CASE WORLD NURSING
CASE WORLD NURSING 18
Diabetesis a long-term health condition that makes a patient to haveconcentration of blood sugar. According to the latest healthstatistics, 999,000 (4 %)of Australians are affected by this condition. The affected peoplehave increased from 1.5 %in 1989 to 4.2 %between 2011 and 2012. In addition, healthcare experts also estimatethat 450,000 Australians are also have undiagnosed diabetes or arevulnerable to the condition in the future. Diabetes can be classifiedas either type1 ortype 2. The type2 diabetes(also known as adult-onset diabetes or noninsulin-dependentdiabetes) affects individuals whose bodies are not manufacturingadequate insulin to operate appropriately (Guvener et al. 2002, p.532). Moreover, it can occur in case the body cells are not reactingto insulin. This condition is called insulin resistance. On the otherhand, type1 diabetes,which also known with other names such as juvenile diabetes orinsulin independentdiabetes, is occurs in individuals whose pancreas organ lacks betacells that manufacture insulin. Patients control this conditionthrough intermittent injections of insulin supplement. In case thecondition is left untreated, it may become fatal (Juul et al. 2004,p. 679). However, Type-2 diabetes is the most common condition amongseveralpatients. Although this health condition is mainly associated witholder persons, young persons are increasingly becoming vulnerable tothe condition. This case study will is based on a 17-year-oldaboriginal boy, Kevin Johnson, suffering from type-2 diabetes. Theobjective of this study is to evaluate the health condition ofJohnson, and then develop a comprehensive care plan. Plan ofCare
Todevelop an all-inclusive treatment plan, the first goal should bedetermining the nursing priorities. This includes the treatmentstrategies that nurses will use to contain Kevin’s blood-sugarlevel at a safe level. Second, the plan will also focus on thedischarge objectives. The discharge goals should list the desiredtreatment outcome, which patients should achieve after receiving thetreatment. The plan should also feature the diagnostic studies, whichguide nurses on developing health strategies tailored to suit therequirements of a patient (Juul et al. 2004, p. 679).
Kevin’sdiabetes mellitus type 2 nursing care plan (NCP) will contain six keyelements. They will include (1) identifying factors that couldenhance the risk for infection (2) Specifies the risk associatedwith interrupted sensory perception (3) Powerlessness (4)imbalanced nutrition that have decreased below the limit required bythe body (5) Inadequate fluid volume (6) Fatigue
Theobjective of this element is defining the goals that a nurse shouldaim at achieving when treating Johnson. The main objectives shouldinclude: (i) Restoring balance between the acid-base and theelectrolyte (ii) correcting metabolic deviations (iii) Thwartingcomplications (iv) Diagnosing and assisting with management ofunderlying disease cause (v) Offering information concerningdiabetes 2 diagnosis, treatment requirements, and recommend self-careadvise (Guvener et al. 2002, p. 534).
Theseare the activities that the nurse should accomplish when treatingJohnson. The goals include: (1) Ensuring the homeostasis status isattained (2) Minimising complications that may arise from theDiabetes 2 (3) Controlling factors predisposing patients to varioushealth conditions (4) Planning in advance to accomplish dischargerequirements (5) Ensuring the patients effectively understandstherapeutic regimen, diagnosis, and self-care requirements.
Theobjective of these analyses is helping patients to determine suitabletreatment processes that will meet the patient’s requirementefficiently. For instance, the nurse should base the treatment planon various factors such as electrolyte blood result tests, arterialblood gas results, and the full blood count test results. Forexample, the presence of arterial blood gases (ABG) indicates reducedHCO3(metabolic acidiosis) and low pH with balanced respiratoryalkalosis. For Kevin, his ABG results are standard. A good care planfor Kevin should aim at maintaining his breathing and fluids in thebody stable. The heartbeats and breaths per minute are stable hence,Kevin can undergo an operation safely (Robinson & Ronco 2009,1286).
Thecare plan should outline various predisposing factors that could makeKevin experience complications. These risk factors may includecirculation changes, increased glucose level, and reduced leukocytefunction. Other risk factors may include UTI or prevailingrespiratory infection. Once the nurses establish these risks, theywill manage to develop healthy treatment programme that will matchKelvin’s healthcare needs (Robinson & Ronco 2009, 1294).
Thedanger for troubled sensory perception
Troubledsensory may result from chemical changes that cause electrolyte andinsulin imbalance. The target outcomes for these treatment processesinclude diagnosing and fixing possible sensory damages as well as,sustaining the normal mentation level. The treatment care shouldincorporate strategies that would in turn help Kevin to maintainstable sensory status. So far, Kevin was wiggling the toes and he wasresponding to the sense of touch both below and above the knee. Inaddition, health care professionals should ensure to maintain a goodrelationship with Kevin. For instance, they should address him by hisfirst name to create a closer relationship (Capes et al. 2001, p.2429).
