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Type 1 diabetes is considered as an autoimmune health condition, in which body's immune system is involved in the destruction of beta cells in the pancreas thereby increasing the blood glucose level due to lack of insulin. In the UK, the occurrence of type 1 diabetes in children is very common. NMC (2018) recommends that a multidisciplinary care team must be assigned to analyse the health needs, lifestyles, physical, and psychological needs, social and cultural needs and pre-medical history of children with type 1 diabetes. This essay has selected a case study of 10 years old child suffering from type 1 diabetes. The essay will discuss the pathophysiology of type 1 diabetes thereby presenting a comprehensive discussion on the cause, characteristics and associated risk of this health condition in children. This essay will discuss how the Ropan-Logan-Tierney nursing model can be used in the case study by the nurses to analyse the health condition of the child in the case study. Moreover, the essay will also discuss how the APIE model is used by nurses to carry out effective health assessment of the child in the case study. Finally, the essay will present a suitable conclusion in which the summary of the entire discussion will be presented. Florida, a 10 years old child (female), has been admitted to A & E ward with a nearly 10 lb weight loss during the last few days, abdominal pain, frequent urination and severe dehydration. After the admission of Florida, an A1c test has been carried out which presents a complete history of average blood glucose of Florida for the last three months. Based on this report it has been confirmed by doctors that Florida suffers from uncontrolled type 1 diabetes along with ketoacidosis and ketonuria. As mentioned by Chapman (2017), ketonuria is the common symptom of uncontrolled diabetes, in which patient experiences excretion of a large number of ketone bodies from the body. On the other hand, ketoacidosis is the condition in which a large amount of ketone bodies present in blood and blood is highly acidic. Pathophysiology of type 1 diabetes shows that this health condition occurs while the insulin-producing beta cells that present in the Islets of Langerhans of the pancreas are destroyed by the body's immunes system (Chelvanayagam and James, 2018.). As beta cells play active role in insulin production thereby converting the excess blood glucose into glycogen, the destruction of these cells increases the blood glucose level in an uncontrolled way (de Souza et al. 2019). NMC (2018), children with Type 1 diabetes must be provided with planned care in which their holistic needs will be met [NMC, 2018]. Type 1 diabetes has adverse impacts on Florida’s social life, living standard, physical and psychological wellbeing and personal and professional life. For the last few months, Florida could not attend any social functions due to her poor physical health. She begins to avoid playing with her friends and peers at the schools because of her frequent urination issue and abdominal pain. She feels a lack of energy and exhausted all time which make her unable to perform any school task or any other social function. Diabetes also impacts adversely on her psychology, such as she suffers from severe depression, anxiety and loneliness. Florida needs a person-centred and highly organised care plan which will not only improve her physical health but also promote her holistic develop thereby improving her quality of life. As mentioned by Gordon (2019), while it comes to develop an effective care plan for children with type 1 diabetes, nurses must use relevant models for assessing health needs of children. In the case of Florida, nurses can use the Ropan-Logan-Tierney nursing model in terms of assessing her activity of daily livings which will assist the health professional to set effective and relevant care based on her health assessment. Under NMC (2018), before using any nursing model, nurses must ensure that they have enough competencies and skill in using the health assessment model appropriately to promote safe as well as holistic care regimes for the patients [NMC, 2018]. This model is highly relevant in the case of Florida that will assist the nurses to assess her communication needs, environmental needs, breathing condition, drinking and eating, temperature, mobilisation, sleeping pattern and ability to work and play. As mentioned by Hamilton et al. (2017), through analysing these activities of living, nurses can get a clear concept of patient’s living standard, lifestyle, food habits, physical health, psychology and emotion. In the case of Florida, as she is only 10 years old and suffers from more than one health condition such as diabetes, ketoacidosis and ketonuria, she needs person-centred care in which her holistic needs will be considered and met. Through using the Ropan-Logan-Tierney nursing model, nurses can analyse the nutritional intake, food selection, professional life, preferences, social life, lifestyles and physical and emotional health in Florida (Gordon, 2019). Based on this assessment the health professional can set such a care plan that will not only reduce the blood sugar level of Florida but also improve her overall lifestyles and quality of living by making positive reformation of her food habits, sleeping pattern and regular habits. As mentioned by Knight et al. (2018), before setting any care plan for type 1 diabetic patients, nurses must ensure that a well-constructed health assessment of the patients had been carried out. NMC (2018), nurses must ensure the health assessment is carried out through a systematic process through which they can consider all kind of health needs of the patient [NMC, 2018]. In the case of Florida, nurses have used the APIE [ assessment, planning, implementation and evaluation] model health assessment. As mentioned by Hill (2017), APIE is a widely used health assessment in the modern nursing field, in which nurses can follow a systematic pathway to assess the health of the patient. In the first stage of the APIE model nurses assess the current physical health of patients by carrying out necessary physical test and analysing the pre-medical history of the patient (Kozlowska et al. 2017). NMC (2018), recommends that nurses must ensure that they respect the patient’s autonomy, confidentiality and preferences while carrying the health assessment. Under NMC (2018) ethical guidelines, nurses have taken the informed consent from the parent of