pneumonia. The patient in this case suffered from pneumonia due to Congestive Heart Failure. Studies (see Heart Foundation 2011) suggest that the usage of alcohol and old age make a person more prone to the disease. This is the situation in this case. The alcohol consumption and his old age made him contract pneumonia. Alcohol consumption leads to more production of cholesterol in the body. This reduces the size of blood vessels by coating them. The cholesterol is insoluble hence lags the surface. Less blood is pumped out of the heart. This further complicates the Congestive Heart Failure disease making it more severe. A patient suffering from this disease should avoid alcohol consumption to reduce the intensity of the disease (Lindenfeld et al. 2010, p. 484). Nursing Management Nursing management is essential in monitoring and caring for a patient. Every nursing staff member involved in treatment of the patient should have a clear role, which is interdepedent with other staff members. This makes care giving to the patient efficient and smooth. A nurse provides the necessary background for working of the doctor. Nurse assesses the patient and provides a basis of diagnosis to the doctor. Any hospital should have a good nursing management to ensure that the nursing staff coordinates well for effective service delivery and good working conditions. In this situation, the patient first visited the consultation officer. Here, the nurse in charge recorded the medical history of the patient down. This data was used in analyzing and further testing of the medical condition. A radiologist was also involved in the treatment. The radiologist carried out chest X-ray and other radiological tests on the patient. These tests were essential in determining the most accurate treatment for the disease. A laboratory technician was also involved to carry out other basic laboratory tests. These staff members provided basic data, which will be used to diagnose. After results were gotten, the doctor then analyzed the test results to determine the disease to be treated. The doctor was therefore involved in the process. A dietician was involved to advice the patient on the most appropriate diet to undertake while undergoing treatment and after treatment. The caretaker provided catering services to the patient. The services will included meals, checking him regularly to make sure he is ok and changing his beddings and clothing. The caretaker was therefore another essential staff. The physiotherapist will be involved to advise the patient on non-pharmacological treatment of the disease. A pharmacist will be involved to provide the pharmacological services to the patient. The patient underwent a regular BGL monitoring to check his condition. An insulin test was done to check his diabetes condition. Blood was sampled and tested which indicated a kidney dysfunction due to high level of urea. Medical Management and Treatment The test results for the patient are presented in the table below: Test Results Troponin Positive ECG Absence of P wave A and F waves present Echo Enlarged heart size Blood Test High urea and creatinine Chest X-Ray Minute mutual pleural effusions INR 1.1 Due to low INR results, the warfarin dose is adjusted by adding 20% of it (Ministry of Health Services 2010). The frequency is also adjusted through increasing weekly basis by 10 to 20 per cent. Due to minute pleural effusion in the chest, the patient had to undergo pleural tap. This was to make a valid and certain judgment of the medical condition of the patient (Porcel 2011, p. 44). There are complications that might arise from this procedure. These complications include fainting, coughing, high risk of infection of the wound due to heart complications, and collapsing of the lung. The latter can be solved by inserting a chest tube into thoracic cavity to inflate the lungs again. However, some uncommon complications like fluid building up after removal leading to breath shortness and pain might occur. Bleeding is rare, as well as emergency surgery and death due to the procedure (Queensland Health 2011). The patient in this case experienced some pain. The system was checked regularly after every four hours to detect any presence of pneumothorax complications. This will ensure that the complications are eliminated in good time. Due to Diabetes type 2, the patient was given a dose of Metformin SR 500mg to regulate his blood sugar. Due to hypertension, he was also given Bisoprolol to reduce congestion of the blood vessels and thus lower the blood pressure. He was also given Amiodarone for his Arial Fibrillation treatment. Although it was basically for Arial Fibrillation, it also helps in treating Congested Heart Failure. He was given an oral dose of Frusemide 120mg. This was for treating Congestive Heart Failure and boosting the effect of related previous medication. He was also given Spironolactone 12.5mg which was to treat Oedema and help in treatment of Congestive Heart Attack. The reason of these Congestive Heart Failure medications is to manage the