Thiselement is mainly common with people suffering from incurableconditions such as Diabetes type 2. The patients may requiredepending on others for their wellbeing over time. Patients sufferingfrom diabetes 2 refrain from participating in progressive activities,they are reluctant to communicate their real feelings, and they areoften depressed by the deteriorating physical condition. ImmediatelyKelvin gets at the hospital, the health care professionals willconduct an AVPU (Alert, vocal, pupils reactive to light,unresponsive) test immediately. The test is a neurologicalexamination that aims at determining whether the body organs arefunctioning efficiently. In addition, the nurses will also check thetemperature of Kevin as he arrives at the hospital. The paramedics orthe ambulance nurse should report about the place that they haveacquired the patient and its general environment. This will help thenurses to determine whether Kevin’s body is healthy enough toretain a stable temperature, or his body might require externaltemperature control assistance (Bailey & Turner 1996, p. 576).
Asuitable NCP programme for Kelvin should ensure that the nutrients tomaintain keep his body nutrients balanced in order to avoidexperiencing adverse effects. Nutrients imbalance may arise fromvarious factors such as hypermetabolic state, which releases stressrelated hormones, insulin deficiency and reduced oral consumption(Babineau & Bothe 1995, p. 185).
Nursesshould strive to ascertain that the patient has adequate fluidssupply. Kevin’s fluid level is stable because since he has nohaemorrhage issue. However, the nurse should insert two big boreintravenous cannulas in his body to acquire bloods and anticubitalfossa samples for various tests such as ABG (BGL), FBC, U&E, andLFT. In addition, the healthcare experts should also conductdetermines the fluid level in the abdomen because it is a major bodypart where the body loses fluids. The aboriginal people embraceholistic approach to life, including, the perception of health andwellbeing that encompasses physical and psychological dimensions,cultural, social, and spiritual perspective (Babineau & Bothe1995, p. 188).
Educatingthe patient on diabetes management techniques both before and afterthe surgery – Sometimes, elective surgeries influence themanagement approach of diabetes condition. As such, Kevin’s doctorshould educate him on suitable strategies he should use to controlthe condition.
Short-termcare plan goals
Determiningsugar glucose: Prior to conducting an elective surgery, the doctor orthe nurse should evaluate the glucose concentration level.Pre-elective glycaemic restrain is essential since it reducesnegative outcomes. To get the best operative results, surgeons shouldrefrain from operating hyper- or hypo-glycaemic patients. Kevin’sblood glucose level is stable hence, the doctors can conduct anoperation safely (Capes et al. 2001, p. 2425).
Thenurses and paramedics are supposed to evaluate the breathingcondition of the patient to ensure that it is normal. The diabetesrelated complications can significantly change the results of asurgical operation. In some cases, a successful surgical operationcan turn fatal in case the doctors fail to stabilise the blood-sugarlevel of a patient (Axelrod et al. 2002, p. 897). In Kevin’s case,his blood glycaemic level is stable hence, the surgeon can proceedwith the operation immediately. However, the healthcare professionalsmay require emptying the food content in a patients’ gastricstomach in order to control various chemicals manufactured in thebody. However, Kelvin’s respiratory and glycaemic level is stable,the healthcare professionals can proceed with the operationsuccessfully (Jamet et al. 2004, p. 680).
Neurovascularobservations – physical analyses that clinicians, nurses orparamedics conduct to determine injured locations as well as,appropriate techniques that healthcare experts should use to fixhealthcare issues affecting them. For instance, Kevin’sneurovascular observation shows that his left leg is the one that hassustained injury (Jamet et al. 2004, p. 682).
Dayof operation – although the operation could be minor, the doctorshould discourage Kevin from driving immediately after the operation.
Professionalsinvolved in the health care plan
Anaesthetists– sometimes, individuals with independent neuropathy may experiencedamaged cardiovascular reflexes that may result to hypotension afterinducing anaesthesia. Furthermore, anaesthesia may also result intoimpaired respiratory system after the operation. This makes itessential for the paramedics, nurses, surgeons or any other personwho has investigated the health status of the patient to inform theanaethetist that Kevin is diabetic. This will help him or her todevelop effective healthcare plan that can prevent severe diabeticside effects after an operation (Pomposelli et al. 1998, p. 79).
Emergencycontacts – These could be non-professionals, perhaps the relativesof the patients, whom the medical staff can contact in case of anemergency. These persons know the health condition and history of thepatient such that they can furnish the emergency response team withessential information concerning the affected patient. Recently,patients suffering from long-term illnesses such as diabetes wearmedical cards, pendants or wrist watches that they can press to senda distress signal to an emergency response team, or a an emergencycontact who in turn calls the medical responders. Patients wearpendants integrated with GPS technology to allow the first respondersto find them easily (Pomposelli et al. 1998, p. 80).
Emergencycare assistants (ECA) – these professionals reply to incomingdistress calls as part of the emergency crew or first responders.These professionals have vast skills and experience for movingpatients as they are directed. When patients are on transit, theyconduct tests such as pulse rates, possible fractured bones, bloodsugar, seriousness of the injury and treatment procedures the doctorsshould prepare prior to the arrival of the patient (Friedlander 1995,p. 498).
