13 YEAR OLD DIABETIC FEMALE
This is a follow-up assessment of a 13 old year female Hispanic diabetic patient. The purpose of this follow-up is to determine the challenges the patient and patient’s family are facing as they try to manage patient’s condition. The data from this assessment will aid in formulating nursing interventions which will help the patient together with the family to have better control of the illness. Additionally, the data gathered will form the basis of making decisions concerning nursing practice which can be used to improve the well-being of the patient.
The 13-year-old was diagnosed with type 1 diabetes mellitus two weeks ago. According to her mother, she still experiences severe thirst and hunger. She also complains of fatigue and general body weakness. Her condition has not improved much, but they have witnessed some improvement in regards to patient’s thirst, hunger and elimination pattern.
The mother asserts that the last two weeks have been challenging to the patient since she had to change her diet and keep a timetable for her medication. She has poor adherence to treatment routines since this is new illness and change of lifestyle which she is yet to get accustomed to. She is also afraid to take her medication at the school since she does not want to appear different or being a victim of bullying. The patient confirmed that she does not like the changes in her life since she used to indulge in the consumption of foods with high sugar content which now is against medical requirements. This saddens her since she will not be able to enjoy life like other children of her age. However, to cope with the situation, adhere to medication instructions and maintain privacy, she prefers to check her blood glucose levels from the nurse’s office at school. At home, she does not face any difficulties taking her medication since her siblings have embraced her situation completely.
On this day of the visit, the patient was well dressed with little signs of distress. According to the medical history, the patient has no known allergies. According to the mother, the patient does not suffer from any sleeping disorders. Her weight is 90lb, height is 61 inches while BP is 135 and her pulse are 70. She has an excellent sensory response. The patient has no any rashes on her skin or wound. She has a normal breathing pattern.
According to the national charts from the CDC in reference to the patient’s height and weight, the patient falls in 50% percentile (CDC, 2010). This shows the patient has normal growth and development. Notably, the national charts are essential tools which help health practitioners to gauge whether a person has normal growth or not. Additionally, the charts can also indicate to caregiver whether the child in questions has the risk of becoming obese or overweight in the near future (CDC, 2010).
Principles and concepts of Health promotion
Health promotion is a process of enabling people to advance their control over their health and its determinants; it is an important practice to integrate into the health care system since its aim at improving the wellness of the community. To achieve this goal, our health institution has grouped us into interdisciplinary teams in order to take part in community health promotion initiatives in a different part of the city. In these health promotion activities, we usually disseminate health information to people with an aim of changing people’s attitude towards health and encourage them to adopt healthy behaviors to improve their quality of life and make them achieve a balanced mental and physical well-being.
The other principle and concepts in regards to health promotion are the creation of supportive environments which is safe, interesting and satisfying in promoting happier and healthier living. This can be achieved through promoting healthy eating at school. The schools administrators can be educated on the significance of formulating healthy eating policies that prohibit the advertising, promotion and selling of snacks and drinks which are not complying with the requirement of healthy eating guides. We also teach the community the significant of tuck shops to encourage students to consume fruits and healthy snacks at concessionary prices so as to establish a culture of healthy eating and make it possible for teens to choose healthy food. Furthermore, we engage in developing personal skills through the provision of health education with a goal of strengthening their daily living skills at the individual level.
We advocate proactively for the adoption of a balanced diet that encourages members of the community to eat at least three servings of vegetables and two servings of fruits every day as well as offering them advise on how to incorporate these measure into their daily life (Canadian diabetes association, 2013). A healthy public policy has also been delivered to the youth organizations. We have managed to deliver established public health policies which include sexual health policy, substance use policy, national alcohol policy and health behaviors policy. The youths were given the role of creating awareness and advocating for improvement of public policy. Lastly, we strengthen the community action by partnering and collaborating with other community-based organizations and sectors that include parent programs and healthy towns’ initiatives so as to build capacity which will continue to influence healthy living among the youths (Canadian diabetes association, 2013).
Interventions
Family involvement
The family-patient construct is an important intervention in respect to management of the teens’ diabetes. The family should play a role in ensuring teens maintain adherence and glycemic control through behavioral interventions. When family members are understandable, supportive and skillful in handling teens with diabetes it will lead to successful interventions (Borus & Laffel, 2012). Thus, a caregiver/parent with diabetes problem-solving skills and diabetes-specific knowledge will predict the level of diabetes management. In contrary, the higher parental burden will result to poor diabetes management and, thus, it call for a need to develop and implement an improve intervention facilitated by care ambassadors. Care ambassadors are personnel who are non-medically trained to facilitate visit follow-up, in a random manner to some subset of families. However, they ought to be trained on the eight psychoeducational modules through regular clinic visits for a period of 2 or more years (Canadian diabetes association, 2013).
Preventing loss-to-follow-up
Adherence to treatment specification is very difficult if patients are not going to the clinic regularly. As a consequence to loss-to-follow-up, the risk of diabetes complications will increase. Care ambassadors mentioned earlier have found out that non-medical trained team who assist families to set up appointments, address billing concerns and help patients follow-up the missed visits increase the frequent visits to clinic by patients compared with standard care where families schedule their own follow-up activities (Borus & Laffel, 2012). This in return will decrease high blood sugar level and reduce the rate of readmissions. This is a cost-effective and a modest intervention which has led to decrease in distress in securing an appointment with a nurse or a doctor. This has subsequently led to improvement in health outcomes.
Realistic approaches to eating
Attending to meals planning is another challenge to adherence to proper diet and it also hinders proper insulin dosing. Teens are facing challenges to follow the recommended diet meant for people with diabetes due to impulsive and peers influence. In order to overcome this problem, nurses have to come up with less stringent eating regimens known as normal eating which involve titrating insulin dosages to go with recommended diet (Borus & Laffel, 2012). This program is also referred to as Dose Adjustment For Normal Eating. The program is engaging in teaching adults with skills concerning insulin dose adjustment to their children. The result of this program has generally revealed improvement in the well-being of patients compared with the normal or standard care. This program is more suitable for teens between 11-16-year olds particularly female teenagers.
Psychological intervention
Adolescents with diabetes together with their families are supposed to be screened throughout their development to check for the psychological disorders. Teenagers are susceptible to psychological issues and screening in this area is very important to them. Psychological interventions with an adolescent with diabetes have shown to generally improve mental health, overall well-being and quality of life (Canadian diabetes association, 2013). Hence, psychological interventions will contribute to glycemic control and diabetes treatment in addition to improvement of psychosocial functioning.
Conclusion
There are several challenges to adherence measures meant to curb diabetes complications as well as to improve the general well-beings of teens with diabetes. The successful interventions are those which will diminish the emotional and cognitive barriers in addressing diabetes among the teenagers. Successful interventions should also include family support in the management of this illness. Other interventions such as those that provide outreach, motivate behavior change and streamline services are very beneficial to adolescents with diabetes. Professional providers of adolescence care should always think of ways in which they can provide support that can lead to easing the burden and minimize interference to the lives of teenagers with this illness.
References
Borus, J. S., & Laffel, L. (2012). Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159529/
Canadian diabetes association. (2013). My Site - Chapter 34: Type 1 Diabetes in Children and Adolescents. Retrieved from http://guidelines.diabetes.ca/browse/Chapter34
CDC. (2010). Growth Charts - Homepage. Retrieved from http://www.cdc.gov/growthcharts/
