Care Plan for Diabetes Type

Introduction

From time immemorial, diabetes has been a condition affecting millions of populations in the UK. As per statistics by Diabetes UK (2019), the number of people diagnosed with diabetes in the UK has risen from 1.4 million to 3.5 million in the past 25 years, and the number is expected to rise to an estimated 5 million in the next five years. There are two types of diabetes, namely, type-1 and type-2 diabetes. The former occurs when the body does not produce insulin at all, while the latter occurs when the there is an inadequate production of insulin in the body, or when the body cells fail to react to insulin (Diabetes UK, 2019). This essay will focus on a case study involving a patient (June) who has been diagnosed with diabetes type 2. The essay will be organized in sections. After this introduction, there will be a brief description of the case study, followed by an evaluation of specific care needs for June as a type 2 diabetes patient. Next, the essay will outline a care plan for each care need before developing evaluation criteria for ascertaining whether the goals of each care plan has been achieved.

The Case Study

A few months ago, June was diagnosed with type 2 diabetes and put under medication. However, recently, June was readmitted after his conditions deteriorated. He was immediately recommended for further assessment, which revealed the following results:

From the above assessment results, it was clear that June was hyperglycemic and needed a care plan that would help establish a balanced blood glucose levels in him. Ideally, hyperglycemia occurs when the patient has an insulin deficiency in their blood compared to their glucose levels (Ackley, 2008). According to Black & Hawks (2009), the excess glucose results into an osmotic effect in the body, leading to increased thirstiness and frequent urination. Evidence by Brunner et al. (2004) also indicates that the patient may develop blurred vision or be fatigued. All these symptoms were evident in June’s assessment.

Some medications may also cause an imbalance in the blood glucose levels. For instance, the drug reported to have been taken by June as a remedy to migraines, Atenolol is a Beta-Block, which has an impact on the body glucose level as a side effect (Doenges et al., 2016). According to Gulanick & Myers (2016), Beta-Blockers such as estrogen, lithium, diuretics, and isoniazid are common drugs known to cause hyperglycemia as a side effect. Hence, the drug might have contributed to June’s glucose level imbalance.

An assessment of June’s blood glucose levels as postprandial and fasting levels revealed that he was under critical levels of hyperglycemia with a fasting glucose level of 420 mg/dL. According to Rosenberg (1990), healthy fasting glucose levels for adults should be 70-105 mg/dL, compared to the patient’s observed 420 mg/dL. Nonetheless, June was not in total parenteral nutrition, and thus it is highly unlikely that the high glucose levels were as a result of high levels of dextrose (Mertig, 2012). Furthermore, June reported to hardly engage in physical activities, which is an essential component of diabetes management.

Blood Glucose Levels Care Plan

Having established June’s hyperglycemic condition, there needs to be a care plan that ensures his blood sugar level stabilizes. On this note, there are several interventions organized into a care plan to ensure that June’s blood glucose level is balanced.

First, June’s nurse would need to assist him in establishing specific eating patterns and dietary behaviour that would need particular modification. According to Avery (2009), identifying specific dietary patterns that require change would help in providing the necessary information for developing a more individualized nutritional instruction that targets his clinical condition of a fluctuating blood glucose level.

Secondly, as part of the care plan, the nurse would be required to administer prandial and basal insulin to June so that he may regain his tissue perfusion. According to Carpenito (2009), adhering to the prandial and basal regimen enables the patient’s body to keep a balances range of glucose, and may help in slowing the progression of microvascular disease. Once discharged, an elaborate care plan would also include referring June to a local nutritionist to get an individualized meal plan that responds explicitly to his blood glucose conditions. According to Day et al. (2010), a personalized meal plan would be based on the patient’s blood glucose levels, weight, specific clinical condition, and activity patterns, thereby contributing to a stabilization of his blood glucose content.

The nurse’s care plan would not be complete without an administration of insulin to the patient based on specific prescriptions. While type 2 diabetes patients require insulin, it is essential to note that patients under total parenteral nutrition may need insulin to keep stable blood glucose as a result to high dextrose intake (Mertig, 2006). Thus, June may only require insulin medications if he is recommended for total parenteral nutrition.

The care plan should also involve a regular check of June’s blood pressure to minimize the risk of hypertension common with diabetic patients, and any blood pressure level exceeding 160mmHg should be responded to, by administering prescribed hypertensive. According to Dudek (2010), an elaborate plan to control the patient’s blood sugar would help prevent other possible complications such as coronary heart disease, nephropathy, retinopathy, and stroke.

