Case Scenario of Michael Anderson
Michael Anderson suffers from morbid obesity and types 2 diabetes, and he has some care needs which he needs to be attended to improve the situation he is undergoing. Among the care needs identified are shakiness, diaphoresis, increased hunger, high BGL levels and difficulty in breathing when he sleeps. Excessive sweating is associated with a high metabolic rate which is triggered by the thyroid gland that produces lots of hormones.
However, thigh BGL levels result from the inability of insulin to function properly. Increased hunger results from the failure of energy to convert eaten food to energy (Ding et al., 2015). Dyspnoea was as a result of diabetic ketoacidosis a problem of diabetes where acids accumulate in blood and urine. Shakiness on the other had results due to high BGL which made Michael weak and shaky. The paper will address a case study of Michael Anderson who suffers from morbid obesity and diabetes 2.
The mentioned conditions need care done on Michael so that he could be in the position to stabilize his conditions. However, high BGL and difficulty in breathing forms complex care priorities which should be addressed first before any step. High blood level could affect Michael in many ways, for instance, it causes cataracts and possibly he will lose vision, diabetic nephropathy which damage kidney and also diabetic neuropathy which harm nerves (McGuire et al., 2014). His high weight and BMI causes TLC to decrease, and entry of breathed air is restricted, and due to these conditions, Michael needs immediate care to stabilize his conditions.
BGL Care
Michael had high blood glucose level (GGL) also termed as hyperglycemia. It means that his blood glucose level was > 140 -180mg/d hence he needed treatment. A1C value ≥ 6.5% is an appropriate method which his blood sugar levels could be checked. This procedure will assist in indicating the pre-hospitalization treatment, and also it can be an asset in determining the discharge planning for Michael. For Michael, steady carbohydrate meal and management of glucose ought to be checked prior to each diet; Oral formulations must be halted at severe illness.
Michael was hospitalized, and his insulin therapy needed flexibility to rapidly change within his condition and also best offered by bolus insulin regimen.
It is also significant to mention that it is not good to utilize correction scale insulin or sliding scale insulin on Michael based on his conditions .Continuous intravenous (IV) insulin forms a secure and efficient approach to attain glucose levels in a particular variance and react quickly to varying medical situations (Tay et al., 2014). IV insulin must be prescribed at sugar levels of > 180 mg/dl and corrected to sustain sugar levels within a 140–180 mg/dl range. Homogeneous orders promote an acquaintance with guiding principle among medics and reduce mistakes.
A number of IV insulin regimens have been utilized proficiently (Harding et al., 2014). Examination of IV insulin combination procedures indicates orders which regulate insulin in regards to existing glucose levels and frequency of modification of sugar levels are successful as compared to the principles which alter prescribed amount of insulin in regards to existing glucose ranges (Varney et al 2014)
Complex Care Priorities
IV insulin offers Michael basal insulin. Once he starts eating, MBI must be offered. Incase IV insulin shoot up counter to postprandial hyperglycemia, noteworthy danger of hypoglycemia happens subsequent to declination of the postprandial hyperglycemia. Consequently, changeover to subcutaneous basal insulin the moment Michael is eating consistently is appropriate. IV insulin must be persistently offered for about 4 hours following administration of the glargine insulin, more expediently, be stopped sooner after the glargine administration by halting it instantly following provision of rapid-acting analog as a mealtime bolus dose.
A dose of basal insulin should be projected through finding the IV insulin necessity while Michael is under meals. The stress of acute ill health will amplify needs of insulin. When stress reduces; the required levels of basal insulin will also decline (Hamar, et al., 2013). The time of change from IV to subcutaneous insulin, there is a fall in basal dose by percentage range of 20–33 in order to counter for the decline. Patients having only stress-induced hyperglycemia, could have their insulin persist to reduce when the state get better. The mealtime bolus doses rely on Michael’s caloric intake. He should not be consuming full meals as a result; the expedient initial treatment is going to be ten percent in regards to basal dose provided during each diet. Mealtime boluses should be raised each day as the meal improves.
