Diabetes Assessment and Management Plan

This assessment task covers the types of diabetes, emergency nursing interventions, management plan, NDSS, diabetic organizations, and factors contributing to diabetes in Australia and Aboriginal and/or Torres Strait Islander people. It also discusses issues related to diabetic care delivery or services in Australia.

Assessment Task
- Written
1. Place the correct type of diabetes beside the anatomy, physiology, pathophysiology description.
 Type 1 diabetes
 Type 2 diabetes
 Pre diabetes
 Gestational diabetes.
Gestational Diabetes Causes insulin resistance
Placenta produces hormones that can block the action of insulin
Higher than normal blood glucose levels first appear during
pregnancy.
Type 1 diabetes. Pancreas is involved
Onset often abrupt
Pancreas does not produce insulin
Symptoms include excessive thirst and urination thirst and
Is not reversible
Pre diabetes. Pancreas is involved
Pancreas does not produce enough insulin
Pancreas progressively loses the capacity to produce insulin
Type 2 diabetes. Pancreas is involved
Blood glucose levels are higher than normal
Impaired fasting glucose
No signs or symptoms
Impaired glucose tolerance
2a. Below is a list of some of the potential conditions of diabetes that can impact on the care of a person
with diabetes– complete the table for the -:
 Common pathological indicators
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 Emergency nursing interventions you may assist with under the RNs guidance once the
condition has been established – this can include medications to be administered.
 (This means what you can do after you have done vitals, BGL, DRABCD)
Condition Most common pathological indicator
of the condition
Discuss 2 emergency nursing
interventions for each condition you
may assist with under the guidance of
an RN.
Your answer should be in-depth and
demonstrates specialised
understanding.
hypoglycaemia The pathological indicator of
hypoglycaemia is reduced levels of
glucose in blood.
The nurse should monitor glucose and
provide medical nutrition therapy.The
patient should feed on high level of
carbohydrates to match the insulin
regimen.This will prevent the cases of
hypoglycaemia.
hyperglycaemia Diabetes mellitus The nursing intervention is through
administration of insulin that breaks
down the excess glucose in
blood.Another nursing intervention is
education on regular exercise and
healthy lifestyle such as cessation of
smoking.
ketoacidosis The most common pathological
indicator of ketoacidosis is Diabetes
mellitus type 1
The nursing intervention involves
continuous monitoring whether the
patient is using injections or
subcutaneous infusion to assist in the
glycemic control.The nurse should
also educate on a healthy diet that is
high in carbohydrates and fibre.
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Hyperosmolar
Hyperglycaemic
Syndrome (HHS)
This is a complication of type 2
diabetes mellitus.
The nursing interventions in this case
involves assessing skin turgor,the
mucous membranes and thirst.This is
just to provide data for comparison.
Q2b. You have been asked to administer the following emergency medications for a patient who has been
brought into the emergency departments with ketoacidosis.
For each emergency medication in the table below, explain the following:
- The mode of action
- The route of administration
- The reason for its use in the treatment of Ketoacidosis
Emergency medication Action of medication and why it is used
0.9% NaCl solution 1 L/hr Sodium Chloride drug is usually introduced through the oral
route.Since it is basic,it works by neutralizing the excess
acids in the blood(Hahr & Molitch, 2015).Since ketoacidosis
is the elevated levels of acids in blood,Nacl is a base and
would therefore reduce the elevated acidic conditions by
neutarilization.
Insulin Infusion 0.1 U/kg/hr. Insulin is usually introduced to the body through the IV
route.It acts by breaking down the excess glucose in the
blood to form the less harmful glycogen as the end
product(Inzucchi et al., 2014).The insulin infusion is
therefore used to reduce the high level of blood glucose.
As A EN please explain your scope of practice in regards to IV medications? (Max 60 words)
As an enrolled nurse,the scope of practice in regards to IV medications include adhering to the rights of
drugs.This includes the right patient,the right dose,right time as well as the right route of administration
which is the Intraveneous route in this case.I also have to counter check the medicine before it is injected
to the patient.
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Case study 1
Simon is a 54 year old male lawyer who lives in Burleigh on the Gold Coast. He was diagnosed as a
type 2 diabetic 2 mths ago. He has been married for 25 years to Mary a marketing consultant; they
have 2 children who are both living at home while attending university.
He has had frequent visits to his GP to try and get his blood glucose under control; however he is
having issues with this and also coping with his diagnosis.
Simon is 180cm tall, weighs 100kgs, waist circumference of 104cm = a BMI of 29 this puts him in
the overweight category and the high risk range for diabetic complications.
