Causes of Abnormal Findings
Discuss about the Impact Of Fat Protein, And Glycaemic Index.
Normal
BP: 90/50
Sp02: 94%
Soft abdomen, no rebound tenderness
Bowel sounds present
Abnormal
HR: 120 beats per minute
RR: 20 coarse air entry, moist productive cough
Temp: 37.9 degrees
Irritation, confusion, and agitation
Poor skin turgor.
Frequent urination
BGL 24
Increased blood glucose level (24) is considered abnormal in this case. It is because the patient is type 1 diabetic. The patient has been taking increasing amount of soft drinks and coffee to complete her thesis. Coffee and soft drinks contain too much calories and carbohydrates that increases the blood glucose level in type I diabetes. It is manifested as frequent urination, confusion and shortness of breath as initial and later signs. With increase in sugar kidneys filter more to absorb sugar, causing polyuria (Bell et al. 2015). Increased blood glucose level in the patent is a concern as Nancy is under serious stress due to her thesis submission. According to Buchberger et al. (2016) stress increases the level of Cortisol and Adrenaline, that raises the blood glucose level. In addition, neglecting on insulin intake at regular interval also is the risk factor for blood glucose. In the given case Nancy has been avoiding insulin for couple of days as it was missing in her log book, where she regularly entered her recording for BGL and insulin regime. With lack of insulin, the body fails to convert sugar to energy for the body cells resulting hyperglycemia and decreased insulin production by pancreatic beta cells.
The other abnormal finding in this case is the moist productive cough with respiratory rate of 20 indicates the risk of infection. It is because the patient is already been diagnosed with viral chest infection which was managed conservatively. Inflammation in upper airways leads to chesty cough usually caused by the bacterial infections such as pneumonia or viral infections like flu. The coughing occurs due to infection that increases congestion in lungs, restricting air entry (Casqueiro, Casqueiro and Alves 2012). Coarse entry of the air causes cough and shortness of breath. The signs of the infection are manifested as increased heart rate (120), respiratory rate (20), and fever (37.9). Warmer temperature in Nancy is increasing heart rate. It is the combined action of pyrogens that stimulates the hypothalamus to change the temperature during infection. To compensate for this heat, the blood circulation to the skin is increased with other vital signs. Nancy being type 1 diabetic is more prone to the infections as diabetes increases the inflammatory compounds like C-reactive protein that decreases lung function. According to Caughey et al. (2013) patients with type 1 diabetes are highly likely to suffer from COPD, pneumonia, asthma or scarring in lung that increases shortness of breath due to weakened immunity.
Nursing Problems and Goals
If no nursing intervention is given for increasing blood glucose level, the frequency of urination increases leading to dehydration, confusion, and lack of energy. The body increases fat metabolism for energy increasing ketoacidosis. It may lead to coma and death (Weinstock et al., 2013). On the other hand if the viral infection in Nancy is not treated, it may lead to complications decreased oxygen saturation and risk for other bacterial infections. Eventually it may damage heart and lungs severely. Infection when enters the blood stream may cause septicaemia. The toxins are then carried to entire body, which may lead to multi-organ failure. It may be fatal and cause death (Magliano et al., 2015).