The schedule basal insulin is only made to prevent high blood sugar, but the correction scale insulin merely tries to reducer BGL after it occurred. Studies have also indicated that scheduled basal insulin is 66% more appropriate to tackle hypoglycemia as compared to 38% of sliding scale insulin (Rogerson et al., 2013). Basal-bolus Regimen has got three components which are relevant to the conditions of Michael. These are meal bolus insulin, basal insulin, and correctional insulin. The perfect basal insulin offers a continuous twenty four hours peakless range of insulin which can restrain the production of glucose by the liver at the meals times and fasting rate.
The shakiness of Michael can result from him not able to eat hence NPH insulin is not appropriate for him because it can lead to an unpredictable increase in blood glucose level. However, Glargine is insulin which is also appropriate for Michael because it offers relatively peakless basal insulin. It has a longer duration of action when administered daily. When adhered correctly, the basal insulin will not cause high blood glucose levels particularly when Michel is limited to oral nutritional intake (NPO)
The mealtime bolus insulin aims to avert the predicted postprandial increase in the sugar levels. The bolus insulin will be best offered with one of rapid acting analogs during each meal (Koehler et al., 2014). All these types of insulin analogs have got the high onset of actions and attained peak levels in an hour. Researchers have indicated that the rapid-acting insulin analogs (RAIA) controlled the postprandial increase in the blood sugars and also afterward reduce hypoglycemia more efficiently than the regular insulin (Gunton et al., 2014).
BGL Care
For Michael to get benefited from (RAIA), he ought to be provided this insulin 0-15 minutes after meals while if doctors prefer regular insulin, then he should be given 30 minutes before he eats any meal due to its rates of actions. The timing necessities for pre-meal regular insulin management will not usually practically work in an occupied hospital entity. However, bolus insulin ought to be withdrawn while Michael is under NPO.
CI is projected to reduce high sugar levels and but not prevention of nutritional hyperglycemia. On the other point, mealtime bolus insulin, the utilization of the rapid-acting analog forms the appropriate alternative for CI for Michael who at this time can eat. Before each meal, the MBI dose and the CI dose is supplemented and administered concurrently (Hawley & McGarvey, 2015). Nevertheless, it is advisable to request them separately so they can get changed independently. The MBI ought to be suspended when patients are under meals correctional doses must still be provided when required to care for hyperglycemia.
Breathing problems
The issue caused by breathing difficulty can be remedied using pharmacological and physical interventions, and the commonly used are inhaled bronchodilators and oxygen therapy. Due to difficulties in breathing suffered by Michael, oxygen should be prescribed for him. The face mask will be used or even the nasal cannula (Mayfield et al., 2014). Nurses should be careful to ensure that a correct proportion of oxygen is delivered. The use of humidification prevents the nasal cavities from drying and also prevents retention of sputum. Taking larger meals can prevent the relaxation and expansion of diaphragm hence Michael is encouraged to eat several, regular balanced meals. These will prevent discomfort and also facilitate the uptake of food. He should also drink lots of water daily to reduce the risk of dehydration.
Some specific breathing exercises should be taught and offered to Michael and also should be encouraged to use regularly. When he is unable to breathe, he should be able to use these techniques to minimize discomfort. While hospitalized, Michael needs a good position to make the respiratory passage functions well. Pillow should support small section of his back. It is advisable to avoid many pillows which can sink Michael and restricts the chest movement (Dixon et al., 2013). The pressure points such as ankles, elbows, and heels should be regularly checked. He should be assisted to relieve pressure points frequently to prevent skin breakdown.