Simon also smokes approx. 4-6 cigarettes a day, drinks wine most evenings and struggles to eat
healthy due to long work hours and meetings. Simon also tries to walk early in the morning however
only seems to manage this on weekends. As he is in work shoes all week he likes to walk in thongs.
Simon has been reluctant to face the fact he has diabetes, however he has been feeling a bit low
lately and has decided it’s time to “sort his disease out”, the doctor has recommended that he attend
diabetic education and planning which is conducted at the nearby community health centre where
you work.
In conjunction with the Diabetic RN you sit down with Simon and his wife to create a plan
3. You are to assist the RN in the creation of a management plan for Simon
In the table below please outline 2 goals and 2 expected outcomes for each goal
Keep each goal and outcome realistic to Simon’s case study
Note – Simon will have a follow-up appointment in 6 weeks’ time to review his progress and plan
Health education /
promotion
2 goals 2 expected outcomes for the
goals
Exercise Simon is able to exercise more.
The BMI to reduce and be within
the normal range.
Simon is able to exercise
regularly
The BMI of Simon will fall
within the normal range after
exercise.
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Diet & weight loss (body
mass index or waist to hip
ratio)
To ensure that simons weight
reduce to desirable levels.
To ensure that Simon eat a
healthy diet full of fibres.
Simons weight reduce to
desirable level.
Simon eats on a healthy diet
especially carbohydrates.
Smoking cessation To ensure that Simon quits
smoking.
To ensure that Simon has the
knowledge on the negative
effects of smoking.
Simon quits smoking and another
desired outcome is that Simon
learns the dangers of smoking on
his health.
Foot and eye care The first goal Is to prevent
infection of the foot and the
second goal is to prevent
infection of the eyes.
Simons eyes do not infected.The
second goal is to ensure that his
foot does not get infected.
4. Simon’s wife Mary has been told about the National Diabetic Services Scheme (NDSS) and would
like to know what provisions for support and funding do they provide for diabetics.
In regards to the NDSS, outline 3 ways this service can assist Simon and his family – must include
1 funding benefit that applies to Simon. (Max 80 words)
The NDSS can be of benefit to Simon and the Wife in different ways.It can provide funds,offer education
and provide necessary nursing interventions.The function of the National Diabetic Services Scheme is to
provide funds to diabetic patients so that they can get access to a healthy lifestyle(Johansson et al.,
2016).It also ensures that all the patients are educated on how well they can manage the conditions and
this will really be of benefit to Simon.Finally,simon might get the necessary nursing interventions from
the program such as IV injections of insulin.
5. Aside from the NDSS, discuss 3 other credible diabetic organisations that you could suggest for
Simon and his wife to access that will assist with their support – you may also include local support
groups.
You must also identify the service and what they offer that will compliment Simon’s needs. Within
your answer identify how Simon can make contact with these groups and identify who else within
the interdisciplinary team would benefit from this information (Max 60 words)
There are different organizations in Australia that deal with diabetes that I can recommend to Simon.They
include the Australian Diabetes Educators Association,Australian Diabetes Society and finally the State
and Territory Diabetes Organisations.All this organizations provide funds for diabetes patients.They also
provide nursing interventions and educate patients on healthy lifestyles(Razmpoosh, Javadi, Ejtahed, &
Mirmiran, 2015).The contacts for this particular organizations can be found on the Australian Ministry of
Health Website.
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6. Discuss 2 ways you as the EN can liaise with diabetic services so that you know what to
recommend to Simon and his family. (Max 30 words)
The two ways in which I can liaise with diabetic services is by seeking updates on new available
interventions and finally seeking recommendations on a regular basis on how best to assist diabetic
patients like Simon.
7. You are teaching Simon about managing his blood glucose levels and taking oral glipizide
(Glucotrol). Which of the following statements made by Simon indicates to you that he needs
additional teaching?
"If I overeat at a meal, I will still take the usual dose of medication."
"Other medications besides the Glucotrol may affect my blood sugar."
My diabetes won't cause complications because I don't need insulin." Correct
"When I am ill, I may have to take insulin to control my blood sugar."
8. Outline 3 ways you can ensure that Simon and his wife understand the management of his condition
(Max 30 words)
There are three ways in which I can ensure they have understood.One is asking questions to evaluate
them.Secondly,I will ask them to teach back so that am sure they have understood and finally use of
visual aids.
9. Discuss how a family / carers understanding of diabetes can affect a diabetic person’s planning and
implementation of any devised plan. (80 word limit)
If one of the family members or the carers understands diabetes,they will positively affect the patients
planning and implementation of any devised plan.This is because they will offer or will provide the best
advice to the patient on how well to improve on the plan(Sen, Chakraborty, & De, 2016).They will also
assist the patient to adhere to the plan since they are fully aware of the consequences if they don’t adhere
to the plan.