The three key nursing problems are increases in-
- blood glucose level,
- high risk of serious infection and
- deficit fluid volume
|
Problem 1 |
Goal |
Related actions (Chiang et al. 2014; American Diabetes Association 2018) |
Rationale (Inzucchi et al., 2015) |
|
High blood glucose |
Maintain the glucose in normal range and prevent insulin deficiency |
Administer the basal and prandial insulin The nurse must assess the vital signs as as hypovolemia can be manifested by tachycardia and hypotension Provide fluid therapy to eliminate dehydration The nurse must assess the patient’s current knowledge of the diet and its importance and recommend diet plan for her need. The nurse must asses to find the patient’s preferences to diet The nurse must educate the patient about relaxation technique to stay calm and reduce anxiety. The nurse must give psychological support to patient |
It will promote tissue perfusion and slows micro vascular disease. Insulin treatment can have rapid onset and help move glucose into cells. It will reverse the osmotic effect of the high blood glucose level, that increased urination It will prevent the fluid volume deficit as the patient is having Polyuria. It will help reduce confusion Nonadherence to dietary guidelines can cause hyperglycemia. Dietray preferences of the patient can be included in the meal planning Stress increases the blood sugar level. Stress reduction may decrease the irritation and agitation of Nancy |
|
Problem 2 |
Goal |
Related actions (Pearson-Stuttard et al. 2016) |
Rationale (Simonsen et al. 2015) |
|
infection risk |
Reduce the risk of infection and prevent the infection with lifestyle changes |
The nurse must observe the signs and symptoms of the infection. The nurse must maintain the aseptic technique in invasive procedure The nurse must give the patient regular skin care The nurse must educate the patient to monitor and report the colour ad order of secretions. Nancy must be educated about good hand washing technique as well as her husband The nurse must assist the patient with good pulmonary toilet. The nurse must regularly change the patient’s position, encourage deep breathing Determine the need of antibiotics and dosage to be given |
It will help determine of the patient has sparked the state of the noscomial infections and ketoacidosis. To help determine the secondary infection. High blood glucose may be suitable growth medium for nurses. It is because the peripheral circulation puts patient at increased risk of damage It will help prevent the cross infection Memventilasi mobilise the pulmonary secretions It will help in faster recovery from infections |
The expected outcomes that will ensure the efficacy of the nursing actions are-
- The patient may show up with blood glucose level below less than 180 mg/dL and
- Timely resolution of the current infections, without any complications
- Reduce risk of spread of the infections and secondary infections
- The patient may show less irritation and confusion
- Restore of the normal vital signs
This encounter had improved the nursing knowledge of diabetes care and interventions for dealing with complications. Jn future, I would be more efficient in perceiving the patient’s condition relating with pathophysiology and delivering interventions faster. I will research for evidence based practices that can better relive diabetes and infections, and use in future practice. I have learned the role of supporting people with diabetes in multidisciplinary setting considering psychological, and physiological needs of patient.
References
American Diabetes Association, 2018. 4. Lifestyle Management: Standards of Medical Care in Diabetes—2018. Diabetes Care, 41(Supplement 1), pp.S38-S50.
Bell, K.J., Smart, C.E., Steil, G.M., Brand-Miller, J.C., King, B. and Wolpert, H.A., 2015. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care, 38(6), pp.1008-1015.
Buchberger, B., Huppertz, H., Krabbe, L., Lux, B., Mattivi, J. T., & Siafarikas, A. (2016). Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis. Psychoneuroendocrinology, 70, 70-84.
Casqueiro, J., Casqueiro, J. and Alves, C., 2012. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian journal of endocrinology and metabolism, 16(Suppl1), p.S27.
Caughey, G.E., Preiss, A.K., Vitry, A.I., Gilbert, A.L. and Roughead, E.E., 2013. Comorbid diabetes and COPD: impact of corticosteroid use on diabetes complications. Diabetes care, 36(10), pp.3009-3014.
Chiang, J.L., Kirkman, M.S., Laffel, L.M. and Peters, A.L., 2014. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes care, 37(7), pp.2034-2054.
Inzucchi, S.E., Bergenstal, R.M., Buse, J.B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A.L., Tsapas, A., Wender, R. and Matthews, D.R., 2015. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care, 38(1), pp.140-149.
Magliano, D.J., Harding, J.L., Cohen, K., Huxley, R.R., Davis, W.A. and Shaw, J.E., 2015. Excess risk of dying from infectious causes in those with type 1 and type 2 diabetes. Diabetes Care, 38(7), pp.1274-1280.
Pearson-Stuttard, J., Blundell, S., Harris, T., Cook, D.G. and Critchley, J., 2016. Diabetes and infection: assessing the association with glycaemic control in population-based studies. The Lancet Diabetes & Endocrinology, 4(2), pp.148-158.
Simonsen, J.R., Harjutsalo, V., Järvinen, A., Kirveskari, J., Forsblom, C., Groop, P.H., Lehto, M. and FinnDiane Study Group, 2015. Bacterial infections in patients with type 1 diabetes: a 14-year follow-up study. BMJ Open Diabetes Research and Care, 3(1), p.e000067.
Weinstock, R.S., Xing, D., Maahs, D.M., Michels, A., Rickels, M.R., Peters, A.L., Bergenstal, R.M., Harris, B., DuBose, S.N., Miller, K.M. and Beck, R.W., 2013. Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry. The Journal of Clinical Endocrinology & Metabolism, 98(8), pp.3411-3419.
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