Diabetes for Case Study Analysis- myassignmenthelp.com

Question: Discuss about theDiabetes for Case Study Analysis. Answer: Pathophysiology of Type 1 Diabetes High blood glucose level High blood glucose level in diabetes type 1 is directly related to the low levels and/or lack of insulin in the body due to autoimmune response that destroys the pancreatic beta cells (Cleland, 2017). The destruction of these insulin-producing cells leads to low and/or no insulin in the blood. Without sufficient insulin which is supposed to enable the movement of glucose from the bloodstream to body cells to be used as energy in metabolism, there develops a glucose surge within the bloodstream. Glucose in the urine The high glucose level among type 1 diabetic patients which can sometimes exceed 160 180mg/dl which is the Renal Threshold for Glucose makes the proximal tubules of the kidneys overwhelmed making it to excrete glucose in urine. Children just like pregnant women usually have low Renal Threshold for Glucose (below 7mmol/L) beyond which they developglycosuria (Reznik Cohen, 2013). Since the proximal tubule only reabsorbs limited amounts of glucose, the excess glucose passes into the urine of the patient. Increase urination Also referred to as polyuria, the condition occurs when an individual has excess sugar levels in blood. In normal circumstances, kidneys they reabsorb all glucose to be directed back into the bloodstream (Cleland, 2017). However, type 1 diabetes leads to high glucose levels in urine which pulls more water through osmosis from the bloodstream forming excess urine within a short time. Increased thirst Increased thirst is referred to as polydipsia which is directly related to the increased loss of water through excessive urination among type 1 diabetics. A high concentration of glucose in the bloodstream beyond 200mg/dL the kidneys, can no longer reuptake glucose from water (Weise et al, 2017). This leads to a high osmotic pressure in the in the urine within the proximal tubules of the nephron. As a result, water cannot be any more absorbed into the bloodstream but lost as urine leaving the body dehydrated. The increase in thirst therefore is the bodys response to the low water levels in the bloodstream as result of its high loss through urination. Increased appetite Increased appetite also referred to as polyphagia is caused by insufficient amounts of glucose in the body cells. This, results from low or lack of insulin in the body; hindering the movement of sugar from bloodstream into the tissues. In this case, hypoglycaemia develops due to the bodys inability to convert the food in the body into energy and thus perpetually starving cells (Reznik Cohen, 2013). The body responds appropriately to prevent starving of crucial tissues by making patients feel rapidly hungry and a need to feed. Ketones The lack of and/or low levels of insulin among type 1 diabetes patients makes the body cells to starve due to lack of sugar and thus resort to breaking down fat for energy. Ketones among type 1 diabetes patients result from the burning of fat in the cells instead of glucose (Ogbera, 2014). This process leads also to the spilling of ketonesthat form in blood into the urine.A loss of weight among diabetic patients also produces ketones since there is no sufficient insulin to enable the body break down sugar to create energy. Weight-loss Patients with type 1 diabetes experience sudden weight-loss. The loss of weight is mainly attributed to the bodys breakdown of fat to create energy. The fat which contributes to the body weight in normal circumstances is broken down by cells to create energy since there is no sugar in the cells due to lack of insulin (Ogbera, 2014). The body also burns the muscle energy to compensate for the insufficient glucose levels leading to reduced overall body weight. The Nursing Responsibilities and Supporting Rationales Related to the Administration of Aspart (Novorapid) Insulin Via FlexPenPrior to administration It is the responsibility of the Registered Nurse to ensure that they are able to understand and interpret the insulin prescription sheet. The nurse should ensure that the insulin prescription is not only complete, legible, unambiguous but also correct before administering it to the patient (Pharmacy Today,2017). This helps prevent wrong administration of the dosage and possible side effects to the patient. The nurse also should check insulin name and the dose against the patients insulin prescription chart from the records to ascertain the correct type and prevent accidental administration. The identity of a patient must also be confirmed before administering the insulin to ensure that the right person is given the right medication (Kma, 2017). There is also need to ensure that the insulin has not been administered already to a different person so as to prevent cross-contamination and/or infections. The nurse should then wash their hands, wear gloves, confirm and record blood glucose levels before administering the insulin for comparison purposes (Reznik Cohen, 2013). It is very important to confirm that insulin storage was appropriate and that it has not expired yet. The nurse can then prepare the insulin FlexPen device with an 8mm needle since Briana is not underweight. During administration During administration of NovoRapid by the FlexPen device the nurse should select an appropriate injection site that has clean skin. There is need to avoid to use of alcohol wipes since alcohol makes the injection to be more painful and hardens the skin which is not desired in insulin administration (Davis et al, 2010). The nurse should inject insulin into sub-cutaneous tissue and/or the soft fat but not the muscle. Therefore the nurse needs to raise the skin before administering. There is need to continue raising the injected skin and holding the FlexPen in place for about 10 seconds so as to enable the dispersion of insulin from the site (Kma, 2017). The nurse should ensure that they do not withdraw insulin from a prefilled pen by use of a needle as this contaminates the vial and thus interfering with FlexPen dose determination accuracy (Davis et al, 2010). NovoRapid should be administered subcutaneously using an injection in the wall of the abdomen, the thigh, upper