History of the patient
The patient’s name has been changed and will be referred as John. The patient is a 25-year-old man living in New York City. He was diagnosed in 2010, that he had type 2 diabetes. Before that, he had all the symptoms of a person suffering from hyperglycaemia. According to his glucose level, that was 118-127 mg/dl, it was said to be ‘borderline diabetes’. The only action taken was that the patient was told to lose weight. He was referred to this clinic, which specialises in diabetes. This is because the patient’s weight continued to increase and his feet were swollen therefore, making his movements and walking very difficult.
He was asked if he was taking any medication and responded that initially he was taking the glyburide but had to stop using it because of the side effects that made him sweat, agitated and very dizzy. He also said that he was taking other medication, which would control his diabetes and the medications are gymnema sylvestre, and chromium picolinate but he stopped using them as well when he notice that it was not helping him.
The patient did not test his glucose level when he was supposed to because of lack of knowledge of the importance of testing. This is observed when the patient says, “I don’t see the need to always check my glucose level because I don’t feel sick.” John is complaining that he has done many outdoor activities and exercise but he is still gaining weight. The reason for this is that he takes more carbohydrates than the other nutrients. His meals consist of breads and pasta with a lot of butter and cream. This means that he does not have a nutritionist who would help him with his diet. When asked about his family history he states that his father had type 2 diabetes and he was afraid that his children would also get it. This is because his girlfriend was pregnant with his baby. There was no way that he could be assured that his children would not get the disease because it is hereditary (Vera, 2002).
According to the history of the patient, the assessment is as the following and the first is that he has uncontrolled type 2 diabetes. This is because the medication, which he is taking, is not making any progress of controlling the diabetes. The other assessment is that the patient has obesity. This is observed when the patient continues to gain weight due to unhealthy eating. The patient has a lifestyle deficit because he does not have enough exercise routine, which would help him reduce his weight and have better health. The patient eats more carbohydrates, which is very unhealthy for the body and most especially to patients who have this type of diabetes. The patients has very little understanding of diabetes this is because when he was previously diagnosed with the disease he did not consult a nutritionist and also stopped taking his medication without a doctors consent. The patient has decreased muscle strength this is because the patient shows signs of fatigue and difficult with walking due to his swollen legs. The last assessment made was that the patient was very anxious in that he depends a lot on others (Vera, 2002).
Diagnosis
Imbalance nutrition, which is brought on by the increase of carbohydrates because the patient likes eating pasta and bread. The amount of insulin has decreased therefore, causing the use of glucose to decrease. The patient has obesity because the breakdown of fats in the cells decreases (Vera, 2002).
Hypoglycaemia, which causes the patient to sweat a lot, be nervous and have excessive hunger. This is why the patient eats every now and then. This also causes the patient to be very restless, depressed and very irritable easily with anyone.
The risk of getting infections due to high blood sugar levels in the body. The body is also experiencing changes in circulation therefore; it will affect the body thereby making it easy to get infections. The other things that will cause a patient to get more infections are because of skin damages and inadequate peripheral defence system (Vera, 2002).
Fatigue this is caused by the decreased levels of insulin in the body as explained by the John how gets tired easily for doing simple tasks. This is also brought on by the decrease in the production of metabolic energy, the increase of demand of energy and the changes that occur in the blood chemistry.
Knowledge deficit, which is caused by lack of knowledge of how to manage the disease or misinterpretation of the information, one gets about the disease. The patient does not know the importance of testing the glucose levels (Young & Flower, 2002, p.70).
Intervention and implementation of the disorder
Imbalance nutrition
The main purpose at this point is to ensure that the patient loses weight to normal and maintain it. This therefore means that the intake of food especially carbohydrates should reduce. The body weight of the patient should be checked regularly as instructed by the doctor. The patient should consult the nutritionist regarding the diet they are taking or make a diet plan, which should not be broken. The nurse determines the diets of the patients and the programs then compare them with the food that was previously eaten by the patient.
Check and record the bowel sounds or the presence of abdominal pains and vomiting. The nurse should make sure that the insulin is delivered on time and the blood sugar test is conducted. This is all done to ensure that the blood sugar levels are maintained (Conlon, 2001).
Hypoglycaemia
The nurse should observe the signs of hypoglycaemia. The signs are dizziness, the level of consciousness, patient complains of the temperature being cold or humid, confusion and rapid pulse. This is all done to ensure that the patient does not get hypoglycaemia because it is fatal for the patient. This means it should be handled with care or given the attention, it deserves (Inzucchi, 2002, p.365).
The risk of getting infections
The main goal for this is to ensure that an infection does not occur to the patients. A nurse should be able to identify which individual risk factors and the best way of intervention, that can reduce the infection. The nurse should look for the signs of any inflammation or infection such as change of urine colour, fever, purulent sputum, redness and pus in any wound. While the nurse is in contact with the patient or things that belong to them, it is very important for nurse to wash their hands. This is done in order to prevent the infection of nosocomial. In order to prevent the urinary tract infection it is very significant for the nurse to ensure that the catheter is well put. The nurse must make certain that the patient is positioned in a semi Fowler position in order to allow the lungs to expand. The collaborating antibiotics should also be used in order to prevent sepsis from occurring (Ahmann & Riddle, 2002).
Knowledge deficit
When a nurse is doing or starting a particular procedure, it is vital to explain to the patient the reasons why they are doing such things. The patient and the family should be questioned about the level of knowledge they have about the disease (Clement, 1995). This is done by finding out from the patient and his family about the level of understanding and the knowledge they have about the disease. By explaining to the family about the diseases and its conditions, it will help reduce anxiety. It is also imperative for the nurse to educate the family in order for them to be able to look at the patient’s diet. The education of the clients and the family will make the treatment of the client successful without much difficulty. This will enable john to see the birth and growth of his child.
Evaluation
After three weeks, the patient showed some major improvements especially his glucose levels, which had increased. The patient’s weight had also decreased slightly but that was a major milestone for the patient because earlier on all he did was increase in body weight. This was because the patient was following his diet as instructed by the nurse. The swelling of the feet of the patient had decreased but not in the manner that was expected. After two months of treatment, the patient was starting to look healthy, as his body weight had reduced tremendously this is due to following the diet plan and working out frequently. His glucose level was near normal and his feet were no longer swollen. He looked like a different man. This shows that he was following all the instructions given to him by the nurses and doctors.
In conclusion, john has all symptoms and signs of a patient suffering from type 2 diabetes. This therefore, means that the patient has to get all the help he needs from family to the physicians in order to regulate the blood sugar to normal as a nurse it is important to educate the patient and family members to reduce anxiety and help in the regulation of diet. This makes the nurse one of the most important people when it comes to the treatment of a diabetic patient.
Reference
Ahmann AJ, Riddle. M. (2002). Current oral agents for type 2 diabetes. Post Grad Med.
Conlon, P. (2001). A practical approach to type 2 diabetes. Nurs Clin North Am.
Clement, S. (1995). Diabetes self-management education. Diabetes Care.
Inzucchi, S. (2002). Oral antihyperglycemic therapy for type 2 diabetes. JAMA, 360–372.
Vera, M. (2012). Diabetes Mellitus Nursing Care Plans. Nurses labs.
Young, A. & Flower, L. (2002). Patients as partners, patients as problem-solvers. Health Commun, pg.69-97.
