Nursing Actions for UTI, Type 2 Diabetes Mellitus, and Graves' Disease: Clinical Scenario 2
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This clinical scenario discusses nursing actions for UTI, type 2 diabetes mellitus, and Graves' disease. It covers causes, symptoms, and management of these conditions. The article also includes information on wound healing, HBA1c, and allied healthcare professionals to refer the patient to.
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Running head: CLINICAL SCENARIO 21 Clinical Scenario 2 Name Institution
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CLINICAL SCENARIO 22 Clinical Scenario 2 1. Nursing actions to confirm if it is a UTI The first action would be to monitor Betty’s urinary pattern such as hesitancy, frequency, and urgency. The nurse also needs to assess the patient’s urine for characteristics such as the concentration, color, cloudiness, and volume (Rowe & Juthani-Mehta, 2014). The nurse needs to also assess her history of sexual transmitted illnesses. 2. Things that could show up in a dipstick for UTI diagnosis The dipstick test is invaluable in the diagnosis of the UTI through assessment of pyuria and bacteriuria (Mambatta et al., 2015). Therefore, the levels of nitrites and leucocyte esterase would be expected to be highly elevated in Betty’s urine if she has a urinary tract infection. 3. Findings that would support a diagnosis of UTI From Betty’s symptoms, the findings such as incontinency of urine, fever, and the offensive odour support the diagnosis of a UTI. 4. Reducing incidence of UTI in the future Management of the diabetic condition and proper urinary tract hygiene could be some of the measures Betty should take to reduce incidence of UTI in the future (Al-Badr & Al-Shaikh, 2013). 5. Cause of lymphedema Cancer and infection are some common causes of lymphedema. Betty has a history of breast cancer and masectomy, which are risk factors for lympedema. 6. Using her right arm for BP Betty had a right mastectomy, which might have led to lymphedema. Using her right arm to take BP might cause swelling and discomfort.
CLINICAL SCENARIO 23 7. Normal blood glucose level The normal blood sugar levels range from 3.9 to 6.0 mmol/L when fasting (and up to 7.8mmol/L after a meal (Melmed, 2016). Infections (including UTIs) are often associated with a rise in stress hormones such as cortisol, which often cause an increase in the circulating blood sugars. 8. Signs and symptoms if Betty had a hypoglycemic episode Betty would experience shakiness, heart arrhythmias, anxiety, sweating, hunger, and irritability if she experiences a hypoglycemic episode (Melmed, 2016). 9. Pathophysiology of type 2 diabetes mellitus Type 2 DM arises through two different mechanisms. The first mechanism is the low or inadequate production of insulin by the beta cells of Langerhan of the pancrease. As a result, the insulin action is reduced, resulting in high levels of circulating glucose. The second mechanism is through insulin resistance. The body cells might fail to respond to insulin actions, even when the insulin levels are high (Melmed, 2016). Consequently, there is a sudden increase in the levels of glucose in the blood. Insulin resistance is linked to lack of physical activity and obesity. 10. Differences with type 1 diabetes mellitus Type 1 DM, also known as insulin-dependent, is an autoimmune disease that is detected during childhood. The body’s immune cells mistakenly attack the beta cells of the pancreas that produce insulin (Melmed, 2016). Consequently, the pancreas is incapable of producing increase. The patient requires constant injection of insulin to survive. 11. Effect of type 2 diabetes on wound healing Diabetes has a negative influence on the wound healing properties of the patient. The slow wound healing is linked to the high levels of circulating blood glucose. Higher than optimal
CLINICAL SCENARIO 24 glucose levels have been linked to stiff arteries, which causes poor circulation and the concomitant diabetic neuropathy. Delayed wound healing might expose Betty to an increased risk of bacterial and fungal infections, and even gangrene. 12. HBA1c Glycated haemoglobin (HBA1c) results when the circulating haemoglobin attaches to the sugars in circulation. The glucose attaches to the haemoglobin in the red blood cells, and makes it “glycated” (Melmed, 2016). Since the average lifespan of red blood cells is 120 days, the levels of HBA1c can help assess the circulating glucose levels in the patient for the two to three months. High levels of HBA1c could imply that Betty’s sugar levels have been elevated in the past three months. 13. Graves’ disease The disease (also toxic diffuse goiter) is a thyroid autoimmune disease. It is caused when the body’s antibodies attack the thyroid, causinghyperthyroidism. The patient might present with an enlarged thyroid, but the symptoms might extend to severe signs such as Graves’ ophthalmopathy, dermopathy, and even psychosis (Burch & Cooper, 2015). Therefore, Betty might present with excessive lacrimation, depression, or even psychosis if the disease becomes unstable. 14. Nursing care plans for Betty The first plan is on her UTI symptoms. The major goal for the patient is relief of the discomfort and pain caused by the urinary tract infection. The actions would include commencement of antimicrobial and antispasmodic agent treatment after diagnosis. The nurse can also evaluate of the patient’s knowledge of antimicrobial use. The expected outcome is Betty experiencing relief of the pain and discharging normal urine.
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CLINICAL SCENARIO 25 The second plan is on the management of Graves’ disease to avoid complications. The goal for this plan is to prevent the development of complications associated with unstable Graves’ disease. The course of action include using stabilizing medications for her symptoms and referring her to a specialist to manage her condition. The expected outcome is reduced complications from Grave’s disease such as confusion or ophthalmopathy. The third plan is the treatment of her wounds caused by the fall she had. The goal for this plan is to ensure that her wounds heal quickly to prevent any associated complications. The course of action if to provide guidelines and information about appropriate diet for diabetic patients, and encourage the patient to adhere to antidiabetic medications. The expected outcome is quick wound healing of the patient. 15. Allied healthcare professionals to refer Betty The patient can be referred to an endocrinologist for her diabetes mellitus treatment, an optician to assess her probability of developing Graves’ ophthalmopathy, a microbiologist to assess her urinary tract infection and a psychiatrist to assess her symptoms of confusion.
CLINICAL SCENARIO 26 References Al-Badr, A., & Al-Shaikh, G. (2013). Recurrent urinary tract infections management in women: a review.Sultan Qaboos University Medical Journal,13(3), 359. Burch, H. B., & Cooper, D. S. (2015). Management of Graves disease: a review.Jama,314(23), 2544-2554. Mambatta, A. K., Jayalakshmi Jayarajan, V. L. R., Harini, S., Menon, S., & Kuppusamy, J. (2015). Reliability of dipstick assay in predicting urinary tract infection.Journal of family medicine and primary care,4(2), 265. Melmed, S. (2016).Williams textbook of endocrinology. Elsevier Health Sciences. Rowe, T. A., & Juthani-Mehta, M. (2014). Diagnosis and management of urinary tract infection in older adults.Infectious disease clinics of North America,28(1), 75.