Case Study of Diabetes Mellitus and Community Health Nurse

Case sketch of Diabetes Mellitus and Community Health NurseThis paper is going to instance a case study, which has been elect during the two weeks of clinical practicum. It take away present the medical examination history of the patient, focus on current health status and discourse the main(prenominal) responsibilities of community health confine.H.S is a 74 years quondam(a) Emirati, female, married and has 3 daughters and 5 sons. She has been referred to health seat c ar shot on 24/2/2011. The patients past medical history include mild intermittent asthma, irritable bowel syndrome, acute gastritis, esophageal reflux, acquired hypothyroidism, generalize anxiety disorder, inseparable hypertension, diabetes mellitus type-1, chronic diastolic failure, blurred vision and damage hearing. The patient has solelyergies from dust and medication interchangeable penicillin. Her surgical history was earthshaking for cholecystectomy. Also, she had grafting surgery that d unit y to repair the wound at proper(a) forearm which chaired from road traffic accident. Current medications include montelukast (singulair) 10mg ad-libly at once mundane, steroids 500mg orally once per day, insulin 34 units in the morning and 32 units on evening, and cozaar 50mg once fooling. Currently, the patient is suffering from un underwriteled diabetes. The fasting course glucose ranged from 239-455 mg/dl and the past prandial glucose and bed time glucose ranged from 240-598 mg/dl. This appointment will shed light on one of the chronic illness which the patient has, diabetes, including pathophysiology, sign and symptoms, happen factors, epidemiology, diagnosis and treatment. In addition, it will illustrate the community health nurse roles regarding diabetic patient.Diabetes mellitus is a worldwide plaguey disease. It is a metabolic disorder manifested by elevation of blood glucose direct overdue to an absolute shortage of insulin toil and action (American Diabetes As sociation, 2004). The two main classification of diabetes be type 1, this type represents insulin myrmecophilous diabetes, and type 2, non-insulin symbiotic diabetes (Meetoo Allen, 2010). Additional types of diabetes mellitus include gestational diabetes, maturity once diabetes of the young, diabetes resulted from cystic fibrosis, and cushings syndrome diabetes (Meetoo Allen, 2010).As our patient is suffering from diabetes type-1, the nurse mustiness understand the pathophysiology of this type in order to provide optimal financial aid. Type-1 diabetes is order to be a result of an autoimmune mediated damaging of B-cells, pancreatic cells responsible for insulin production. Destruction of these cells will belong to insulin deficiency, which will result in increase of blood glucose and glycosuria. primarily it is symptomatic disorder unlike type-2 diabetes (Meetoo Allen, 2010). Type-2 diabetes is con billetred silent killer approximately state with much(prenominal) disea se argon unaw are because it is asymptomatic in some cases. It is characterized by ab general insulin production, insulin resistance, and alteration in glucagon synthesis (Casey, 2011). Elevation in blood glucose caused by limitation of insulin in transporting glucose into the cells for energy synthesis. High glucose take aim call forths insulin production. So that, passel with this type of diabetes often characterized by excessive insulin production (Casey, 2010). Diabetes symptoms might slightly vary according to the type.Hyperglycemia manifested by a issue of symptoms such as polyuria, polydipsia, weight loss, in some cases associated with polyghagia picture hungry as a result of cellular starvation, and blurred vision. Polyuria occurs when the beat of glucose filtration by the kidney overwhelms reabsorption mechanism (American Diabetes Association, 2004). Fatigue may be presented due to metabolic changes (Casey, 2011). These symptoms could not be severe in type-2 diabetes as a great deal as type-1 (Casey, 2011).Uncontrolled diabetes like in H.S case might lead to unpleasant consequences. These complications include retinopathy with loss of vision, nephropathy which results in renal failure, peripheral device nephropathy with high fortune of foot ulcer and cardiovascular symptoms (American Diabetes Association, 2004). there are many jeopardize factors that lead to hyperglycemia. Some of these factors are non-modifiable such as heredity and race factors. Other modifiable factors include obesity, neediness of exercise, impaired glucose gross profit, cardiovascular disorder, and high level of triglycerides (Rodbard et al, 2007).Diabetes mellitus accounts for high epidemic dower throughout the world. The total number of people with diabetes was significantly increased from 124 zillion in 1997 to 221 million in 2010 (Meetoo Allen, 2010). From a global thought, the highest three countries estimated to flummox the highest number of people with diab etes in 2000 and 2030 are India, China, and the United State of America. The most affected groups are people between 45-64 years old (Meetoo Allen, 2010). The risk of death for people with diabetes mellitus is twice that among individuals without diabetes of similar age (Rodbard et al, 2007). If patient diagnosed in the beginning age 40 years, the average reduction in disembodied spirit foreboding is 12 years for men and 19 years for women (Rodbard et al, 2007).There are a number of diagnostic procedures that absorb been used to determine the blood glucose level. These strategies include observation the symptoms of diabetes such as polyuria, polydipsia, and weight loss (Rodbard et al, 2007). In addition, diabetic patient could be identified with fasting plasma glucose niggardness more than or equal 126mg/dl or plasma glucose dousing more than or equal 200 mg/dl in normal status. These measurements taken by using a 75-g oral glucose tolerance test (Rodbard et al, 2007).Applying seize interpolation for patient with chronic disease like diabetes is an essential strategy to prevent any complications that might result from doubtful arrest (Pimouguet, Goff, Thiebaut, Dartigues Halmer, 2011). The aims of diabetes treatment are to control blood glucose level to prune the risk of long term complications and to help the patient with diabetes to live normal healthy life (Meetoo Allen, 2010). The choice of treatment depends on the type of diabetes. For instance, patient with type 1 and some cases with type 2, insulin is an separate treatment in maintaining nearly normal level of blood glucose (Meetoo Allen, 2010). Unlike type-2 diabetes, in which focussing processes are based mainly on life style modifications. For example, rhythmical food intake, symmetric exercise, weight management and limited alcohol intake. Also, oral anti-diabetic agents are used to maintain normal level of blood glucose and to enhance the action of pancreatic cells (Meetoo Allen, 2010). Furthermore, one of the most effective methods which are essential for patients with type-2 diabetes or for people who are at high risk is repair monitoring of blood glucose level .This method helps to prevent acquiring diabetes for people who are at increased risk of hyperglycemia or for those who have poor glycemic control (Grant, 2010).The role of the nurse in delivering community health care is considered an essential part in managing patients suss out at home sitting. As nurses working in community care, a number of responsibilities are involved in care of patient with diabetes including assessment and providing optimal intervention (Carey Courtenay, 2008). The nurse is considered the only professional who has a complete knowledge roughly patients medical status (OReilly, 2005). Effective assessment will enable the nurse to create appropriate plan regarding patients condition and provide best care (World Health Organization, 2001). For optimal care, the community nur se should has enough knowledge regarding patients health disorder include functional limitations, patients medical history, prognosis, physical assessment for all body systems and behavioral status (OReilly, 2005). In addition, it is important to assess separate factors that could affect patients health such as safety of living environment, types of daily living activities, medication awareness and compliance, equipment availability such as oxygen, intravenous therapy, and parenteral nutrition (Smeltzer, Bare, Hinkle Cheever, 2008). For diabetic patient, the nurse is responsible to assess precise factors that might interfere with glycemic control. One of these factors is age- related changes such as physiological functions. For instance, loss of taste and olfactory functions may lead to malnutrition intake. So, that will lead to abnormal metabolism and blood glucose maintenance (OReilly, 2005). Dehydration is also one of the complication that might occur due to loss of thirst knowledge which affected by age factor. The nurse must evaluate the condition carefully in order to meet the needs (OReilly, 2005). Also, the nurse must assess for the presence of neuropathies, because it increase the risk of fall and infection (Smeltzer, Bare, Hinkle Cheever, 2008). Furthermore, optical deficits and retinopathy must be assessed because the patient may be at risk of taking medication in correctly and become unable to perform regular blood glucose test (OReilly, 2005). The nurse should ensure that the patient is aware closely all medications and being compliance with. Also, identification and investigation of any complications are very crucial to protect the patient from life threatening condition (Diabetes Specialist Nurses, 2007). If the patient has diabetic foot, the nurse should assess the wound, regular get dressed must be done and monitor for any further complications (Smeltzer, Bare, Hinkle Cheever, 2008). Moreover, accurate documentation is necessary to e nsure patients need correctly (OReilly, 2005).Diabetes mellitus requires regular egotism care behaviors. Nurse is responsible to teach the patient about appropriate self management (Smeltzer, Bare, Hinkle Cheever, 2008). Physical and emotional stress could affect glycemic control negatively, so patients must learn how to balance among such factors. They should learn daily self care skills to prevent instability of blood glucose. In addition, patients must be aware about good nutrition by pastime a calorie- controlled diet (Smeltzer, Bare, Hinkle Cheever, 2008). They should know that they might need additional meals and snacks during diverse exercises or at bedtime to prevent hypoglycemia. Also, patients must have knowledge regarding medications side effects and disease progression. Patients and family members should be taught about the symptoms of both hyperglycemia and hypoglycemia in order to be able to provide a ask care (Smeltzer, Bare, Hinkle Cheever, 2008).In conclusio n, this essay has discussed a case study that has been chosen during the clinical practicum time. Mainly, it focused on one of current health enigma in which the patient is suffering from, diabetes mellitus. It discussed the pathophysiology of the two types of diabetes, type-1 and type-2. Diabetes is characterized by a number of symptoms such as polyuria, polydipsia, weight loss, and polyghagia. There are many risk factors might cause diabetes such as obesity and sedentary life style. This paper has also presented statistical information regarding diabetes disorder throughout the world, it found that India is the highest country that account for the highest number of people with diabetes. Moreover, there are various diagnostic methods that are used to identify and investigate patients with diabetes or who are at high risk. Treatment strategies are varying with different types of diabetes. Type-1 is insulin dependent diabetes while type-2 is non-insulin dependent. Diabetes mellitus is considered a chronic disease that required regular appropriate care at home sitting. Community health nurse has a number of responsibilities regarding diabetic patients care include effective assessment and providing learn plan that help the patient to maintain controlled blood sugar level. Finally, diabetic patients should be aware about daily self care.