arm, deltoid re gion and also in the gluteal region. This sites should however be rotated to ensure that there is minimal lipodystrophy risk. Since the NovoRapid is characterised with a faster onset of actions, the nurse should administer the medication immediately before the patient takes a meal. After administration After administration, the nurse should remove FlexPen device with the needle and dispose them among other sharps used in the procedure to prevent probable reuse and nosocomial infections through accidental pricks (Davis et al, 2010). The nurse should record the dose administered, timing and the site of injection. These records are for follow up process in managing the patients current and future sugar levels. In case the patient bleeds at the injection site, there is visible insulin at his site and/or the patient feels too much pain, the nurse should report to the supervisor (Pharmacy Today,2017). This could mean the need to re-administer the vial as I is likely that it was injected into the muscles when it should not. The nurse should use a needle remover to remove the needle before disposing it into the sharps safety box. This procedure prevents needle-stick injuries. Potential Impact of Type 1 Diabetes on Briana And Her Family Emotional Briana is likely to suffer from emotional ill-health due to the diabetes subsequent management. Research indicates that one in every three people suffers depression as a result of diabetes diagnosis and this impairs their normal functioning, individual adherence to medication and the required glycaemic control (Reznik Cohen, 2013). Brianas parents will also be affected emotionally as they will develop anxiety, depression among other phobias that are related to their childs health condition. Considering that Mr Tom, Brianas father already has a mental health problem, his situation is likely to deteriorate he receives special counselling on homecare procedures for Briana. The mother will most likely have to undergo the emotional effects of caring for both the father and Briana to prevent any deterioration in their health. Both parents will be concerned that their child might face discrimination from friends due to the condition and thus become anxious and unnecessarily over-protective . Physical Diabetes leads to nerve damages and this leads to slowed rate of stomach emptying, constipation, bloating, urine retention, dizziness while standing, tingling, numbness in the feet and hands among patients. Due to damages caused to the blood vessels, diabetes results to vision impairment, chronic kidney disease, arteriosclerosis among other cardiovascular diseases (Ogbera, 2014). Briana is thus at the risk of developing the above health conditions. Understanding this risk will make the parents physically worn out in managing their childs health condition. The management of sugar levels, providing special diet for Briana and ensuring that she is take out for safe physical exercises are all physically demanding practices to the parents. How to Adapt Your Nursing Care of Briana and Her Family to Accommodate Toms Intellectual Disability Tom as a parent needs to be involved in caring for Briana. However as a nurse I will ensure that I communicate the procedures and care option to him in the most effective way knowing well that he has communication difficulties due to his intellectual disability. In this regard I will use nonverbal communication and encourage his wife to use this approach to meet Toms cognitive and communication needs as indicated in Turan (2017). I will speak directly to him with his permission after confirming from the wife how he speaks and communicates. I would also encourage Tom to use his communication device if any before I brief him of Brianas condition and the necessary homecare activities needed, using simple but direct sentences. It is likely that Mr Tom will not understand all the procedures in one sitting and I will therefore encourage him and the family to be coming back to the facility for a continued instruction of their daughters care. Further, I will provide written instructions to t he family for everyone including Tom to understand the treatment regimen for Briana as suggested in Turan (2017). The written instructions are important as they serve as reference for the family to rely on in managing Brianas sugar levels and administering insulin. References Cleland, S. (2017). Double diabetes: the cardiovascular implications of combining type 1 with type 2 diabetes.Practical Diabetes,34(6), 210-213. Davis, E., Sexson, E., Spangler, M., Foral, P. (2010). An evaluation of prefilled insulin pens: a focus on the Next Generation FlexPenreg;.Medical Devices: Evidence and Research, 41. E, L. (2013). Type 1 Diabetes and Physical Activity in Children and Adolescents.Journal of Diabetes Metabolism,01(S10). Kma, A. (2017). Application of Premixed Insulin NovoMix30 and NovoRapid as Multiple Daily Injections or as Basal Bolus Format in Selected Diabetic Patients: Practical Evidence from Prospective Case Series.International Journal of Diabetology Vascular Disease Research, 1-2. Lukcs, A., Mayer, K., Juhsz, E., Varga, B., Fodor, B., Barkai, L. (2012). Reduced physical fitness in children and adolescents with type 1 diabetes.Pediatric Diabetes,13(5), 432-437. Mogylnytska, L., Mogylnytska, O. (2017). Endothelial Monocyte Activating Peptide II: Serum Levels in Type 1 Diabetes Mellitus.International Journal of Physiology and Pathophysiology,8(1), 57-63. Ogbera, A. (2014). I.13 Pathophysiology of Type 1 diabetes mellitus.Diabetes Research and Clinical Practice,103, S4. Reznik, Y., Cohen, O. (2013). Insulin Pump for Type 2 Diabetes: Use and misuse of continuous subcutaneous insulin infusion in type 2 diabetes.Diabetes Care,36(Supplement_2), S219-S225. Turan Gurhopur, F. (2017). Family Burden among Parents of Children with Intellectual Disability.Journal of Psychiatric Nursing. Updated guideline on use of oral medications to manage type 2 diabetes. (2017).Pharmacy Today,23(4), 14. Weise, J., Pollack, A., Britt, H., Trollor, J. (2017). Primary health care for people with an intellectual disability: an exploration of consultations, problems identified, and their management in Australia.Journal of Intellectual Disability Research,61(5), 399-410.