Introduction
The symptoms experienced by Mrs Possingham over the last two weeks are the typical case of diabetes. From the case study, it is revealed that Mrs Possingham had shown some symptoms that can be linked with the complication of diabetes mellitus.
The objective of this paper is to confirm that the symptoms manifested on Mrs Possingham is the complication resulted from diabetes. The confirmation of her diabetes condition was because of the signs and symptoms experienced by Mrs Possingham over the last few weeks at home.
The paper also presents reasons for her immediate clinical diabetic condition and the complications related to her diabetic condition.
Typically, the symptoms of diabetes usually appear on people of any age. Although type 2 diabetes is very common among adults aged 40 and above.
The rest of the paper is structure as follows:
- First, the paper identifies shortcoming of current management, and provide recommendations of additional management that can aid Mrs Possingham from diabetic condition.
- In addition, the paper identifies patient’s educational needs, and this is linked with management guideline.
- Finally, the paper identifies planning needs to alleviate the case of Mrs Possingham.
Confirmation of Diabetes in the Case of Mrs Possingham
There are several evidences to confirm the evidence of diabetes in the case of Mrs Possingham.
First, it was tested that Mrs Possingham had too much glucose in her blood stream with high-level glucose. According to Normal (2009), one of the major symptoms of diabetes is when there is elevated glucose in the blood stream of a patient, and excessive glucose in the blood stream lead to complication of diabetes.
Cyrer (2005) also argued that the syndrome of defective glucose which leads to glucose concentration is typical symptom of diabetes. It is essential to realize the high concentration of glucose in the blood can lead to advance cases of type 2 diabetes.
It should also be noted that when there is increase in the blood glucose, this will lead to a situation where cell will not able to function normally, and the complications will lead to nervousness, confusion, cool skin, and headache. From the test examination conducted on Mrs Possingham, it is revealed that there was high level of glucose in her blood stream, which confirms the symptom of diabetes on Mrs Possingham.
Moreover, from the medication such as Aspirin of 100mg daily prescribed to Mrs Possingham, this is shown to be essential for diabetic patients. Typically, Aspirin therapy is one of the medications for people with diabetes, and Aspirin is effective to reduce cardiovascular events by 15% and myocardial infarction by 36%, which have one of the symptoms of diabetic patients. (American Diabetes Association, 2004).
Essentially, the case study revealed that Mrs Possingham did not enjoy exercise, all her exercise was only to take family dog around the block for the dog’s exercise. However, it is revealed that people who partake in little or no exercise such as Mrs Possingham possess the high risk of developing diabetes. With people of her age, exercise is very essential. There is need to partake in physical exercise in order to prevent diabetes especially type 2 diabetes. Meanwhile, people partaking with little or no physical exercise are at higher risk of developing type 2 diabetes. The research paper presented by Sigal et al (2006) confirmed this assertion that there is high importance on the effect of structured intervention of physical exercise in the prevention of diabetes, and the exercise is beneficial on glycemic control.
The author further argued that adults are beneficial in exercise because it improves insulin resistance. Since, Mrs Possingham had been tested for diabetes three years ago; the type of exercise recommended by World Health Organization (2002) is aerobic exercise that includes swimming, walking, or stationary cycling for at least 30 minutes a day. Thus, by not partaking in this type of exercise will aggravate her diabetes condition. It should be noted that Mrs Possingham habitual exercise was only to take the family dog around the block for the dog’s exercise 4 times a week, which is contrary to WHO recommendation of physical exercise.
In addition, Mrs Possingham takes excessive intake of food and alcohol. Fox, Kilvert(2007) argued that alcohol contains calories, and carbohydrate are higher in alcohol, and may contain lot of sugar. Taking excessive alcohol can lead to diabetic occurrence on individual. Thus, there is evidence that Mrs Possingham suffers from diabetes.