Dyspnoea is often frightening for patients, and it can result in anxiety which can further cause him to become more breathless. Michael, therefore, needs nursing intervention where he will be communicated calmly and instructing him to breathe slowly. Michael also should be offered tactile approach where gentle rubbing of his back and arm stroking is done. It will assist him to get relaxed and minimizes the respiratory efforts. The room should be ventilated and also blowing air to his face is appropriate to approach. Michael should not be left alone under these conditions but he should be distracted so that his mind is taken off and occupied with something else
Conclusion
Michael Anderson complications need lots of care, and upon controlling his high BGL and breathing issues, his condition will stabilize. The exercise which he mentioned that he was going to do after the discharge will assist him in reducing the pressure levels. However, the fat content will be reduced by exercises, and lung volume will increase making him in a better position to breath.
References
Ding, D., Chong, S., Jalaludin, B., Comino, E., & Bauman, A. E. (2015). Risk factors of incident type 2-diabetes mellitus over a 3-year follow-up: Results from a large Australian sample. Diabetes research and clinical practice, 108(2), 306-315.
Dixon, J. B., Browne, J. L., Lambert, G. W., Jones, K. M., Reddy, P., Pouwer, F., & Speight, J. (2013). Severely obese people with diabetes experience impaired emotional well-being associated with socioeconomic disadvantage: results from Diabetes MILES–Australia. Diabetes research and clinical practice, 101(2), 131-140.
Gunton, J. E., Cheung, N. W., Davis, T. M., Zoungas, S., & Colagiuri, S. (2014). A new blood glucose management algorithm for type 2 diabetes: a position statement of the Australian Diabetes Society. Med J Aust, 201(11), 650-653.
Hamar, G. B., Rula, E. Y., Wells, A., Coberley, C., Pope, J. E., & Larkin, S. (2013). Impact of a chronic disease management program on hospital admissions and readmissions in an Australian population with heart disease or diabetes. Population health management, 16(2), 125-131.
Harding, J. L., Shaw, J. E., Peeters, A., Guiver, T., Davidson, S., & Magliano, D. J. (2014). Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997–2010. Diabetes Care, 37(9), 2579-2586.
Hawley, N. L., & McGarvey, S. T. (2015). Obesity and diabetes in Pacific Islanders: the current burden and the need for urgent action. Current diabetes reports, 15(5), 1-10.
Koehler, U., Buchholz, C., Cassel, W., Hildebrandt, O., Redhardt, F., Sohrabi, K., … & Grimm, W. (2014). Daytime sleepiness in patients with obstructive sleep apnea and severe obesity: prevalence, predictors, and therapy. Wiener klinische Wochenschrift, 126(19-20), 619-625.
Mayfield, S., Bogossian, F., O’Malley, L., & Schibler, A. (2014). High?flow nasal cannula oxygen therapy for infants with bronchiolitis: Pilot study. Journal of paediatrics and child health, 50(5), 373-378.
McGuire, A. M., Anderson, D. J., & Fulbrook, P. (2014). Perceived barriers to healthy lifestyle activities in midlife and older Australian women with type 2 diabetes. Collegian, 21(4), 301-310.
Rogerson, M. C., Le Grande, M. R., Dunstan, D. W., Magliano, D. J., Murphy, B. M., Salmon, J.,& Jackson, A. C. (2016). Television viewing time and 13-year mortality in adults with cardiovascular disease: Data from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Heart, Lung and Circulation, 25(8), 829-836.
Tay, J., Luscombe-Marsh, N. D., Thompson, C. H., Noakes, M., Buckley, J. D., Wittert, G. A., & Brinkworth, G. D. (2014). A very low-carbohydrate, low–saturated fat diet for type 2 diabetes management: a randomized trial. Diabetes Care, 37(11), 2909-2918.
Varney, J. E., Weiland, T. J., Inder, W. J., & Jelinek, G. A. (2014). Effect of hospital?based telephone coaching on glycaemic control and adherence to management guidelines in type 2 diabetes, a randomised controlled trial. Internal medicine journal, 44(9), 890-897.
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