Insulin, Diabetes Type 1, and Nursing Interventions for an 18-Year-Old Male Patient, Exercises of Nursing

Download Insulin, Diabetes Type 1, and Nursing Interventions for an 18-Year-Old Male Patient and more Exercises Nursing in PDF only on Docsity! 1 Insulin is a hormone secreted by beta cells, which are one of four types of cells in the islets of Langerhans in the pancreas. Insulin is an anabolic, or storage, hormone. When a person eats a meal, insulin secretion increases and moves glucose from the blood into muscle, liver, and fat cells. In those cells, insulin transports and metabolizes glucose for energy stimulates storage of glucose in the liver and muscle signals the liver to stop the release of glucose, enhances storage of dietary fat in adipose tissue, accelerates transport of amino acids into cells, inhibits the breakdown of stored glucose, protein, and fat. Diabetes Type 1: It is characterized by the destruction of the pancreatic beta cells. Diabetes Type 2: It is insulin resistance and impaired insulin secretion. Insulin resistance refers to a decreased tissue sensitivity to insulin. CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS) Fasting Blood Glucose (blood glucose determination obtained in the laboratory after fasting for at least 8 hours), random plasma glucose, and glucose level 2 hours after receiving glucose (2-hour post load) may be used. HgbA1C (A1C), Fasting lipid profile, Test for microalbuminuria, Serum, creatinine level, Urinalysis, Electrocardiogram. An abnormally high blood glucose level is the basic criterion for the diagnosis of diabetes. PATIENT INFORMATION Skyler Hansen is an 18- year-old male, diagnosed with Type 1 Diabetes 6 months ago. He was brought to the ER by his friends, the patient has not eaten over 5 hours and is drowsy, wakes with stimulus, has slurred speech, is diaphoretic, and is acting irrationally. ANTICIPATED PHYSICAL FINDINGS Fatigue and weakness, sudden vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, and recurrent infections. The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed. ANTICIPATED NURSING INTERVENTIONS 2 - Administer prescribed medications on time - Provide glucose checks before meals - Offer a snack to patient after administering insulin to avoid hypoglycemia - Asses patient LOC to make sure they don’t go into DKA PHARM-4-FUN PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE MEDICATION: Dextrose CLASSIFICATION: Carbohydrate caloric agents PROTOTYPE: N/A SAFE DOSE OR DOSE RANGE, SAFE ROUTE Adults: Use peripheral IV infusion of 2.5%, 5%, or 10% solution for minimal fluid needs. Adults: 10 to 25 g IV infusion of 50% solution. May need to repeat doses in severe cases. Determine blood glucose level before injecting; in an emergency, promptly administer without waiting for pretreatment test results. PURPOSE FOR TAKING THIS MEDICATION Fluid replacement and caloric supplementation in patients who cannot maintain adequate oral intake or are restricted from doing so. It is also used for Insulin-induced hypoglycemia. PATIENT EDUCATION WHILE TAKING THIS MEDICATION PHARM-4-FUN PATIENT EDUCATION WORKSHEET - Explain need for supplement to patient and family and answer any questions. - Tell patient to report adverse reactions promptly, especially severe dizziness or syncope. NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE MEDICATION: Glucagon CLASSIFICATION: Antihypoglycemics PROTOTYPE: GlucaGen Diagnostic Kit, GlucaGen HypoKit SAFE DOSE OR DOSE RANGE, SAFE ROUTE Glucagon: Adults and children weighing more than 20 kg: 1 mg (1 mL) IV, IM, or subcutaneous. May repeat in 15 minutes if needed. Glucagen: Adults and children weighing more than 25 kg or older than age 6 when weight is unknown: 1 mg (1 mL) IV, IM, or subcut. May repeat in 15 minutes if needed. PURPOSE FOR TAKING THIS MEDICATION Hypoglycemia PATIENT EDUCATION WHILE TAKING THIS MEDICATION • Instruct patient and caregivers how to give glucagon and recognize a low glucose episode. • Tell patient to immediately report syncope, severe dizziness, fast or slow heart rate, or severe headache. • Explain importance of calling prescriber immediately in emergencies. • Teach patient and caregivers how to prevent hypoglycemia. Path to Death or Injury: Palliative care is not considered for this patient, he is young and strong, he just needs more education on his diagnosis. Alerts: What are you on alert for with this patient? (Signs & Symptoms) 1. Polyuria (increased urination), Polydipsia (increased thirst), Polyphagia (increased hunger). Increased/decreased blood sugar. 2. Fatigue and weakness, sudden vision changes, tingling or numbness in hands or feet. 3. Dry skin, skin lesions or wounds that are slow to heal, and recurrent infections. What Assessments will focus on for this patient? (How will I identify the above signs &Symptoms?) 1. Physical Assessment and History 2. Fasting Plasma Glucose test done 3. Evaluation for complications List Complications that may occur related to dx, procedure, comorbidities: 1. Hypoglycemia 2. Diabetic Ketoacidosis (DKA) 3. Hyperosmolar Hyperglycemic State (HHS) What nursing or medical interventions may prevent the above Alert or complications? 