Assessment and examination to a diabetic patient are important for the improvement of their condition and proper management and care. Particularly, assessing the client’s diet and how they manage it is of the essence, especially in determining its relationship with their insulin levels (Coleman et al., 2017). This will include any exercise done or nutritional supplements taken. Regular monitoring of the blood sugar to the client is looked into.
Following the diagnosis, any admissions in the recent past is looked into so as to be able to determine any complications that might have arose due to the medical condition (Chen et al., 2017). The symptoms that are manifesting due to the diagnosed conditions are also looked into for proper management. In sum when dealing with clients with diabetic symptoms, it is vital to conduct a comprehensive assessment to understand what they need.
Relatedly, a holistic assessment that includes observation of vitals such as temperature, weight and blood pressure is done. This will involve her mental statuses such as mood, appearance and emotional state (Hamilton, 2017). An understanding of this by the nursing team will not only improve client’s care during her treatment but also give insight to the health team on how to relate with her professionally and socially. Examination of the legs is essential for evidence of amyotrophic (Elliott et al., 2018). Eye screening will also rule out any evidence of cataract formation or ophthalmoplegia. The probability of any infection in the body is examined through urinalysis, especially for nitrite, ketones and protein.
Improper and inaccurate assessment can make it challenging to manage the client for example, in determining how and why the sugar levels might be going up which could be as a result of eating various types of foods (Jones & Foli, 2018). Blood pressure, pulse as well other vitals, together with the knowledge of preexisting conditions of the client is important. Specifically, checking the measures helps in determining which type of care is best for the patient (Hamilton, 2017).
Additionally, it helps to understand the suitable option for drugs that will be administered and the proper dosage. Effective assessment also improves client’s literacy and the health team. Therefore, if not completed accurately, it can lead to poor patient knowledge; therefore, errors during the treatment process of the client will be inevitable (Chiang et al., 2019). Poor examination will inevitably pose a challenge in the clinical management of the patient. Therefore, it is vital to ensure that the assessment is not only comprehensive but also accurate.
Documentation and recording of the client’s assessments will be done with the clinical standards, using the progress notes. This will include the evaluations done and the reasons for them, together with any other problem the client might be having, which will be important when coming up with a nursing intervention (Chen et al., 2020). A chart will also be used to record the vitals and blood sugar levels for easier and faster tracking and monitoring. In sum, proper documentation and presentation of the results make an observation of the patients’ progress easier.
Nursing Care Plan
|Nursing Problem: Risk of fluid volume deficit|
|Related to: Increased thirst and passing out of urine frequently|
|Goal of Care||Nursing Intervention||Rationale||Evaluation|
|Grace to be no longer deficient in fluid volume||To encourage the client to drink the prescribed amount of fluid. |
Emphasizing on the importance of oral hygiene.
Educate the client on the causes and effects of loss of fluids and a decreased intake.
Encourage the patient to take fluids in bountiful amounts as per the needs they can tolerate (Essien et al., 2017).
|Oral hydration solutions will increase the fluid replacement. Selection of fluids that are comfortable to the client for instance sports drink will promote the intake further (Jones & Foli, 2018). |
Oral hygiene will reduce the discomfort that comes with dry mucous membranes as a result of fluid deficit. This will also promote interest in drinking.
Adequate and sufficient knowledge will increase the initiative on the client to plan and be part of her care without daily reminders (Chatterjee et al., 2018).
The client might have decided to reduce fluid intake so as to control the frequent urination and reduce the homeostatic reserves thus risk of hypovolemia (Jones & Foli, 2018).
|Grace is taking the daily recommended amount of fluids. |
The patient brushes her teeth twice on a daily basis.
Grace has documented her care plan with specific time for taking fluids.
The patient is responding positively to taking of fluids on a daily.
|Nursing Problem: Risk of electrolyte imbalance|
|Related to: fatigue and diabetes ketoacidosis|
|Goal of Care||Nursing Interventions||Rationale||Evaluation|
|Client to understand the importance of dietary and fluid restrictions||Take patient’s weight daily and observe for any sudden gain in weight. |
Assess for any presence and location of edema and involve the patient as well
|This will be important in monitoring any fluid retention as one liter of retention in fluids is equivalent to 2.2 pounds (Jones & Foli, 2018). |
Osmotic pressures and blood hydrostatic as well as interstitial fluid can cause fluid retention in one localized area (Hamilton, 2017).
|The noted change in weight gain was linked to fluid retention hence proper management of electrolyte imbalance. |
Client is engagement in her care plan and reports of any changes observed in her body.
|Nursing Problem: Risk of unstable blood glucose level|
|Related to: hyperglycemia|
|Goal of care||Nursing Intervention||Rationale||Evaluation|
|Patient to maintain a healthy weight through a healthy diet plan||The client to be assisted in identifying eating patterns that need modification. |
Psycho educating the client on the benefits of following a meal plan that is prescribed.
|This is important in coming up with foods that are necessary for the fluctuation in levels of blood glucose. |
This will be important in helping the client to maintain glucose levels in the blood that are stable.
|Grace has insight on her diet and what is suitable for her. |
Client is involved in a diet that she understands and complies to with ease. She is comfortable with educating her fellow patients in the ward.