disease and eliminate it. Managing the disease will help in controlling and eliminating the problem of Oedema. The two are treated in parallel to ensure that this problem is effectively brought under control. The medication progress is checked regularly to identify any complications or negative reactions towards the treatment. This will help in initiating necessary changes in the treatment plan. As warfarin was stopped during pleural tapping, the patient was given Clexane 50mg injection to reduce blood clotting which might lead to stroke. This is due to decreased movements of the patient while in hospital. The patient was also given Digoxin 125mg to regulate his heart rhythm. The patient was given nutritious food to supplement the nutrients required for the treatment. As his condition improved, he was taken around the hospital in wheel chair as part of physiotherapy. Assessment and Recommendation System checking was done after every four hours. Glocose level was checked regularly which showed improvement from hypoglemia to normal condition. There was also reduction of weight after admission. This showed improvement. The skin was intact and dry which showed improvement. As his medical condition was improving and he could now undergo a home care (Fitzpatrick & Kazer 2012, p. 127). This will help minimize his medical bills and at the same time ensure effective recovery when near his loved ones. At home, he should stop alcohol consumption. This is because alcohol worsens his condition (Heart Foundation 2011). Psychological, Environmental and Economic Aspects The patient has psychological problems. He is saddened by his wife’s death. He is also upset by treatment at Ashford Hospital. However, he has a good relationship with his relatives despite these occurrences. Although he has no fall history, his children should take care of him as if he falls his bones will break. He can cater for his medical bills through his medical insurance. The patient should be advised accordingly before undergoing any treatment. He is also to be advised on his medication before being issued. Patient Education The nursing staff should educate the patient on how to go about his medication. He is also educated on is dietary needs. This will improve his health. He is advised to stop alcohol consumption. This is done by educating him on the effects of alcohol consumption to his condition. He is also educated on the kind of exercise to undertake and the importance of that exercise. This will ensure full recovery from the disease. Discharge Planning The patient is transferred to home care at home. He is to be undergoing a regular endocrine and cardiology check up. He should also be visiting the doctor regularly to check his condition. Although he has no job, the daughter and son-in-law are willing to tkake care of him. He should have a handle in the toilet to aid him. The relatives and his sons are also to take care of him. There will be a follow up of his appointment to ensure complete recovery. Article Discussion The article (Shrivastava et al. 2013) introduces diabetes and then goes on to discuss types of diabetes. This article is relevant to the case as the patient is suffering from Diabetes Mellitus Type 2. Therefore, this article is of great importance in managing the disease of Mr. X. The article provides both the challenges for diabetic care and possible ways to carry out this care. The article emphasizes on self-care, which is more effective. In the case of Mr. X, the management of the case was done after it became severe. This, according to the suggestion of the article, is a great risk. Managing diabetic complications should be done before the complications emerge. This puts the patient at a point to cope with the disease effectively. The same idea has been put across by Redmon et al. (2014). When patient care responsibility is vested to the patient and the family, there is love and affection exhibited during the treatment. This love may not be evident when the patient undergoes treatment at the hospital. This alleviates any stigma that may be associated with the disease thus helping the person to fit in the society. A patient undergoing Diabetes Type 2 treatment should modify his lifestyle so that recovery can be effective (Group Health Cooperative 2013). The patient should ensure that he observes the diet advice of the dietician. This will ensure that his body remains healthy and strong. In addition, he should check on his weight. He should ensure that Body Mass Index is below 25. This is ensured by having a healthy diet and carrying out favorable body exercises. The patient should also take care of the health of his fee. This is because Diabetes Type 2 affects feet too. Although the article is educative, it does not give light on a comprehensive method of catering for Diabetes Type 2. Lifestyle approaches have been ignored or rather given a basal light. Diabetes Type 2 is a lifestyle disease (American Diabetes Association 2010) and assumption of such areas of lifestyle management can complicate the treatment. However, this