Finally, Mrs Possingham showed sign of increase thirst, which is one of the symptoms of diabetes. According to Watkins (2003), thirst is one of the symptoms of diabetes.
Fox, Kilvert(2007) also argued that thirst is the most common signs of diabetes. It should be noted that people with diabetes regularly pass out urine, which lead to constant thirst, and effect will eventually lead to dry skin.
Having confirmed that Mrs Possingham is suffering from diabetes, the paper identifies the shortcoming of current management, and provides recommendations of additional management that can aid Mrs Possingham from her diabetic condition.
Additional Suggested Diagnoses, and Shortcoming of Current Management, and Recommendations of Additional Management
Apart from the diagnoses in the case study, additional supported diagnose for Mrs Possingham should be conducted with relevance to guideline provided by National Institute of Health (2008). The following test should be used for additional diagnosis of Mrs Possingham.
- Fasting Plasma Glucose (FPG) Test: This is the test to measure the blood glucose. This test should be conducted before eating for at least 8 hours. This test is conducted to detect diabetes in patients.
- Oral Glucose Tolerance Test (OGTT): This is another test to measure the blood glucose. The test is conducted between 2 and 8 hours that a person drinks glucose-containing beverage.
- Random Plasma Glucose Test: Another major test to detect diabetes is to measure blood glucose to show whether blood glucose level is 200 mg/dL or higher. The test reveals that a person has diabetes if there increased thirst, increased urination, and unexplained weight loss.
However, there is shortcoming in the management plan in the case. Apart from prescribing medication for Mrs Possingham, there is need to educate her on the appropriate method to manage her diabetes. From indication, Mrs Possingham has diabetes, and there is need to include including the procedure on how to manage her diabetes. Apart from symptom of diabetes, Mrs Possingham was at high risks of diabetes because of her age. She is 48 years, and adult from the age of 40 and above could develop type 2 diabetes if they eat high calorie of carbohydrate or glucose.
Management diabetes is essential because it is revealed that diabetes patients can live normal life if properly managed.
For instance, Hays, Clarks (1999) argued that physical activity is an integral for managing diabetes among adult. Adult of 40 and above have high risks of developing diabetes if not partaking in physical exercise. It should be noted that 30 minute a day of physical exercise is recommended for diabetes patients in order to manage their case. The benefit of physical exercise should not be underestimated. Regular physical activity improves glycemic control among adults with diabetes. Moreover, physical activity with moderate intensity provides additional benefits for cardiovascular health, as well as increasing life span to about 3 to 9 years (Tucker et al 2000).
Thus, the management of diabetes that Mrs Possingham should partake is physical activity. Essentially, Mrs Possingham could partake in 150 min/week of moderate-intensity aerobic physical activity. She could also partake in 90 min/week of vigorous aerobic exercise. These type of exercises increase heat beat rate by 70%. Typically, exercise is very advantageous for diabetic patients because of its CVD risk reduction. (Sigal et al 2006).
Meanwhile, from the indication of the advantage of physical exercise in the management of diabetes, there is need for proper education for the patient.
Patient Education Identified from the Scenario
As indicated by Davis and Rebecca (2007)
“Diabetes patients who have no outpatient education have more than a fourfold increased risk of developing complications than those who do receive education. Early referral to an RD soon after diagnosis can help patients achieve better glucose control, decrease their risk of complications, and develop positive self-management behaviors at the outset” (p.103).
From the case, it is revealed that the patient works as an accountant and has business lunches/dinners several days a week, which makes it difficult for her to avoid excessive intake of food and alcohol. It is essential to realise that people with obese body have high risks of developing diabetes. Thus, from indication, the patient take excessive of food and alcohol, and this made her to develop obese body. Fox, Kilvert (2007) argued that excessive alcohol contain calorie that make a person to develop weight.