10. Discuss briefly 2 environmental and 2 social factors within the general population of Australia that
contributes to diabetes (Max 80 words)
Environmental factors Social factors
Access to healthy food.Majority of the
Australians do not access healthy food and
therefore consume foods that are low in fibre but
high in sugar and fats leading to diabetes.
Low education whereby some of the Australians
end up with less knowledge on the management
of diabetes.
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Living in sedentary environment.Majority of
Australians live in sedentary environment that
does not adhere to physical exercise and proper
diet and therefore contributes to diabetes.
Low income among some of the Australians
makes it hard for them to eat on healthy foods
and this increases diabetes.
11. Discuss Briefly 3 factors experienced by Aboriginal and/or Torres Strait Islander people that may
contribute to their higher rates of diabetes. (Max 80 words)
There are three factors that contribute to the high rates of diabetes among the Aboriginal and Torres Strait
Islander people.They include genetic predisposition,unhealthy lifestyle and lack of knowledge on
management of the condition.Studies have established that majority of this community are living a
westernised life and consuming food that have low fibre and rich in fats and sugar and this increase
incidence of diabetes.Besides,they also smoke (Westaway, Seager, Rheeder, & Van Zyl, 2005).The
genetic make up of this people was also meant to adapt to scarce food but it is now prompting obesity
which is a risk factor for diabetes.
12. Discuss 3 issues relating to diabetic care delivery or services in Australia (Max 60 words)
One of the issues related to diabetic care in Australia is sheds.This is an initiative where the elderly meet
at designated places to get education on how to control diabetes.Another issue is the control or regulation
of diet especially among the indigenous communities since they are supplied healthy food from a central
store.The final issue is commitment from the government in providing education on management of
diabetes through the Ministry of Health.
Case study 2ue
You are the EN on shift at a multipurpose medical centre; your next patient to review prior to the
doctor is Chloe aged 15 a Type 1 Diabetic in year 10 at school. While you are taking her vitals and
BGL you ask her how she has been going, she makes the following comments during your
conversation.
“Sometimes you’ll binge eat and you’ll feel disgusting and you’re like, ‘Well, I just won’t inject my
insulin for it and it’ll kind of even itself out again’... it sounds screwed up.”
“I’m fat compared to Sara”
“Why do I have to have diabetes, why can’t I be normal, it’s so frustrating?”
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13a. Outline 4 factors that can influence self-esteem in a young person (Max 30 words)
Low self esteem can be caused by undesirable characteristics like binge eating.Another factor is certain
chronic conditions such as diabetes.Being fat is another cause and finally the inability to achieve their
targets.
13b. As a nurse hearing these comments from Chloe, outline 4 nursing strategies you could help Chloe
with, to build up her self-esteem (Max 80 words)
As a nurse,I would teach visualization techniques that can assist Chloe replace the negative self images of
being fat and the thoughts of why he cant be normal.I would also encourage the client to participate in
group therapies with people of the same condition so that they encourage each other.I would also work
with the client to identify cognitive distortions that can encourage negative self-appraisal.Finally,I would
evaluate Chloes need for assertiveness training tools so that he can pursue the things he needs in life.
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References
Hahr, A. J., & Molitch, M. E. (2015). Management of diabetes mellitus in patients with chronic
kidney disease. Clinical Diabetes and Endocrinology, 1(1). doi:10.1186/s40842-015-0001-9
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., …
Matthews, D. R. (2014). 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), 140-149.
doi:10.2337/dc14-2441
Johansson, T., Keller, S., Winkler, H., Ostermann, T., Weitgasser, R., & Sönnichsen, A. C. (2016).
Effectiveness of a Peer Support Programme versus Usual Care in Disease Management of
Diabetes Mellitus Type 2 regarding Improvement of Metabolic Control: A Cluster-
Randomised Controlled Trial. Journal of Diabetes Research, 2016, 1-10.
doi:10.1155/2016/3248547
Razmpoosh, E., Javadi, M., Ejtahed, H., & Mirmiran, P. (2015). Probiotics as beneficial agents in the
management of diabetes mellitus: a systematic review. Diabetes/Metabolism Research and
Reviews, 32(2), 143-168. doi:10.1002/dmrr.2665
Sen, S., Chakraborty, R., & De, B. (2016). Management of Diabetes Mellitus. Diabetes Mellitus in
21st Century, 153-174. doi:10.1007/978-981-10-1542-7_11
Westaway, M. S., Seager, J. R., Rheeder, P., & Van Zyl, D. G. (2005). The effects of social support
on health, well-being and management of diabetes mellitus: a black South African perspective.
Ethnicity & Health, 10(1), 73-89. doi:10.1080/1355785052000323047
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