Subjective and Objective Data
The patient might share the additional subjective data regarding the chronic fatigue he is experiencing as well as provide a detailed description of pain intensity. Further, the patient should describe the type of diet he has because cholecystectomy is recorded in his medical history and the patient has gained weight (Nathan, 2015). In terms of the objective data, explicit signs should be evaluated. For instance, it is essential to examine the patient’s eyes and skin turgor. Also, it is necessary to check if his skin is dry or flushed.
One of the most important national guidelines to be considered is the initiative on Diabetes proposed by Healthy People 2020. The objectives discussed in D-16 “Increase prevention behaviors in persons at high risk for diabetes with prediabetes” are applicable in that matter (Healthy People, 2014). The guideline as well as the objectives through light on the essential healthcare practices, interventions, and plan of care for patients suffering from diabetes and for those individuals who run the risk of developing this disease.
Tests and Consultation
To determine the primary diagnosis, it is necessary to conduct a series of tests including blood sampling, which will help to identify quantitative indicators of blood cells. Also, it is important to order a blood chemistry test, urinalysis, and electrocardiogram (Nathan, 2015). It might be required to look for a consult from other professionals, such as an ophthalmologist who will examine the fundus. After the obtained data, enzymatic UV-method should also be applied to the patient.
Due to poor lab results (borderline risks in terms of total cholesterol, low-density lipoprotein, high-density lipoprotein), the preliminary nursing diagnoses should be heart pain due to shortness of breath. Fluid and electrolyte imbalance due to the possibility of diabetes and insufficient digestion after eating related to disrupted metabolism (Nathan, 2015). The medical diagnosis is diabetes.
Patients with diabetes require particular attention due to the complexity of this disease. In terms of the current patient, the nurse should understand that patients with this illness are likely to have emotional outbursts; therefore, maintaining an individual’s psychological stability is essential. Also, the man’s wife has MS, and the individual might experience additional stress related to caregiver burden. As stated in the description, he experiences chronic fatigue, which complicates and affects his emotional balance; thus, the nurse should be considerate about the man’s acuity levels.
Plan of Care
The plan of care should include adequate control of blood pressure and lipids. Also, it might be required to prescribe metformin. If the goals of glycemic control are not achieved, it will be necessary to add other drugs (sulfonylureas or insulin) (Gulanick & Myers, 2013). Further on, if the treatment does not help, the patient might be prescribed oral hypoglycemic agents; however, insulin intensification is preferable. Regarding the complementary therapy, the specialist should consider the type of patient’s diet in the case when the individual receives insulin. Carbohydrates increase blood glucose levels; therefore, they should be taken into account when determining the appropriate dose of insulin.
Circle of Caring
To ensure the best patient outcomes, it is essential to empower nurses. In the current case, it is important that the nurse can increase the input by exercising autonomy and participating in the decision-making process (Gulanick & Myers, 2013). Using the Circle of Caring, the specialist would be given the authority to provide educational services to the family members and to instruct the patient on the side effects of unmanaged diabetes.
The nurse should teach the patient how to check blood sugars. Importantly, if the patient has to make injections, the specialist must demonstrate how to give insulin injections correctly (Gulanick & Myers, 2013). In terms of the complementary therapy, the nurse should educate the man on his plan of exercise. Moreover, due to the complex nature of the illness, the patient should be instructed on the effective coping strategies to be able to relieve stress related to the disease and the caregiver burden as well.
Gulanick, M., & Myers, J. (2013). Nursing care plans. New York, NY: Elsevier.
Healthy People. (2014). Diabetes. Web.
Nathan, D. (2015). Diabetes: Advances in diagnosis and treatment. JAMA, 314(10), 1052-1062.