While signs of hypoglycemia were not eminent in June’s assessment, it would also be useful for the care plan to include food or other sources of glucose. Ideally, this is because glucose in a rapidly absorbed form may help in minimizing hypoglycemia. Hence, June may benefit from fruit juice or oral intake of foods rich in glucose to reduce the risk of hypoglycemia. Alternatively, a glucose injection could also help.

Patient education would also be an essential part of the care plan. According to Tabesh et al. (2018), patient education is a critical aspect of ensuring that the patient follows the drug prescriptions and adheres to the proposed diet plan. Hence, on the one hand, educating June on how to follow the diet plan would help in ensuring that he maintains and good blood glucose balance. Conversely, educating June on how to take the prescribed drugs would help provide more knowledge to June on how to take drugs to lower his blood sugar level, or how to take insulin.

June would then be invited to the clinic for regular check-ups and to review the treatment plan. The visits would also help in ensuring that he is involved in the treatment plan, thereby enhancing his ability to adhere to that plan (Dunning, 2009). Meanwhile, it would also be essential to educate him about the need for physical exercise, and how to balance the physical exercise with dietary intake. With this regard, Carpeniti-Moyet (2004) asserts that proper physical exercise helps in balancing the blood glucose levels by enhancing the uptake of glucose into the blood cells. Hence, the patient needs to understand the relationship between blood glucose levels, physical exercise, and dietary intake.

The patient education exercise should also include teaching June how to measure his blood glucose levels through capillary glucose monitoring. Carpenito (2009) write that capillary blood glucose monitoring helps in providing the patient with immediate information about their blood glucose levels rather than waiting to see a physician. This enhances the patient’s ability to respond with the medication before the situation worsens. The last part of patient education would be to instruct June to have medical alert information whenever he visits any medical team, as each member of the team needs to know that the patient is experiencing problems related to unbalanced blood sugar levels.

Evaluation of the Blood Glucose Level Care Plan

This care plan would be considered effective when June develop a blood glucose level reading below 180mg/dL and fasting blood glucose levels below 140 m/dL. Besides, his hemoglobin A1C levels should be below 7%.

Healthcare Need 2: Nutritional Balance

June’s condition also exposes him to the risk of imbalanced nutrition. Based on the evidence by Avery (2009), diabetic patients may have fewer nutrients than the body requires; and this may be related to various characteristics of his clinical conditions such as low tissue intake and utilization of glucose-leading to increased protein metabolism and low oral intake, which may be characterized by abdominal pain or nausea (Doenges et al., 2016). Meanwhile, June’s nutritional imbalance was evidenced by his high urine output, reported lack of interest in food, and weight loss. Thus, June needed an elaborate care plan that would ensure that he develops adequate nutrient ingestion, gains normal energy levels, and develops a stable weight or moves towards the desired clinical weight levels.

Nutritional Care Plan

The first important care plan for June would be to have a daily weighing plan. Black & Hawks (2009) argue that frequent weighing assists in having a proper assessment to determine the appropriateness of the patient’s dietary intake. Hence, the care plan would include a frequent weighing plan, twice a week, to keep close monitoring of the patient’s weight.

It would also be helpful to evaluate June’s meal program and the usual meal intake pattern by comparing it to his recent intake. Ideally, this would act as a spot check to identify any existing deficits and non-adherence to the prescribed dietary intake (Dunning, 2009). Furthermore, Avery (2009) argues that a regular assessment of the patient’s diet plan would be an important tool for determining the need for a revision of the dietary program.

However, it would also be important to ascertain that June understands his nutritional needs. It is only when the patient understands their dietary requirements that they will be more willing to adhere to the dietary program (Doenges et al., 2016). Besides, according to Black & Hawks (2009), this ascertainment would enable the clinician to know if there is any information they need to pass to the client.

It would also be helpful for the nurse to discuss with June some of the dietary behaviour and some of the diabetic diets that he may be of benefit to his health – according to the doctor’s prescription. Ideally, this would enhance June’s ability to achieve his health needs through proper nutritional intake and adherence (Doenges et al., 2016).

When measuring June’s weight, the exact weight measurement should be recorded, rather than estimating what he could be weighing. Besides, it is important to note his daily dietary intake, including his meal times and patterns of meal intake. According to Carpenito (2009), working with an estimated weight rather than the real weight may provide wrong information regarding the patient’s actual weight or weight loss.

It would also be important to contact a dietician for any for frequent evaluation and recommendations on nutritional support and dietary preferences. According to Avery (2009), this would help identify any necessary changes in the dietary program and enlighten the patient on any specific food that they should take or avoid.

