Introduction
Diabetes is one of the most rapidly spreading chronic conditions amongst the US and global populations. Approximately 29.1 million Americans are diagnosed with the disease, making it the seventh leading cause of death and a tremendous burden on society (Office of Disease Prevention and Health Promotion, 2018). As a lifestyle and dietary choices are central to diabetes prevention and management, it is critical to develop a plan of care for the use in health delivery to this population.
Nursing Diagnoses
- Type 1 Diabetes – autoimmune, commonly genetic disease which causes the body to stop producing insulin. The immune system attacks cells in the pancreas which inhibits insulin production. Also known as juvenile-onset diabetes, as it is commonly discovered at a young age and requires daily insulin intake (National Institute of Diabetes and Digestive and Kidney Disease, 2016).
- Type 2 Diabetes – the most common type of diabetes, with onset at later stages of life. Due to lifestyle and physical factors, the body becomes unable to metabolize glucose in the blood. This is known as insulin resistance due to the body’s naturally produced insulin is not enough. Over time, this can lead to organ damage and co-morbidities (“Type 2 diabetes”, n.d.).
- Gestational diabetes – instances of hyperglycemia during pregnancy developed between 24 and 28 weeks. Commonly disappears after giving birth but is a risk factor for developing type 2 diabetes later on.
Assessment Data
Subjective
The patient describes their health in subjective terms, including how they are feeling, any pain or discomfort, and overall issues. Subjective aspects of hyperglycemia (and diabetes) include:
- Temperature variations,
- Excessive sweatiness,
- Slurred speech,
- Irritability,
- Confused by surroundings
- Blurred vision
- Leg pain
- Feeling of nausea
Objective
An assessment focused on diabetes should include basic vital signs, assessment of the skin, as well as checking minor vascular and neurologic functions. Vital signs should focus on checking blood pressure for hypertension. Basic measurements of weight, height, and waist should be taken to determine the Body Mass Index (BMI). Skin and neurologic examinations can determine if dryness, muscle atrophy, neurological deterioration, and temperature sensations are present or abnormal (Khardori, 2018). A fasting laboratory A1C test should be ordered to determine hyperglycemia.
Interview Results
The interview with the patient should determine qualitative factors which may be impacting their lifestyle, dietary choices, and disease management. Most patients are aware of their condition, and to some extent, how to mitigate it. However, there is inherent resistance and a lack of comprehension that diabetes remains a risk factor for lethal conditions. The interview should anticipate and determine the approach that the patient has been taking with managing the disease and which interventions would be most effective. This may include amongst other things: psychological health, medication adherence, consistent change of lifestyle habits, and other factors that may impact this condition.
Desired Outcomes
The desired outcome of the plan of care and any interventions is to achieve measurable, health, self-care behaviors in patients with diabetes. The primary objective is to achieve blood sugar control. This is done by a combination of medical and lifestyle interventions. Subsequent health benefits such as weight loss (if applicable), reduced hypertension and tachycardia, and increased strength and activity are desirable as well. The patient will demonstrate an understanding of the disease and techniques to manage blood sugar.
Evaluation Criteria
The guidelines from the American Diabetes Association and the World Health Organization recommend that adults with a BMI ≥ 25 kg/m2 are evaluated for type 2 diabetes (Tan, Poiello, & Woodward, 2014). Other risk factors should be considered as well. Practically every organization suggests evaluation if a first-degree relative has been diagnosed with diabetes. Furthermore, vital signs criteria such as hypertension of 140/90 mmHg, HDL cholesterol <35 mg/dl or triglyceride levels of >250 mg/dl also warrant diabetes screening.
Actions and Interventions
Diabetic patients require complex care and multifaceted interventions. Nurses can take action on a direct and indirect level. However, research shows that pragmatic interventions produce the best outcomes and the effect is maximized by guideline adherence. The interventions can be supported by family and caregivers as well, by adopting certain lifestyle habits to encourage the patient. Families should learn about the nature of diabetes and aid their loved ones in maintaining a strong discipline and adherence to lifestyle and medication. The following are suggested interventions for diabetes.
- Blood sugar monitoring – the patient is encouraged to measure and record daily fasting blood sugar to reach an optimal range established by a physician.
- Insulin administration – the patient should be taught the fundamentals of insulin injection and how and when to administer it in accordance with guidelines and physician requirements.
- Medication adherence – the patient should strive to take all medications as prescribed.
- Implement a physical activity and dietary plan. The patient should attempt to perform at least 30 minutes of vigorous activity per day. Additional light physical activity such as walking or stretching is encouraged. The patient should be educated about the basics of nutrition and how it affects blood sugar levels. It is encouraged for the patient to maintain the diet and upkeep a food log.
Evaluation of Patient Outcomes
The patient should come in for follow-up appointments after the intervention. Rapid-cycle improvements are implemented and tested in the period of three months. Long-term observation can be done for eight months. The recommended treatment goals are as follows:
- Blood pressure – <130/80 mmHg,
- A1C% – <7.0,
- Total cholesterol – <200 mg/dl,
- Triglycerides – <150 mg/dl (Oxendine, Meyer, Reid, Adams, & Sabol, 2014).
References
Khardori, R. (2018). Type 2 diabetes mellitus clinical presentation. Web.
National Institute of Diabetes and Digestive and Kidney Disease. (2016). What is diabetes? Web.
Office of Disease Prevention and Health Promotion. (2018). Diabetes. Web.
Oxendine, V., Meyer, A., Reid, P. V., Adams, A., & Sabol, V. (2014). Evaluating diabetes outcomes and costs within an ambulatory setting: A strategic approach utilizing a clinical decision support system. Clinical Diabetes: A Publication of the American Diabetes Association, 32(3), 113-120. Web.
Tan, E., Polello, J., & Woodard, L. J. (2014). An evaluation of the current Type 2 diabetes guidelines: Where they converge and diverge. Clinical Diabetes : A Publication of the American Diabetes Association, 32(3), 133-139. Web.
Type 2 diabetes. (n.d.). Web.