Nursing Care for Patient with Diabetes

This article discusses nursing care for patients with diabetes, including symptoms, diagnosis, and treatment. It covers the importance of holistic care and provides expert advice and guidance.

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Bachelor Nursing Assignment
BACHELOR NURSING ASSIGNMENT
Nursing care to the patient having diabetes
MAY 4, 2019
Student Details:

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Bachelor Nursing Assignment
Contents
Introduction......................................................................................................................................2
Nursing care to the patient having diabetes.....................................................................................3
Conclusion.......................................................................................................................................7
References.......................................................................................................................................8

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Bachelor Nursing Assignment
Introduction
Diabetes is a disorder of not being able to produce the proper amount of glucose in the
blood of a person. It is of three types, one type 1 diabetes mellitus and second is type 1 diabetes
and another one is gestational diabetes. Excessive thirst, fatigue, excess urination, vomiting are
the most common symptoms of diabetes (Nall, 2018).
Acute kidney injury is the situation where the kidney would not be in working condition
for a short period of time (Fund, 2019). Hypovolemia shock is caused when changes in the blood
such as loss of blood or loss of other fluids of the body cause decrement in blood volume. This
may happen due to damage in the body parts, severe vomiting, diabetes and many other
problems such as diarrhea (Ratini, 2017). In the body of a person due to excess formation of
ketones, the balance of chemical named acids and bases get changed and acid balance gets
lowered down. This situation leads to metabolic acidosis to the person (Dansinger, 2019).
Electrolytes such as potassium, bicarbonate, sodium, calcium are useful in regular body
functioning. But because of rapid loss of fluids due to any problem such as vomiting, it may lead
to an imbalance in these electrolytes (Felman, 2017).
In the followed discussion I would discuss the situation of the patient followed by
diagnostics, treatment, and cure provided during patient-focused nursing care.

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Bachelor Nursing Assignment
Nursing care to the patient having diabetes
Mr. Daniel Hughes is a 28-year-old man admitted to the hospital with the complained of
generally feeling unwell, vomiting, polydipsia and malaise and very mild cold. He had the
history of being admitted before for Type 1 Diabetes Mellitus for 10 years, and ICU admission
for Diabetic Ketoaciduria 5 years ago otherwise well, uneventful appendectomy 5 years ago. He
was a social drinker. Medications named Humalog 8 -16 u/s PC, Lantis 28u/s nocte were taken
by him. During admission in the hospital, vital signs of Mr. Daniel Hughes were SpO2 98% on
RA, HR 125bpm, RR 35 (Kussmaul type with acetone smell), Temp 37.3° Celsius, BP 100/60;
GCS 14/15 PEARL, pain 3/10 central abdomen. Physically, he was feeling restless, c/o thirst and
nausea with intermittent vomiting. His skin was dried and urine output was 0.25ml/hr. During
the investigation, Mr. Daniel Hughes was diagnosed with BGL 26.1 mmol/l, ketones were high
on finger prick, urinalysis was Ketones +++, Glucose ++, microhematuria. Full blood
examination was mildly elevated in white blood cell count and hematocrit, otherwise NAD. Urea
& Electrolytes were fluctuated as following Sodium 150mmol/l, Potassium 3.3mmol/l, Calcium
normal range, Magnesium & Phosphorus mildly low. C - reactive protein was mildly elevated;
blood cultures growth was nil after 1 day. Troponin was within normal limits. Chest XRAY of
Mr. Daniel Hughes was clear. Arterial Blood Gas (ABG) results were pH 7.15, PaO2 105,
PaCO2 35, HCO3 14.
It was observed by Mr. Daniel Hughes reports that sugar level was disturbed in his body.
He had symptoms such as the feeling of unwellness, vomiting, polydipsia, and malaise, which
are the sign of type 1 diabetes mellitus (Cunha, 2019) and kidney injury (Fund, 2019). Mr.
Daniel Hughes was undertaking medications due to the side effects of those medications and due
to diabetes; fluctuation in sugar level inside the body provided disturbance in the blood volume.