Florida ( as she is below 18 years) for carrying out the physical tests. The first A1c test has been carried out, in which the average blood glucose of Florida is checked. Based on this report, Florida has a sugar level of 190 mg/dl in fasting [normal is 72-99 mg/dl]. According to Leary and Dix (2018), the high sugar level is associated with uncontrolled diabetes I children which leads to several additional health complications such as blurred vision, severe weight loss, polyuria and ketonuria. From this test report, it is clear that due to high blood sugar level, suffers from ketonuria and fast weight loss. The Ketone-urine test is also done here to determine the ketone bodies in the urine of Florida. Through the test's report, it is clear that Florida has a high amount of ketone bodies in her urine. The pathophysiology of type 1 diabetes Meletus that, in this health condition this is severe breaking down of the tissues and muscle thereby producing the ketone bodies which are excreted through the urine (Martin and Baker, 2019). As Florida suffers from the continuous production of ketone bodies by breaking down of the muscles and tissues cells they contribute to her severe weight loss. Under NMC (2018), nurses must ensure that they work under that level of competencies and skill in terms of assuring patients’ safety. In the case, of Florida, highly experienced and skilled nurses are assigned to carry out these tests, which eliminate the chances of errors in the test report. A total blood count test is also carried out to check whether Florida has any other disorders such as blood-borne infection, leukaemia and anaemia. According to Lithgow et al. (, 2021), assessing health is associated with not only checking the physical health of patients but also analysing their lifestyle, premedical history and emotional wellbeing. In the case of Florida, nurses carried out a blood test to check DKA (diabetic ketoacidosis), Glycated haemoglobin (hba1c), albumin: creatinine ratio (ACR) and glomerular filtration rate (GFR). Under MC (2018), while carrying out any health assessment nurses must show supportive and empathetic behaviour towards the patients rather than misbehaving with them.
After assessing the quantitative data about the physical health of Florida, nurses collect the qualitative information for assessing the premedical history, genetic history, professional life, living standard and lifestyle of Florida. Nurses make effective communication with Florida’s parents regarding her premedical history and genetic history to check whether she has the genetical carrier of diabetes. Through assessing her premedical history, nurses come to know that Florida’s father has a 10 years history of type 1 diabetes and one of her cousins also has diabetes mellites. Therefore, it is clear that Florida has a genetic history of type 1 diabetes which can be the potential cause of developing this illness in her. As argued by Mathi (2021), although the genetical history of diabetes can be the potential cause of occurrence of this illness, nurses must consider the other factors such as social, physical and economic factors that also contribute to developing this health condition in patients. In the case of Florida, nurses also discuss with Florida’s parents about her food habits, lifestyle, school life and her quality of living. Under NMC (2018), while collecting personal and professional information about patients for carrying out an effective health assessment nurses must ensure that they would use a high level of confidentiality and privacy to handle this information [NMC, 2018]. From communication with Florida’s parent, it is clear there are many contributing factors to her health condition such as her irregular lifestyle, too must intake of junk foods, lack of exercise, late-night sleeping pattern, wrong food selection and skipping of meals. From assessing the overall health, it is clear that Florida needs a holistic and person-centred care plan that will improve her entire lifestyles rather than focusing on mere physical health. The second and most important stage of the APIE framework is the planning stage, in which a highly appropriate care plan is developed based on the health assessment (Rossaneis et al. 2017). Under NMC (2018), nurses must ensure that the care plan that is developed based on the health assessment will be highly relevant to the current holistic needs of the patient [NMC, 2018]. Based on the above-mentioned health assessment, of Florida, a well-constructed and highly relevant care plan is developed which primarily focus on her physical, psychological, care, emotional and social needs. This care plan has different care strategies that are developed for promoting the holistic development of Florida. These care strategies that are implemented by the nurses are, ensuring good nutrition supply to Florida, regular checking her blood glucose, proper medicine management to ensure the safe treatment to Florida, effective medicine administration to ensure the usefulness of ongoing medication, developing healthy habits, providing health education, improving Florida’s self-management ability, prevention of chances of any infection, regular physical examination and checking the nutritional requirements. As argued by Schaarup et al. (2017), while going to set any care plan, nurses and the health professional must ensure that they have the resources to make the proper implementation of the plan. While making the care plan the nurses must understand what resources are needed for developing an effective care plan. In the case study, nurses note down the requirements of different resources such as modern medical equipment’s, skilled healthcare staffs, highly experienced and skilled nurses, a good information delivery system in the ward, skilled reporting staffs and a highly productive workforce. However, while setting the care plan for Florida, nurses face some difficulties regarding resource management, the first issues that nurses face during the planning the care is lack of skilled health staffs managing the health needs of Florida, such as checking her temperature and blood sugar in regular wise, changing her clothes, communicating with her regarding her requirements (Tilenius, 2018). On the other hand lack of a sufficient number of PC and laptops in the reporting room can cause difficulties for the factors and nurses to transfer the updates regarding Florida’s current health condition or any health deterioration. Under NMC (2018), nurses must ensure that they develop such carte