Thus, there is need for the patient to reduce the amount of beer taken. Typically, there is approximately 180 calories in a pint of beer, and this is equivalent to a large roll of bread. Thus, there is strong indication that the patient should reduce the amount of beer taken. Moreover, Mrs Possingham should avoid strong brew that contain high calorie of carbohydrate. In addition, the patient should avoid taken beer that contains lot of sugar.
The excessive food taking by the patient should also be discouraged. Davis and Rebecca (2007) pointed excessive intake of carbohydrate may increase postprandial glucose excursions, and high postprandial blood glucose has been identified as an independent risk factor that can lead to cardiovascular disease. Thus, there is need to educate the patient to reduce the calories intake of her food. There is need for the patient to improve blood glucose control. Thus, to, provide guidance on the type of food that should be taking, Mrs Possingham should ensure taking non-starchy vegetables, and there should be decrease in intake of her food calories. Moreover, the patient should decrease the volume of fat and food that contain large amount of sodium.
Although, this paper is not discouraging the patient from taking carbohydrates, since carbohydrates are vital part of a healthful diet. As indicated “Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with additional insulin or glucose-lowering medications. Care should be taken to avoid excess energy intake. A dietary pattern that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health.” (Davis and Rebecca (2007, p101).
In addition, the case also reveals that the patient smokes 10 cigarettes per day. According Fox, Kilvert(2007) “Smoking is a danger, both to the lungs, and because risk of increased arterial disease, which effects anyone who smokes. Someone with long-standing diabetes is at risks of problems with poor blood circulation, and it is unwise to increase this risk by continue to smoke”. (p 179).
Watkins (2003) also support the argument of Fox et al by stating “smoking exacerbates all complication of diabetes, both micro vascular, and macro vascular.”(P.44). Thus, from indication, smoking is dangerous for the patient, and the patient should be properly educated on the disadvantages of smoking of her health. As a diabetic patient, smoking is dangerous for her health.
Thus, the patient should desist from smoking since it has been indicated from medical literatures that smoking is dangerous to health. Smoking, apart aggravating lung disease, the diabetic patient can develop the risk of cardiovascular disease.
Meanwhile to ensure that Mrs Possingham is able to come out from its diabetic complication, there is need to discharge care planning for her diabetic management.
Discharge Planning Needs for the Patient Case
The discharge care plan is essential to for the diabetic patient. Essentially, the patient needs have adequate plan to manage diabetes in order to ensure that the diabetes does not lead to complication. Thus, the following care plan needs to be implemented in the case of Mrs Possingham.
First, the patient needs to take the all the medication. Essentially, in the case, the medication prescribed for Mrs Possingham, and all the medications recommended by doctor should only be given to patient. There should be precautionary measure that the patient is taking the right medication, and the nurse should only administer all dosage. The medicine such as insulin should be stored in the refrigerator and be taken out 20 minutes before being given to the patient. (Buzz.com, 2009).
In addition, the glucose level of the patient should be taken regularly, and the level of the glucose should be controlled to prevent complication. It should be noted that high glucose in the bloodstream could result to complication of patient. The blood glucose of the patient should be taken every 3 or 4 hours. In addition, the urine of the patient should be taken regularly to detect the amount of glucose in the blood stream.
The regular test is essential because there can be increase of blood glucose of diabetic patients at every hour. Thus, it is essential to test for the glucose in the urine at every interval. The checking of glucose is also to examine whether blood glucose is 240 mg/dL or higher. It the blood glucose is higher, this can lead to diabetic complication of the patient. The patient should be monitored for 7 days after the patient has been admitted into the hospital. The area to be well monitored is the glucose in the blood by using blood glucose monitors to check the level of glucose in the patient’s blood. In addition, there should be foot care test as well as dietary program for the patient.
Moreover, it should be ensured that patient takes lot of liquid in order to manage thirst. It should be noted that increased thirst is part of symptom of diabetes.
To ensure that the diabetes condition of the patients is controlled, the blood pressure of the patient should be regularly controlled. It is revealed from the case that the patient smoke 10 cigarettes a day. Thus, people with long history of smoking may develop high blood pressure. Thus, there is need to take her blood of pressure regularly.
