Chronic Endocrine Condition: Diabetes

This article discusses the nursing priorities, interventions, and evaluation of outcomes for a patient with chronic diabetes. It emphasizes the importance of medication management and self-management skills for positive health outcomes.

Running head: CHRONIC ENDOCRINE CONDITION: DIABETES
CHRONIC ENDOCRINE CONDITION: DIABETES
Name of the Student:
Name of the University:
Author note:

1CHRONIC ENDOCRINE CONDITION: DIABETES
Introduction
For the case scenario of Marcel, a 70 year old retired farmer suffering from chronic
implications of diabetes, the nurse must actively incorporate patient centered care, collaborative
functioning and multidisciplinary principles for the formulation of an appropriate care plan for
Marcel (Sarr-Jansman & Sier, 2018).
Discussion
Nursing Priorities
Two of the primary priorities outlining Marcel’s care is the need to improve his
medication management and improve the existing levels of his self-management skills. The
significant progression and aggravation of Marcel’s diabetic symptoms to chronic conditions
form the underlying rationale for these (Chrvala, Sherr & Lipman, 2016). The nurse may be
required to design a specified medication plan due Marcel admitting to maintaining higher levels
of his blood glucose levels (BGL) for avoidance of hypoglycemia and his experiences with
hyperosmolar hyperglycemic state (HHS). Indeed, inadequate medication management not only
puts the patient at risk for subsequence BGL fluctuations and hypoglycemic shock but also
increases susceptibility of altered mental states (Chaudhury et al., 2017).
Secondly, for enhancing Marcel’s self-management, the nurse must prioritize educating
him on the need to monitor his BGL, administer his insulin as well as adhere to his care plan of
engagement in exercise, dietary and additional multidisciplinary interventions. Multidisciplinary
interventions coupled with patient centered approaches have been implicated to yield beneficial

2CHRONIC ENDOCRINE CONDITION: DIABETES
results in chronic diabetes management since it allows patient self-control, self-empowerment
and knowledge acquisition (Wang et al., 2016).
Nursing Interventions
For ensuring adequate medication management in Marcel the RN must work
collaboratively with a diabetologist or Marcel’s physician to formulate a specific medication plan
for Marcel to prevent any exacerbation of his symptoms. This must also be followed by
administering a patient centered approach and directly involve Marcel in the formulation of a
medication plan (Zullig et al., 2015). Timely adherence to medications at the correct dosages will
not only result in maintenance of stable but will also prevent complications such as HHS and
hypoglycemic shocks which may alter levels of consciousness and mental perception of the
patient (Krass, Schieback & Dhippayom, 2015). Likewise, it can observed Marcel’s previous
experiences with hypoglycemia compels him to maintain slightly higher levels of BGL. He also
wishes to utilize flash glucose monitoring devices. Hence, a key nursing priority here is patient
education and enhancement of patient health literacy. Hence, the nurse will utilize components
of therapeutic relationships and discuss patiently and empathetically with Marcel on the need to
maintain adequate BGL, the effects of resultant HHS and the inaccuracies associated with flash
glucose monitoring usage (Kim & Lee, 2016). The effects of altered mental state due to
mismanaged medications coupled with the inaccurate readings of flash glucose monitoring form
the underlying rationale of these nursing interventions (Reisi et al., 2016).
The nurse must educate Marcel, not only on fast glucose monitoring devices but must
also enlighten him on reference ranges for BGL and that he may still be required to perform
finger prick methods for more accurate BGL monitoring (Lee et al., 2017). Presence of adequate
knowledge on BGL monitoring results in positive health outcomes in the patient since he or she

3CHRONIC ENDOCRINE CONDITION: DIABETES
now feels enlightened and empowerment to adequate manage the diabetic condition (Marcolis,
2015). Considering Marcel’s symptoms of peripheral neuropathy and loss of sensation in his toe,
the nurse must take action and collaboratively work with an occupational therapist and enlighten
Marcel on correct diabetic footwear usage and foot inspection. Prevention of neuropathy and
hyperglycemia associated delayed wound healing and susceptibility of food ulcer acquisition are
key rationales underlying this intervention (Feldmen et al., 2017). Considering Marcel’s
diminishing vision, the nurse must collaboratively work with an optometrist to monitor the same.
Prevention of diabetic retinopathy associated macular degeneration is the underlying rationale
for this intervention (Lee, Wong & Sabanayagam, 2015). The RN must also evaluate Marcel’s
engagement with a diet low in sugar and adequate fiber coupled with exercise in a community or
fitness health center. Balanced diet consumption and exercise engagement have been implicated
to result improved insulin sensitivity, weight management and BGL maintenance (Barrès &
Zierath, 2016).
Evaluation of Outcomes
The nurse will evaluate outcomes by monitoring Marcel’s levels of blood glucose and
anthropometric measurements. These will include BGL blood tests and usage of weighing scale.
Adherence to a balanced diet, exercise and timely medication plan will result in positive
outcomes in terms of achievement of normal blood and body mass index levels (Feinman et al.,
2015). The nurse will also communicate with Marcel using patient centered approaches to obtain
insight on his experiences, preferences and opinions. Inculcating and adhering to adequate self-
management skills will result in positive patient outcomes in terms of patient empowerment and
increase health literacy. Evaluation of these outcomes will provide key insights to the nurse

4CHRONIC ENDOCRINE CONDITION: DIABETES
considering the efficacy of the care plan and the present health status of Marcel (Lee et al.,
2016).
Application of Clinical Reasoning Cycle
As per the steps of the CRC, the Registered Nurse (RN) must consider Marcel’s situation
and as per collection of Marcel’s cues, prioritize the needs and requirements of Marcel in order
to streamline and categorize care principles (Griffiths et al., 2016). After considering the
patient’s situation and collecting cues of his present medication and blood glucose levels as per
the (CRC), it can be observed that, Marcel’s symptoms have progressed significantly and hence,
the need for medication administration is of necessity and must accompanied by adequate levels
of self management (Bowen et al., 2016). For the purpose of medication management, as per the
CRC step of nursing evaluating and processing of patient information following by nursing
diagnosis, the nurse must prioritize formulation of a scheduled medication plan for Marcel
(Capoccia, Odegard & Letassy, 2016). For the prevention of his disease progression as per CRC
steps of undertaking nursing actions, the nurse must also seek to educate Marcel on self-
management skills. For adequate medication management the RN must apply CRC step of
nursing action and firstly work collaboratively to formulate a specific medication plan for
Marcel. This must also be followed by nursing action of administering a patient centered
approach (Zullig et al., 2015). The second priority as per CRC steps of nursing diagnosis and
information processing, which the nurse must consider is enhancement of Marcel’s skills of self-
management which is required for prevention of diabetes progression, and hence administer a
patient centered education plan, as per CRC steps of taking action. For evaluation, the nurse can
apply a repetition of the CRC cycle to review care plan efficacy.

5CHRONIC ENDOCRINE CONDITION: DIABETES
Conclusion
Hence, to conclude, nursing education aimed at enhancing skills of self management in
the patient is of equal importance for the purpose of achieving positive health outcomes. Usage
of a multidisciplinary patient centered approach coupled with a collaborative nursing
functioning, will result in adequate self and medication management in case of Marcel’s disease
condition.

6CHRONIC ENDOCRINE CONDITION: DIABETES
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