Nursing Assessment Management of Diabetes

Question: Describe about the Nursing Assessment for Management of Diabetes. Answer: Heathers abnormal observations are blood pressure of 175/95mmHg, a blood glucose level (BGL) of 17.2mmol/L, glycosuria and severe positive proteinuria (++++) On admission of Mrs Bishops observations indicated abnormalities with a blood pressure of 175/95 mmHg, a blood glucose level of 17.2mmol/L, glycosuria and proteinuria which require immediate and urgent medical attention by the physician on duty. Therefore an urgent call or reporting to the physician of her case should be done. Mrs Bishops diagnosis is type 2 diabetes mellitus. Type 2diabetes is characterised by increased resistance to insulin as well as reduced insulin production by the pancreatic beta cells. Diabetes also results in microvascular complications including retinopathy that leads to blurred vision. Obesity is also a risk factor for other diseases including hypertension (Leslie, 2012). Impacts of hyperglycaemia on body systems Body System Prolonged hyperglycaemia Cardiac system Prolonged hyperglycaemia causes hypertension and electrolyte imbalance due to high osmolality and polyuria respectively. These conditions also lead to cardiac arrhythmias. Ischemia and ischemic stroke may also occur due to glycosylation of proteins that induce collagen cross-linking with other extracellular proteins in blood vessel walls. Congestive heart failure may also ensue due to fluid overload in the cardiovascular system that leads to increased cardiac workload (Brunner, Suddarth Smeltzer, 2014). Cardiovascular system Hypertension Glycosuria leads to high osmolality and consequently, hypertension due to drawing of intracellular water into the extracellular compartment. Moreover, fatty deposits are formed on the blood vessel walls that lead to atherosclerosis and restricted blood to extremities (Leslie, 2012). Nervous system Deposition of products of glycosylation in blood vessels leads to an aneurysm and haemorrhagic stroke due to brain blood vessel rupture (Shrikhande McKinsey, 2012). Urinary system Prolonged hypertension and electrolyte imbalance in diabetes leads to renal failure as well as other effects such as proteinuria due to the destruction of the glomerulus (Leslie, 2012). Sensory systems, the eye Compromised blood supply to extremities due to glycosylation product and fatty depositions on blood vessel leads to lack of nourishment of the nerves supplying them and a subsequent severing of the nerves that leads to reduced sensitivity and increased susceptibility to injury. Diabetic retinopathy also occurs due to microvascular changes and haemorrhage that lead to visual impairment (Shrikhande McKinsey, 2012). The three health professionals who can be involved in the provision of care are a nutritionist, diabetic specialist nurse and a general physician. A nutritionist will play a vital role in providing enough patient education on a diet to the patient. A wide range of food options for diabetic patients can be provided and how to prepare them hence ensuring maintenance of balanced diet that will help in reduction of weight (Frost, Dornhorst Moses, 2013). Equally, a nurse will assist in the management of the condition by providing patient education as well as administration of medication, self-monitoring, management and other therapies within their scope aimed at reducing and maintaining blood glucose levels. They can also prevent and treat the complications associated with diabetes such as bacterial infections, foot ulcers and wounds. As well, the general physician will diagnose any other underlying conditions, provide prescriptions and participate in the day to day management including referring the patient for specialised treatment if the need arises (Shrikhande McKinsey, 2012). The two contributing factors that may have impacted upon the development of Heathers condition are environmental and hereditary factors. According to Leslie (2012), obesity which is the main aspect that is implicated in type 2 diabetes can be a result of modifiable environmental factors such as poor nutrition, sedentary lifestyle and general inactivity. It can also be due to hereditary factors which are non-modifiable. Type 2 diabetes is a chronic progressive metabolic disease that is characterised by insulin resistance in the body and impaired insulin secretion by the pancreatic beta cells. Normally, insulin binds to specific receptors on cell surfaces and initiates glucose metabolism. In type 2 diabetes, the intracellular reactions involved in the glucose metabolism are reduced or absent, thus reducing the effectiveness of insulin to stimulate glucose uptake by tissue cells and regulation (Brunner, Suddarth Smeltzer, 2014). Elevated blood glucose levels are as a result of reduced tissue receptor sensitivity to insulin that leads to reduced uptake of glucose from the blood by tissue cells. Tiredness and fatigue ensue due to the reduced uptake of glucose that is necessary for aerobic and anaerobic respiration to produce energy. Hyperglycaemia causes increased osmolarity in the extracellular compartment and thus a significant amount of water is drawn from the intracellular compartment into the card iovascular system leading increased blood pressure and consequently increased urination (polyuria) as the bodys regulatory mechanism. This also causes dehydration due to loss of large volume of water and electrolytes that lead to a feeling of thirst. Glucose in urine is also observed as the body tries to regulate the blood glucose levels by elimination through the renal system. Blurred vision occurs due to the diabetic retinopathy, a complication associated with microvascular changes of the blood vessels that nourish the retina (Waugh Grant, 2010) Hypertension should be monitored and regulated through medical interventions and dietary modifications to prevent complication associated with it. Similarly, she should be monitored for any deterioration in vision and be offered visual aids to avoid falls and injuries that can be detrimental to her health provided that there is poor wound healing in diabetic patients (Shrikhande McKinsey, 2012). The most appropriate nursing interventions for the patient is monitoring of blood glucose levels and urine output to determine need for intervention to prevent glycosuria and electrolyte imbalance The two health care professionals within the multidisciplinary team who need to be consulted about Heathers care are an ophthalmologist and urologist. The role of an ophthalmologist, unlike that of an enrolled nurse will be active involvement in the diagnosis and treatment of the patients eyes through medical and surgical interventions that prevent further deterioration and complications. They also provide structured patient education collaboratively with other team members to ensure the improvement of the overall health of the client (Young, Laura A. 2016). On the other hand, the urologists work is the use of both invasive and non-invasive techniques in the examination and diagnosis of any other underlying condition affecting the urinary and renal systems of the patient. Furthermore, they will determine the extent of destruction caused on the glomerulus due to diabetes and offer prescriptions as well as participate in the management of Heathers condition. Unlike enrolled nurses, uro logists have a wider scope in the management of renal and kidney conditions (Brunner, Suddarth Smeltzer, 2014). References Brunner, L, S, Suddarth, D, S Smeltzer, S, C, O, C, 2014,Brunner Suddarth's textbook of medical-surgical nursing, Lippincott Williams Wilkins, Philadelphia. Frost, G, Dornhorst, A Moses, R 2013,Nutritional management of diabetes mellitus, John Wiley Sons, Chichester, West Sussex, England. Leslie, R, D, G 2012,Diabetes, Manson Publishing Ltd, London. Shrikhande, G, V McKinsey, J 2012,Diabetes and peripheral vascular disease: Diagnosis and management, Springer, New York. Waugh, A Grant, A 2010, Ross and Wilson, Anatomy and Physiology in Health and Illness, 11thedition, Elsevier Australia, NSW. Young, Laura A. 2016,Medical Management of Type 2 Diabetes, Amer Diabetes Assn, New York.