plan that can be effectively implemented by using the resources available in the healthcare centres. The other most important difficulties regarding the resources that nurses face are the lack of modern medical equipment in the hospital that can be used to check the accurate blood glucose level or ketone bodies. On the other hand, most of the senior nurses in the multidisciplinary team are aged and they are highly obstinate to use the old technologies while implementing the care plan rather than using modern technologies. As mentioned by Chapman (2017), nurses must plan such a care plan that will meet al the care needs of the patients. In case Florida, after checking the requirements for the implementation of the care plan, nurses inform these the care manager. A healthcare committee has been developed to check whether all the required needs for implementing the care plan are met. Finale the care plan is developed and all the resources that are needed for proper implementation of the plan have been organised accordingly. After a care plan is set, the nest step that nurses need to follow is the implementation of the care plan to meet all the health needs of the patient (Chelvanayagam and James, 2018). Under the care plan developed for Florida, nurses ensure that Florida is provided with all the required nutrition, that will help her to get the essential protein. As Florida’s blood glucose is high, therefore, she needs a planned and specific diet that is enriched with protein and low calories fats but lack carbohydrates. Under NMC (2018), while implementing the care plan nurses must consider the patient’s rights, preferences and autonomy. While developing the diet chart for Florida, nurses ensure that her food preferences and eating habits must be considered by the nutritionist. As mentioned by Gordon (2019), nurses must ensure that the care plan will not interfere with the rights and autonomy of the patient. As Florida has a preference for snacks and junk foods, the nutritionist has made such diet chert under includes nutritious snacks. These snacks are enriched with essential vitamins and protein but lack carbs which will not only reduce Florida’s blood sugar level but also provide her with high energy to enhance her mobility and activeness. As mentioned by Hamilton et al. (2017), in a care plan, along with nutrition, treatment is another most important aspect that nurse must implement. Here in the case study, a systematic treatment process is followed that includes regular checking of her blood sugar level, ketone bodies, DKA, temperature and glomerular filtration rate of Florida. Nurses make clear interaction on regular basis with Florida to know that whether she feels any additional health issues after the medicines are administered. Intramuscular insulin administration is carried out which is useful to fasten the reduction of blood glucose level in Florida. Under NMC (2018), nurses must have the skill and expertise to carry out the appropriate medication administration process to ensure the patients’ safety [NMC, 2018]. Under the care plan nurses have maintained an aseptic and hygienic care environment in which Florida is free from any chances of infection ore contagious disease. In the case of Florida, nurses ensure the right dose of insulin and other medicines are administered to Florida. The nurse also checks that proper time-duration is maintained between the two-dose of insulin injection that is administered in Florida. Nurses also check that doctors mentioned the right dose, right times and proper start date for insulin and other medicines on the Drug Chart (DC) (Knight et al. 2018). Under the care plan, nurses ensure that Florida is protected from any kind of discrimination and harm throughout care delivery. Health education is provided to Florida and her parents to improve their concept regarding healthy eating, food choice and systematic lifestyles that reduce the prevalence of diabetes. Under the care plan nurses provides emotional and psychological support to Florida by improving her self -confidence. Additionally, nurses train Florida to improve her self-management ability that can improve her quality of living.
The last step in the APIE framework is the evaluation of the care plan, in which nurses evaluate the care outcomes to analyse the usefulness of the care plan (Knight et al. 2018). Under NMC (2018) nurses must be loyal in revealing the actual outcome of the care plan that can assist the entire health team to make necessary modification to the treatment process [NMC, 2018]. In the case of Florida, nurses use different strategies to evaluate the care plan, such as feedback process, direct communication, review from the patie4ntandcomparing patient’s health with the previous health. As stated by Kozlowska et al. (2017), through evaluating the care plan, nurses can understand that whether the treatment process is relevant to patient’s health needs. In the case study, nurses make direct interaction with Florida to take her valuable feedback regarding her health condition after the care plan has been implemented. On the other hand, a review from the healthcare staffs is also taken to analyse what they observe about Florida’s health improvement after the treatment is implemented. A comparative analysis between the health-related database of Florid before and after treatment is carried out. Here nurse checks the blood sugar level, ketone bodies acidic level of blood before and after implementation of the care plan. Through this evaluation, nurses are able to check whether the care plan is able to improve Florida’s health condition. From the overall discussion, it can be concluded that type 1 diabetes is referred as an autoimmune health condition, in which the beta cells are destroyed which interferes the insulin production. As insulin is the only hormone that maintains the blood glucose level, the lack of insulin production leads to an increase in blood glucose level. Type 1 diabetes generally occurs in the juvenile therefore it is known as juvenile diabetes. While providing high-quality care is to children with type 1 diabetes. Nurses must develop an effective care plan, APIE model is the effective assessment tool that nurses can use to assess patient’s health and implement an effective care plan to meet patient’s health needs. During using this tool, nurses must follow the NMC (2018) guidelines to ensure that patient’s safety, autonomy and rights are protected throughout the care delivery.
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