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Bachelor Nursing Assignment
These were the sign that Mr. Daniel Hughes was suffering from kidney injury. He was a social
drinker, due to drink during diabetes he fell at the risk of kidney injury. Because alcohol has high
calories, due to this it lowered down the blood sugar level. Alcohol causes changes in the blood
pressure and rises triglyceride levels in the blood. Due to these effects of alcohol, Mr. Daniel
Hughes health was having the issue of kidney injury (Dansinger, 2017).
Due to kidney injury and fluctuation in body fluids such as sodium, potassium,
bicarbonate, magnesium, and phosphorus lead hypovolemia to Mr. Daniel Hughes. This
fluctuation in body fluids was caused due to vomiting. When body fluids lose happened to him
then levels of blood volume and blood pressure were lowered down. These changes lead to
hypovolemic shock to Mr. Daniel Hughes (Moyer, 2018).
It was observed from the blood and urine test results that ketones formation in the body
of Mr. Daniel Hughes was increased. When the formation of the ketones amount increased
excessively, it leads to the acidic environment in the blood. Due to this, pH of blood was lowered
down in Mr. Daniel Hughes body and leads to metabolic acidosis (Lewis, 2018). During arterial
blood gas diagnosis, it was observed that PaO2 got higher than normal range and HCO3 was
decreased than the normal range, HCO3 was lowered in arterial blood gas. Potassium level
fluctuated. Sodium, serum chloride, and phosphorus levels were low in Mr. Daniel Hughes body.
These results were used in the diagnosis of metabolic acidosis (Hamdy, 2018)
Mr. Daniel Hughes was suffering from a mild cold. Due to mild cold, hormones were
secreted by Mr. Daniel Hughes body to reduce and end the infection in the body. Because of this
Mr. Daniel Hughes, the body was not able to utilize proper insulin amount. Due to this, blood
sugar levels fluctuated in the body of Mr. Daniel Hughes. When management of blood sugar

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Bachelor Nursing Assignment
levels in the body became tough, then metabolic acidosis arose in the body of Mr. Daniel Hughes
and causes severe problems to Mr. Daniel Hughes (Robinson, 2018).
Electrolyte imbalance was diagnosed to Mr. Daniel Hughes by the help of arterial blood
gases and the pH of the blood. Fluctuation in the body fluids occurred due to vomiting. Because
of vomiting, sodium, potassium, serum chloride, bicarbonate level got decreased in the body
fluids of Mr. Daniel Hughes. This resulted in the decrement in the pH of the blood of Mr. Daniel
Hughes. It also leads to the fluctuation in the blood volume in the body of Mr. Daniel Hughes.
Due to these electrolytes, imbalance blood pressure of his body was lowered down. This resulted
in the severe situation of Mr. Daniel Hughes followed by diabetes, metabolic acidosis, kidney
injury and hypovolemia (Levy, 2018).
The goals were established to cope with the situation of Mr. Daniel Hughes.
These goals were established to prevent severe decompensating, to avoid the increment in the
appearance of complications of diseases in the future. The goals were set to get rid of mortality.
In these goals, it was set that how nurses would have to overcome the fluctuation in body
functioning. They had to control blood pressure, pH of the body, ketoacidosis, Glucose level,
magnesium, sodium, potassium, phosphorous, and bicarbonates in arterial blood gases. Nurses
would provide patient-focused holistic nursing care to Mr. Daniel Hughes (Simo & Hernandez,
2002).
To achieve these goals nurses provided medications prescribed by the doctor of Mr.
Daniel Hughes. For this, 18g cannula in the left cubital fossa, with 4hourly Dextrose (5%)
alternating with Hartmann’s Solution 1L bag in-situ (with supplemental KCL in bags)
intervention was provided by nurses. This intervention was used for the changes in the
electrolytes and for fluid present intravenously. By the help of this intervention, nurses were

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Bachelor Nursing Assignment
coping with the electrolytes fluctuation in the body of Mr. Daniel Hughes. In this Hartmann’s
solution was used for treatment of metabolic acidosis and to treat electrolyte imbalance
(Dhatariya, 2007).
To maintain sugar level in the blood to treat diabetes, Nurses provided 20g Cannula Right
Cubital fossa with Insulin infusion commenced 50u/s Actrapid in 50mls of Saline (1u/ml) at
4mls/hr. intervention to Mr. Daniel Hughes. Actrapid was provided to Mr. Daniel Hughes
(Shunker & Lopez, 2013). Actrapid binds with receptors of insulin to stop output of hepatic
glucose and enhances the uptake of glucose to maintain blood sugar levels. Nurses provided it
because it supports the entry of glucose inside the cells from the bloodstream. Medications were
also provided for mild cold (Agency, 2012).
During this, nurses also provided rehabilitation and recreational therapy to Mr. Daniel
Hughes for the prevention of drink, to prevent fatigue and to provide stress relief. Nurses
provided proper diet to him. They provided social, physical and metal interventions to motivate
him to enhance the quality of life and to acknowledge him about the situation, prevention and
cure to prevent same situation (Gelvez, Osorio, Velasco, & Contreras, 2018).
Improvement was observed in the situation of Mr. Daniel Hughes by the help of these
interventions and holistic nursing care provided by nurses. The help of medications fluid
electrolytes, a mild cold, maintained sugar levels in the blood, diabetic ketoacidosis by the help
of nurses. They helped in monitoring blood pressure and help in the maintenance of arterial
blood gases to alter positive results in the situation of Mr. Daniel Hughes. By improving quality
of life, the stress level of patient was reduced and by the help of this, blood pressure level was
maintained in the body of Mr. Daniel Hughes.