The nutritional care plan should also include a frequent abdominal examination to note and respond to any cases of bloating, undigested food, vomiting, nausea, or abdominal pain. Abdominal examination is vital for June because he is likely to experience gastric function as a result of electrolyte, fluid, and hyperglycemia imbalances (Mertig, 2006). The abdominal examination would also be necessary for identifying the patient’s intestinal motility if there any autonomic neuropathies that require symptomatic treatment. As soon as June can take oral foods, he should be provided with liquids-rich in electrolytes and nutrients, with a gradual progression into more solid food. Ideally, oral feeding is preferable when the patient has gained his proper bowel function, and when he is alert (Doenges et al., 2016).

A patient-centred approach to nutritional care would also be appropriate in this context. This implies that the nurse would need to tailor June’s dietary program based on his cultural and ethnic preferences. It will be easier to enhance the patient’s adherence to the nutritional program if their meal preferences are incorporated into the meal plan (Dunning, 2009). A patient-centered approach would also be facilitated by including the patient’s family in the meal planning process because it enhances a sense of involvement and enables them to have all the necessary information for understanding the patient’s dietary needs (Mertig, 2006). While developing the meal program, the nurse has a variety of options, including pre-scheduled menus, point system, or glycemic index. However, the glycemic index may be the most appropriate for June’s nutritional plan because as compared to the other options, it gives closer attention to the patient’s carbohydrate intake based on how they affect the blood glucose level (Mertig, 2006).

Furthermore, the care plan should include close monitoring of various elements of hypoglycemia such as clammy or cold skin, hunger, anxiety, irritability, rapid pulse rate, or headache. Avery (2009) argues that these frequent checks are necessary because when the blood glucose level is reduced with the concurrent provision of insulin and resumption of carbohydrate metabolism, the patient is likely to develop hypoglycemia. Additionally, the patient may develop hypoglycemia even without a notable change in the disease locus of control when the patient is unconscious. This implies the need for a prior observation of hypoglycemia before it rises to a life-threatening level.

Another important care activity that cannot be left out in the care plan is the performance of fingerstick glucose testing. Ideally, more accurate glucose testing is achievable with an analysis of serum glucose than urine monitoring (Doenges et al., 2016). This is because urine glucose does not have an adequate sensitivity to provide accurate detection of serum level fluctuations (Dunning, 2009). Furthermore, Black & Hawks (2009) argue that in the case of urine sugar test, the results may be affected by urinary retention or the patient’s renal threshold. However, it is important to note that the patient may have varying levels of normal fingerstick glucose testing, depending on the amount of food eaten by the patient in the previous meal.

Evaluation of Care Plan Effectiveness

This care plan would be considered effective if June ends up with adequate nutrient ingestion, gains normal energy levels, and develops a stable weight or moves towards the desired clinical weight levels.

In conclusion, type 2 diabetes is a chronic disease that affects a large population both in the UK and the world over. Furthermore, diabetic patients have various clinical complications that expose them to a variety of health risks such as hyperglycemia, risk of infection, and unbalanced nutrition. This paper has identified two health needs related to hyperglycemia and unbalanced diet, and developed an elaborate care plan for the two health needs. It is advisable to adhere to these care plans to enhance positive health outcomes.

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References

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Avery, L. (2009). Oxford handbook of diabetes nursing. Oxford: Oxford Univ. Press.

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Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier.

Brunner, L. S., & Suddarth, D. S. (2004). Medical surgical nursing (Vol. 2123). Philadelphia: Lippincott Williams & Wilkins.

Carpenito, L. J. (2009). Nursing care plans & documentation: Nursing diagnoses and collaborative problems. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Dudek, S. G. (2010). Nutrition essentials for nursing practice. Wolters Kluwer Health. Wolters Kluwer Health, 2010.

Dunning, T. (2009). Care of people with diabetes: A manual of nursing practice. Chichester, U.K: Wiley-Blackwell Pub.

Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences.

Mertig, R. G. (2006). The nurse's guide to teaching diabetes self-management: What nurses need to know. New York: Springer Pub.

Rosenberg, C. S. (1990). Wound healing in the patient with diabetes mellitus. The Nursing clinics of North America, 25(1), 247-261.

Tabesh, M., Magliano, D. J., Koye, D. N., & Shaw, J. E. (2018). The effect of nurse prescribers on glycaemic control in type 2 diabetes: A systematic review and meta-analysis. (International journal of nursing studies.)