Emergencycall handlers and dispatchers – the call handlers professionals arelocated at the emergency call centres. They receive distress callsfrom both GPS and 999. They collect vital information concerningpatients such as location and the type of assistance required. Thenthey enter the information in a computer. The emergency dispatcherstake the information and making necessary arrangements for collectingthe patient as well as, transporting him or her to the hospital. Forinstance, the emergency call handlers received Kevin’s distresscall, but the emergency dispatchers were in charge of sending anambulance that collected him (Friedlander 1995, p. 501).
Surgeon– the surgeon is the professional in charge of conductingoperations on patients. For example, they can amputate an arm or aleg of a sick person.
Emergencyroom nurse – these are professional nurses who assist surgeons whenconducting an operation.
Familymembers – patients’ families provide company and moral support topatients. The aboriginal people believe in holistic treatment thus,the family members augment the wellbeing and health of patients thatencompass physical, cultural, psychological, and social among others(Capes et al. 2001, p. 2427).
Legaland ethical considerations
Language– the law requires that the nurses and healthcare professionalsshould have good comprehension of the national languages so that theycan communicate effectively with the patients (Furnary et al. 2003,p. 47).
Experience– the surgeon, operation room nurse and the anaesthetist shouldconduct due diligence to determine initial preparation and post-careapproach that will not affect the patient negatively (Furnary et al.2003, p. 1007).
Fundamentalhuman rights – the healthcare professionals should ensure toprovide the patients basic supplies such as food and water, safetreatment, post-operation recovery guide, and safe medical proceduresirrespective of their gender, race, and state of health, nativity,ethnicity, and age among others. Kevin deserves receiving highquality treatment service even if the nurses and doctors treating himight not be aboriginals (Melnyk & Fineout-Overholt 2005, p. 33).
Nonmaleficence- this ethic prevents nurses from causing harm to their patientsbecause they are healers. In such a case, they seek to understand thetreatment approach, which suits various patients best, and thenattend them with their preferred ethics. For example, aboriginalsembrace holistic treatment approach, which integrates their families.Nurses should allow Kevin’s family to stay with him in the wardsince their company can help to speed up his recovery (Dronge et al.2006, p. 377).
Principleof beneficence – According to the Nebraskan Case Study, the nursesand doctors should consistently make decisions that would bebeneficial to the patients. Considering that Kevin comes from abackground that embraces holistic treatment approach, the health careprofessionals should consider involving both of these families indetermining critical decisions. For instance, the surgeon shouldexplain to Kevin’s family the risks and advantages of an operationto fix his condition, and then provide a recommendation. However, thefinal decision should come from Johnson’s next of kin (Furnary etal. 2003, p. 1010).
Honesty– medical care fraternity should strive to give honest informationto patients. For example, professionals should refrain from failingto disclose the conditions that patients are suffering from, unlessthey have justifiable reasons they can use to prove that telling apatient the truth would not be appropriate at that time. For example,if Kevin’s leg was impaired beyond repair, the doctor may decide toamputate it. In such a case, it would be ethical for such aprofessional to inform Kevin that he is intending to cut off his legeven before he does it (Golden et al. 2002, p. 1408).
Dualrelationships – professional nursing ethics prevent medicalprofessionals from engaging in intimate relationships with theirclients. In addition, nurses should treat relatives and friends justlike regular patients. In case Kevin has a relative in this hospital,he or she should treat him like any other patient (Melnyk &Fineout-Overholt 2005, p. 29).
Severalpeople suffering from diabetes type 2 are often admitted in healthcare facilities for treatment of other conditions, apart fromdiabetes. In some cases, the patients may require surgical operationsto treat their conditions. Surgeries often cause significantdisruption to glycaemic management. Glycaemic disruption may causeincreased morbidity, length of hospital stay and mortality todiabetic persons. It is essential to reduce such disruptions toprevent occurrence of adverse outcomes (Melnyk & Fineout-Overholt2005, p. 19). Nurses and doctors treating diabetic patients shouldobserve extra caution when dealing with sick persons in order toprevent them adverse treatment outcomes. The above health care planis tailored to improve the health care plan of Kevin Johnson, aseventeen-year-old aboriginal boy suffering from type-2 diabetes.However, he has to undergo an operation and for another conditionthat is not related to the diabetic condition. As the diabetestreatment knowledge continues to expand, healthcare experts aredeveloping new and effective treatment measures for treating patientssuffering from these conditions without increasing their risks ofsuffering from extreme side effects (Milstead & Furlong 2006, p.14).
Diabetestype-2 is a condition that is characterised by increased blood sugardue to insulin resistance or an impaired pancreas, which has stoppedto produce sugar-processing secretions. In case patients sufferingfrom diabetes undergo a surgical operation that is unrelated to hisor her diabetic condition, the operation may result in complicationsthat may make the operation dangerous. Since health care experts havediscovered that patients suffering from diabetes are vulnerable todangerous side effects than healthy patients, the nurses and surgeonsoften customise pre- and post-operative healthcare plans toindividual patients. For instance, the above care plan is outlinesthe ethic and regulations, precautions and underlying considerationsdoctors should use to ensure Kevin Johnson will recover from anoperation procedure successfully.
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