Education is important in enabling Grace to better manage her health care and easily adapt to any lifestyle changes that might arise in relation to the diagnosed diabetes mellitus. The changes in behavior, habits and routines should be observed for easy identification and addressing of any issue that might arise which will be of essence in improving the current condition. I will educate Grace on diet and the changes that are involved.
This will empower her on proper maintenance and adherence as she will be having insight on the reason for it. Eating more fruits, vegetables and fiber as well as reducing salt intake are among the information she will get, together with her mother. The diet can also include more fish, monitoring of carbohydrates intake and monitoring of fluid intake. Encouraging her on healthy eating on the wide range of foods will also be of essence.
It will be important for Grace to understand how to manage the condition when she goes back to school and how to incorporate into her daily routine. Considering the fact that she is a teenager and a school going girl, it is essential for both the parent and her child to have information on how they are going to manage themselves. This provides a knowledge concerning her range of blood sugar, symptoms that might present themselves while she is at school, her snack and meal plan in school as well as the sports and games she will be engaged in and how they will manage it together (Hamilton et al., 2017). Incorporating information such as who to call during an emergency, what symptoms ought to be monitored, eating duration and the availability and accessibility of the bathroom in the school plan are of great value in the care of the client.
Grace’s mother in order to effectively handle the situation will need to inform the school management and together come up with a medical management plan for her diabetes. This will provide in depth information concerning the patient and how she can be effectively taken care of without interrupting her school activities and learning (Zhang et al., 2020). Determining whether the child needs help in determining her blood sugar levels or not, monitoring the symptoms as well as the necessity in taking of her medications will all be put into consideration. If the school has other students who are diabetic, they can be teamed up together for moral and social support (Hamilton et al., 2017).
Together with her mother, Grace can also come up with a diet plan that explains the meals and foods she takes and in which quantity. This will entail access to water and any necessary fluids that is needed in the treatment plan of the client. Remarkably, the diet plan will give the client a sense of responsibility and involvement in her treatment plan without feeling sorry for herself (Gvozdanović et al., 2019). The plan will be important in controlling and monitoring blood glucose levels and stay on track towards a healthier self hence boost confidence and self-esteem as well.
The hourly rate of the compound sodium lactate and sodium chloride infusions is 4-14 Ml/kg/h. This formula enables in maintenance of insulin levels as well as sodium and fluid levels. The Sodium lactase compound is often administered through drip or infusion in to the vein so that the treatment can get in to the body quickly to improve dehydration (Takagi et al., 2018). Notably, the dosage that a person is given depends on different factors such as the age of the patient, there medical condition, weight and the response that their body has been showing with preceding medications. Notably, if the correct formula is not followed the patient is likely to become dehydrated or exhibit symptoms of confusion.
The patient has been prescribed with intravenous sodium chloride 1000mls/8 hourly and Insulin Glargine 30 units OD (s/c). Intravenous sodium chloride is given through a drip through a cannula placed in a blood stream vein so as to manage fluid loss as well as restore the balance of sodium chloride which is an important mineral salt in our body fluids (Chatterjee et al., 2018). It also dilutes other medicines before being administered in the body. Insulin Glargine is a form of human insulin that has been designed to be low in solubility and at a neutral pH of 4. Its action lasts longer as it promotes the movement of sugar from the blood into other body tissues and stopping of sugar production in the liver. Diabetic patients are therefore able to control glucose in the body.
The patient has been prescribed with the intravenous sodium chloride so as to manage the loss of fluids that was characterized by frequent thirst from the client. She also exhibited symptoms of passing large amounts of urine frequently, fatigue and fever (Barnes & Harriss, 2018). This also manages the amount of minerals in the body fluids hence looking into minimization of electrolyte imbalance. Insulin Glargine will be of importance in regulating the glucose in the body hence normal insulin levels, especially by lowering the sugar levels in the blood (Chatterjee et al., 2018). It also increases the amount of sugar used by the muscles, helping to store sugar fat as well as enabling the body to make protein. This also helps the liver to stop making sugar.
The patient might experience side effects such as hunger due to low blood sugar, dizziness, sweating and chills. She might also encounter swelling of the legs, feet or arms, swollen itchy skin as well as unexplained gain in weight (Bonora et al., 2020). This could also present with upper respiratory infection for example common cold as well as low blood sugar levels. Intravenous sodium chloride could lead to side effects such as fluid retention and hypernatremia (Takagi et al., 2018). Other symptoms include muscle cramps, fever and swelling with redness at the site of injection which can lead to changes in the mood of the client. Thus, such adverse reactions can be handled depending with the severity of the condition. Moreover, if the patient has a specific allergic reaction to any of the compound in the drug, then it is relevant to provide alternative treatment.
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