1. Make sure patient maintains proper nutrition and gets educated on his diagnosis as well as healthy lifestyle. 2. Maintain patient hydrated and restoring electrolyte balance. 3. Administration of insulin. 4. Monitor glucose levels to make sure they are in normal range levels. Management of Care: What needs to be done for this Patient Today? 1. Glucose monitoring PRN 2. Give carbs and protein 3. Always maintain the patient hydrated, and O2 above 92% 4. Given medications prescribed around the clock 5.Educate the patient on Diabetes and management 6.Make sure the patient is not hypo or hyperglycemic Priorities for Managing the Patient’s Care Today 1. Glucose monitoring 2. Medication administration 3. Maintain oxygen level above 92% 4. Asses vitals and the patient to make sure the patient is stable What aspects of the patient care can be Delegated and who can do it? -A UAP can check the blood sugar of the patient. -A UAP can bring the patient juice after the nurse administered insulin or give a hyperglycemic medication. -A nutritionist can explain healthy eating habits for Diabetes. -The nurse is the only one who should educate the patient on self-medication administration. The patient should verbally be able to demonstrate and understand the importance in managing Diabetes. Clinical Worksheet LASATER CLINICAL JUDGMENT RUBRIC Noticing and Interpreting Effective NOTICING involves: Exemplary Accomplished Developing Beginning Focused Observation Focuses observation appropriately; regularly observes and monitors a wide variety of objective and subjective data to uncover any useful information Regularly observes/monitors a variety of data, including both subjective and objective; most useful information is noticed, may miss the most subtle signs Attempts to monitor a variety of subjective and objective data, but is overwhelmed by the array of data; focuses on the most obvious data, missing some important information Confused by the clinical situation and the amount/type of data; observation is not organized and important data is missed, and/or assessment errors. are made Recognizing Deviations from Expected Patterns Recognizes subtle patterns and deviations from expected patterns in data and uses these to guide the assessment Recognizes most obvious patterns and deviations in data and uses these to continually assess Identifies obvious patterns and deviations, missing some important information; unsure how to continue the assessment Focuses on one thing at a time and misses most patterns/deviations from expectations, misses opportunities to refine the assessment Information Seeking Assertively seeks information to plan intervention: carefully collects useful subjective data from observing the client and Actively seeks subjective information about the client’s situation from the client and family to support planning Makes limited efforts to seek additional information from the client/family; often seems not to know what information to seek Is ineffective in seeking information; relies mostly on. objective data; has difficulty interacting with the client and from interacting with the client interventions; occasionally does | and/or pursues unrelated family and fails to collect and famih not pursue important leads information important subjective data Effective Exemplary Accomplished Developing Beginning INTERPRETING involves: Prioritizing Data Focuses on the most relevant and important data useful for explaining the client’s condition Generally focuses on the most important data and seeks further relevant information, but also may try to attend to less pertinent data ‘Makes an effort to prioritize data and focus on the most important, but also attends to less relevant/useful data Has difficulty focusing and appears not to know which data are most important to the diagnosis; attempts to attend to all available data Making Sense of Data Even when facing complex, conflicting or confusing data, is able to (1) note and make sense of patterns in the client’s data, (2) compare these with known. patterns (from the nursing knowledge base, research, personal experience, and intuition), and (3) develop plans for interventions that can be justified in terms of their likelihood of success In most situations, interprets the client’s data patterns and compares with known patterns to develop an intervention plan and accompanying rationale; the exceptions are rare or complicated cases where it is appropriate to seek the guidance of a specialist or more experienced nurse In simple or common/familiar situations, is able to compare the client’s data patterns with those known and to develop/explain intervention plans; has difficulty, however, with even moderately difficult data/situations that are within the expectations for students, inappropriately requires advice or assistance Even in simple of familiar/common