article in conjunction with other medical papers can be used to effectively manage Diabetes Type 2. Diabetes is a prevalent disease and great care should be taken when handling it. There are other methods of managing Diabetes. The best method is to prevent it before it onsets. However, when complete prevention is impossible, a patient is advised to delay maturity of Diabetes at the Pre-diabetes stage (AACE 2011). This prevents the complications that would have resulted. It can also suppress completely the disease. This approach of managing diabetes will ensure effective control of this lifestyle disease. The patient will be aware of the causes and ways of handling it through public education. A good change of lifestyle will help manage Diabetes Type 2 effectively. Conclusion The current complications of the patient are because of Diabetes Type 2. The disease has led to various complications and further ailments in his body. This has led to weakening of his body metabolism and immunity. The patient should be educated on how to manage the disease. He should be informed on how to live a healthy life. Further, he should be advised on the exercise to undertake. He should also be advised on proper diet. This will ensure that his struggle with the disease is effective and he finally recovers fully. A good lifestyle is an effective way of managing Diabetes Type 2. References American Association of Clinical Endocrinologists (AACE). (2011. “AACE Diabetes Care Plan Guidelines.” Endocrine Practice, vol. 17, no. 2. Retrieved 17 November 2014 from https://www.aace.com/files/dm-guidelines-ccp.pdf American Diabetes Association. (2010). “Diagnosis and Classification of Diabetes Mellitus.” Diabetes Care, vol. 33, no. 1. Retrieved 17 November 2014 from http://care.diabetesjournals.org/content/33/Supplement_1/S62.full.pdf Drager, T. & Hoffmann, U. (2012). Listen to your heart! Retrieved 17 November 2014 from http://www.scubapro.com/media/272210/hrmbooklet-eng.pdf FitzPatrick, J.J. & Kazer, M.W.(2012). Encyclopedia of Nursing Research. Springer Publishing Company, New York. Group Health Cooperative. (2013). Type 2 Diabetes Screening and Treatment Guideline . Retrieved 17 November 2014 from http://www.ghc.org/all-sites/guidelines/diabetes2.pdf Hajiliadis, D. (2014). Pleura Effusion. Viewed on 16 November 2014 at http://www.nlm.nih.gov/medlineplus/ency/article/000086.htm Heart Foundation. (2011). Diagnosis and management of chronic heart failure. Retrieved 17 November 2014 from http://www.heartfoundation.org.au/SiteCollectionDocuments/Chronic-heart-failure-QRG-2011.pdf Huntsville Hospital (2013). Congestive Heart Failure: From Heart Failure to Heart Success. Retrieved 16 November 2014 from http://www.huntsvillehospital.org/images/PDFs/CHFbooklet072013.pdf Lindenfeld, J. et al. (2010). “Executive Summary: HFSA 2010 Comprehensive Heart Failure Practice Guideline.” Journal of Cardiac Failure, vol. 16, no. 6. Retrieved 17 November 2014 from http://www.heartfailureguideline.org/_assets/document/Guidelines.pdf McGing, P. & O’Kelly, R. ed. (2009).The Biochemistry of Body Fluids. Retrieved 15 November 2014 from http://www.acbi.ie/Downloads/Guidelines-of-Body-Fluids.pdf McGrath, E. E. & Anderson, P. B. (2011). “Diagnosis of Pleural Effusion: A Systematic Approach.” American Journal of Critical Care, vol. 20, no. 2. Retrieved 15 November 2014 from doi: http://www.10.4037/ajcc2011685 McMurray, J.J.V. (2012). “ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.” European Heart Journal, vol. 33, no. 1793. Retrieved 16 November 2014 from doi: http:///www.10.1093/eurheartj/ehs104 MedicineNet. (2012). ADLs (Activities of Daily Living). Viewed 15 November 2014 at http://www.medicinenet.com/script/main/art.asp?articlekey=2152 Ministry of Health Services. (2010). Warfarin Therapy Management. British Columbia. Retrieved 16 November 2014 from http://www.bcguidelines.ca/pdf/warfarin_management.pdf “Pleura.” (2014). Encyclopedia Britannica. Viewed 16 November 2014 at http://www.britannica.com/EBchecked/topic/464692/pleura Porcel, J.M. (2011). “Pearls and myths in pleural fluid analysis.” Official Journal of Asian Pacific Society of Respirology , 16. Retrieved 17 November 2014 from http://www.infectologia.org.br/pdf/afsdoifpsadvcsew4.pdf Queensland Health. (2011). Thoracentesis (Pleural Tap). State of Queensland. Retrieved 17 November 2014 from http://www.health.qld.gov.au/consent/documents/thoracics_07.pdf Redmon B, et al. (2014). Diagnosis and Management of Type 2 Diabetes Mellitus in Adults. Retrieved 17 November 2014 from http://www.icsi.org/asset/rrm/Diabetes.pdf Shrivastava et al. (2014). “Role of self-care in management of diabetes mellitus. “ Journal of Diabetes and Metabolic Disorders, vol. 12, no. 14. Available at http://www.jdmdonline.com/content/12/1/14 “Thoracic Cavity.” (2014). Encyclopedia Britannica. Viewed 16 November 2014 at http://www.britannica.com/EBchecked/topic/593184/thoracic-cavity Tidy, C. (2013). Pleura Effusion. Viewed 16 November 2014 at http://www.patient.co.uk/health/pleural-effusion Read More