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Bachelor Nursing Assignment
I had learned from the situation of Mr. Daniel Hughes that how to deal with the situation
of being diabetic as well as diabetic ketoacidosis, mild cold and at the same time fall down in the
blood pressure. I would perform holistic nursing care by the use of patient-centered nursing care
and chronic care model used by nurses.
Conclusion
Diabetes with kidney injury, electrolyte imbalance may become chronic if they are not
treated properly. The help of proper diagnosis and test such as urine analysis would observe
blood test, arterial blood gases exact situation of diabetes followed by kidney injury, electrolyte
imbalance. By the help of proper medications and holistic nursing interventions, these situations
would be cured without any difficulty during treatment of the patient. In the holistic nursing care,
enhancement in quality of life, self-management, self-care, and social, physical and mental
interventions would be provided to the patient.

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Bachelor Nursing Assignment
References
Agency, E. M. (2012, December). Actrapid. Retrieved from European Medicines Agency
Website: https://www.ema.europa.eu/en/documents/overview/actrapid-epar-summary-
public_en.pdf
Cunha, J. P. (2019, February 6). Diabetes Early Symptoms and Signs. (C. P. Davis, Editor)
Retrieved from MedicineNet Website:
https://www.medicinenet.com/diabetes_symptoms_in_men/article.htm#is_there_a_test_t
o_diagnose_type_1_and_type_2_diabetes
Dansinger, M. (2017, March 15). Diabetes and alcohol. Retrieved from WebMD Website:
https://www.webmd.com/diabetes/guide/drinking-alcohol
Dansinger, M. (2019, February 17). What Is Metabolic Acidosis? Retrieved from MedMD
Website: https://www.webmd.com/a-to-z-guides/what-is-metabolic-acidosis#1
Dhatariya, K. K. (2007, June 23). Diabetic ketoacidosis. National Center for Biotechnology
Information, 334(7607), 1284-1285. doi:10.1136/bmj.39237.661111.80
Felman, A. (2017, November 20). Everything you need to know about electrolytes. Retrieved
from MedicalNewToday Website:
https://www.medicalnewstoday.com/articles/153188.php
Fund, A. K. (2019). Acute kidney injury. Retrieved from American Kidney Fund Website:
http://www.kidneyfund.org/kidney-disease/kidney-problems/acute-kidney-injury.html
Gelvez, B., Osorio, M., Velasco, M., & Contreras, F. (2018, February 23). Perspectives of
Nursing in the Care of the Patient with Diabetes Mellitus. Interventions in Obesity &

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Diabetes, 1(2). doi:10.31031/IOD.2018.01.000509
Hamdy, O. (2018, February 08). Diabetic Ketoacidosis Workup. Retrieved from Medscape
Website: https://emedicine.medscape.com/article/118361-workup#c1
Levy, J. (2018, March 09). Symptoms of Electrolyte Imbalance, Plus How to Solve It. Retrieved
from Dr. Axe: Food is Medicine : https://draxe.com/electrolyte-imbalance/
Lewis, J. L. (2018, March). Metabolic Acidosis. Retrieved from MSD Manual: Professional
Version: https://www.msdmanuals.com/en-in/professional/endocrine-and-metabolic-
disorders/acid-base-regulation-and-disorders/metabolic-acidosis
Moyer, N. (2018, September 25). What to know about hypovolemic shock. Retrieved from
MedicalNewsToday Website: https://www.medicalnewstoday.com/articles/312348.php
Nall, R. (2018, November 8). An overview of diabetes types and treatments. Retrieved from
MedicalNewsToday: https://www.medicalnewstoday.com/articles/323627.php
Ratini, M. (2017, November 25). What Is Hypovolemic Shock? Retrieved from WebMD:
https://www.webmd.com/a-to-z-guides/hypovolemic-shock#1
Robinson, J. (2018, July 24). Diabetes and Colds. Retrieved from WebMD Website:
https://www.webmd.com/diabetes/guide/diabetes-colds#1
Shunker, S., & Lopez, C. (2013, June). Actrapid (neutral insulin). Retrieved from Agency for
Clinical Innovation Website:
https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0005/306338/
liverpoolActrapid.pdf

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Bachelor Nursing Assignment
Simo, R., & Hernandez, C. (2002, August). Treatment of Diabetes Mellitus: General Goals and
Clinical Practice Management. Sociedad Espanola De Cardiologia, 55(08), 45-60.
doi:http://www.revespcardiol.org/en/treatment-of-diabetes-mellitus-general/articulo/
13037902/