situations has difficulty interpreting or making sense of data; has trouble distinguishing among competing, explanations and appropriate interventions, requiring assistance both in diagnosing the problem and in developing an intervention © Developed by Kathie Lasater, Ed.D. (2007). Clinical judgment development: Using simulation to create a rubric. Journal of Nursing Education, 46, 496-503. January 2007 LASATER CLINICAL JUDGMENT RUBRIC Responding and Reflecting Effective RESPONDING Exemplary Accomplished Developing Beginning involves: Calm, Confident Manner | Assumes responsibility: Generally displays leadership Is tentative in the leader’s role; Except in simple and routine delegates team assignments, and confidence, and is able to reassures clients/families in situations, is stressed and assess the client and reassures control/calm most situations; routine and relatively simple disorganized, lacks control, them and their families may show stress in particularly | situations, but becomes stressed _| making clients and families difficult or complex situations and disorganized easily anxious/less able to cooperate Clear Communication Communicates effectively; Generally communicates well; Shows some communication Has difficulty communicating; explains interventions; calms/reassures clients and families; directs and involves team members, explaining and giving directions; checks for understanding explains carefully to clients, gives clear directions to team; could be more effective in establishing rapport ability (e.g., giving directions); communication with clients/families/team members is only partly successful; displays caring but not competence explanations are confusing, directions are unclear or contradictory, and clients/families are made confused/anxious, not reassured Well-Planned Intervention/Flexibility Interventions are tailored for the individual client, monitors client progress closely and is able to adjust treatment as indicated by the client response Develops interventions based on relevant patient data; monitors progress regularly but does not expect to have to change treatments Develops interventions based on the most obvious data; monitors progress, but is unable to make adjustments based on the patient response Focuses on developing a single intervention addressing a likely solution, but it may be vague, confusing, and/or incomplete; some monitoring may occur Being Skillful Shows mastery of necessary Displays proficiency in the use _| Is hesitant or ineffective in Is unable to select and/or nursing skills of most nursing skills; could utilizing nursing skills perform the nursing skills improve speed or accuracy Effective REFLECTING Exemplary Accomplished Developing Beginning involves: Evaluation/Self-Analysis Independently evaluates/ analyzes personal clinical performance, noting decision points, elaborating alternatives and accurately evaluating choices against alternatives Evaluates/analyzes personal clinical performance with minimal prompting, primarily major events/decisions; key decision points are identified and alternatives are considered Even when prompted, briefly verbalizes the most obvious evaluations; has difficulty imagining alternative choices; is self-protective in evaluating personal choices Even prompted evaluations are brief, cursory, and not used to improve performance; justifies personal decisions/choices without evaluating them Commitment to Improvement Demonstrates commitment to ongoing improvement: reflects on and critically evaluates nursing experiences; accurately identifies strengths/weaknesses and develops specific plans to eliminate weaknesses Demonstrates a desire to improve nursing performance: reflects on and evaluates experiences; identifies strengths/weaknesses; could be more systematic in evaluating weaknesses Demonstrates awareness of the need for ongoing improvement and makes some effort to learn from experience and improve performance but tends to state the obvious, and needs external evaluation Appears uninterested in improving performance or unable to do so; rarely reflects; is uncritical of him/herself, or overly critical (given level of development); is unable to see flaws or need for improvement © Developed by Kathie Lasater, Ed.D. (2007). Clinical judgment development: Using simulation to create a rubric. Journal of Nursing Education, 46, 496-503. January 2007  Clinical Judgement Components Scoring: Exemplary = 4 point Accomplished = 3 points Developing = 2 points Beginning = 1 point Noticing: Score: vSim 1 Score: vSim 2 Score: vSim 3 Focused Observation: E A D B 3 Recognizing Deviations from Expected Patterns: E A D B 3 Information Seeking: E A D B 3 Total for category: 9 Interpreting: Prioritizing Data: E A D B 3 Making Sense of Data: E A D B 3 Total for category: 6 Responding: Calm, Confident Manner: E A D B 4 Clear Communication: E A D B 4 Well-Planned Intervention/Flexibility: E A D B 4 Being Skillful E A D B 3 Total for category: 15 Reflecting: Evaluation/Self-Analysis: E A D B 4