Typically, part of the action plan should include counselling the patient the side effect of smoking. Being a diabetic patient, smoking cigarette can aggravate the patient’s diabetic problems.
In addition, there should be plan for the patient to take regularly exercise each day. Typically, physical exercise is one of the potent methods to manage diabetes; there should be a plan for the patient to take regular physical exercise of minimum of 30 minutes a day.
Moreover, diet control is very essential for diabetes patients. The food eating by the patient should be monitored to ensure that the patient does not eat food that contains high level of calories. In addition, the patient should be discouraged to take food that contains high content of glucose and sugar. The food such as cereals, rice, potatoes should be encouraged for the patient. The patient should be encouraged to consult competent dietician before embarking on dietary plan. There should be monitoring of basal metabolic index of the patient. This should be done on monthly basis for the regular references.
It should be noted that charming and friendly attitude to the patient is very essential to the care plan of diabetic patient. The attitude of a nurse towards the patient can aid the patient to recover from the disease as early as possible. Thus, effective care plan is very essential to achieve a potent health for the patient. (Buzz.com, 2009).
Conclusion
Diabetes is one of the diseases that can cause several complications on patients. Evidence has revealed that diabetic complication range from stroke, heart disease or death. Thus, there is need to manage disease before it leads to complication. This paper examines the case of Mrs Possingham, and confirmed suffering from diabetes. From the symptom developed by the patient, it is revealed that the patient is suffering from diabetes. Thus, the paper provides methods that can be used to diagnosis the patient in order to confirm her diabetic condition. The paper also provides recommendation for patient to manage diabetes.
Part of the recommendations provided is physical exercises. Typically, physical exercise is an essential tool to manage diabetes. Several complications leading to diabetes can be easily managed if the patient is partaking in regular physical exercise. In addition, the paper identifies patient’s education on which to manage diabetes. Finally, the paper discharges plan for patient’s case. The plan is essential to ensure that the patient is properly treated in the hospital, and the education that will be provided for the patient will help the patient to live a normal life.
List of References
American Diabetes Association, (2004) ‘Aspirin Therapy in Diabetes’ Diabetes Care, 27(1) pp s72-s73.
Buzz. (2009) Nursing Care Plan For Diabetes, Buzz Limited.
Cyrer, P.E. (2005) ‘Mechanisms of Hypoglycemia-Associated Autonomic Failure and Its Component Syndromes in Diabetes’, A journal of the American Diabetes Association, 54 (12), pp 3592-3601.
Davis, D.L. Rebecca, P.G. (2007) “Nutrition 911: The First Responders’ Guide to Food and Diabetes” Clinical Diabetes, 25(3), pp.101-103.
Fox, C. Kilvert, A. (2007) Type 2 Diabetes, UK, Class Publishing (London) Ltd.
Hays, L. Clark, D. (1999) “Correlates of physical activity in a sample of older adults with type 2 diabetes”, Diabetes Care, 22, (5), pp.706-712.
National Institute of Health (2008) Diagnosis of Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases.
Normal, J. (2009) Diagnosing Diabetes The two primary tests and their results, which combine to make the diagnosis of diabetes, Edocrine Web.
Sigal, R. et al (2006) ‘Physical Activity/Exercise and Type 2 Diabetes’, Diabetes Care 29 (6), pp 1433-1438.
Tucker, K. Bermudez, O. Casteneda C (2000) “Type 2 diabetes is prevalent and poorly controlled among Hispanic elders of Carribean origin”, American Journal of Public Health, 90(8), pp. 1288-1293.
World Health Organisation (2002) Keep fit for life, Meeting the nutritional needs of older persons, Tufts University School of Nutrition and Policy.
Watkins, J. (2003) ABC of Diabetes, UK. Wiley-Blackwell.