Implement and Monitor Care for a Person with Diabetes

This document provides knowledge and case study questions related to implementing and monitoring care for a person with diabetes. It covers factors affecting self-esteem, issues in diabetes care delivery, environmental and social factors contributing to diabetes, and the role of healthcare professionals. The document also includes a case study and nursing care plan for managing diabetes.

HLTENN025 Implement and
monitor care for a person
with diabetes

Table of Contents
KNOWLEDGE QUESTIONS........................................................................................................................................1
PART A SHORT ANSWER QUESTIONS...................................................................................................................1
1.factors that may affect the self-esteem of a person with diabetes mellitus.............................................................1
2.issues related to diabetes care delivery and diabetes related services.....................................................................1
3.environmental and social factors contributing to diabetes mellitus........................................................................2
4.higher rates of diabetes mellitus experienced by Aboriginals................................................................................2
5.significance of the National Diabetes Services Scheme (NDSS)...........................................................................2
6. role of Diabetes Australia......................................................................................................................................2
7. role of General Practitioners in supporting and delivering diabetes care..............................................................3
8. role of an endocrinologist......................................................................................................................................3
9. describe the role of National Association of Diabetes Centres (NADC)...............................................................3
10.identify the family or carer’s understanding of and involvement in a person’s diabetes care..............................3
11. family or carer’s understanding of and involvement in the person’s diabetes care.............................................4
PART B CASE STUDY QUESTIONS..........................................................................................................................4
1..................................................................................................................................................................................4
2..................................................................................................................................................................................4
3..................................................................................................................................................................................5
4..................................................................................................................................................................................5
5..................................................................................................................................................................................5
ESSAY............................................................................................................................................................................6
INTRODUCTION..........................................................................................................................................................6
MAIN BODY..................................................................................................................................................................6
anatomy and physiology related to the glucose metabolism and absorption.............................................................6
pathophysiological changes occurring in type 1 diabetes and the resulting symptoms.............................................7
The pathophysiological changes occurring in type 2 diabetes...................................................................................7
The pathophysiological changes occurring in gestational diabetes mellitus.............................................................7
Various problems that might occur when providing nursing care to a person with diabetes mellitus......................8
CONCLUSION...............................................................................................................................................................9
REFERENCES.............................................................................................................................................................10

KNOWLEDGE QUESTIONS
PART A SHORT ANSWER QUESTIONS
1.factors that may affect the self-esteem of a person with diabetes mellitus.
There are a number of factors that can affect self-management and esteem of patient suffering
from diabetes mellitus. It includes the following:
Mental health issues: Diabetes mellitus is a public health concern. Diabetes and depression
are associated with each other. Patients with both these diseases haves seen to have negative
health outcome and adverse self-behaviour (Fang, Karakiulakis & Roth, (2020). Diabetic patients
have low self-esteem and also they are unable to manage things at their own. Self-esteem was
related to diet and exercise self-care behaviours among patients with insulin-dependent diabetes.
Evidence has also provided that people who have higher level of self-esteem are better at
managing diseases.
Lack of awareness: Self-management of diabetes mellitus is necessary in order to make
sure glycaemic control. Patients lose their self-esteem as they are not provided with adequate
education for managing disease. This reduces down their health outcome and can have adverse
effect on them.
2.issues related to diabetes care delivery and diabetes related services
There are various issues affecting the diabetes care delivery which can affect the health
condition of patient. It includes the following:
Client specific: Quality of diabetes care can be affected when nurses have an issue in
dealing with patient. It can be because of language barriers. There are chances that patient do not
understand what nurses tend to explain. There can also be inadequate explanation from primary
care physicians (Paschou et.al., (2018).
Cultural issues: In this family’s needs to be placed at appropriate context. It has been
evaluated that people consume food in a culturally defined ways. There can be a reluctance to
use new pattern foods, so in this case diabetes related services to patients becomes ineffective.
Political issues: The financial burden of diabetes both on the patient and the nation’s
economy is extremely high, which might hinder efficient care. Economies disparities is one of
the reason that diabetes management has become burden for government, so there can be gaps in
services provided by them.
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3.environmental and social factors contributing to diabetes mellitus
Research has provided that about one in twenty Australians are suffering from diabetes.
Factors which are contributing includes the following:
Environmental factors: It has a huge role in diabetes mellitus. Australians are suffering
from this disease because of lack of vitamin D, being exposed to enteroviruses and immune cells
getting damaged (Zheng, Ley & Hu, (2018).
Social factors: It includes life style factors, dietary choices, income and education level all
these can contribute to diabetes mellitus in Australia.
4.higher rates of diabetes mellitus experienced by Aboriginals
Aboriginals have higher rate of diabetes mellitus because of inequities in social determinants
of health. Factors contributing to risk of increasing this disease among people of Torres island
includes lower rate of physical exercise, higher level consumption of alcohol and smoking,
following low nutrient and unhealthy diet, stress and physical inactivity. In order to avoid these
risk factors aboriginals should follow proper clinical guidelines related to diabetes management.
5.significance of the National Diabetes Services Scheme (NDSS)
NDSS is an initiative adopted by Australian government so that people suffering from
diabetes mellitus can increase their capacity to self-manage which can assist them in overcoming
the disease (Plows et.al., (2018). They provide people with diabetes timely, reliable and
accessible services. NDSS provides range of subsidised items to patients for their self-
management. It includes blood glucose and urine testing strips, insulin pumps consumables etc.
These subsidise items can enhance health related conditions of diabetic mellitus patients. NDSS
also provides educational services to enhance knowledge of patients for early detection and
prevention of disease.
6. role of Diabetes Australia
Diabetes Australia has a huge role in providing high quality of care to patients who are
suffering from DM. They are engaged in raising knowledge and awareness related to seriousness
of disease. The institute is also a significant contributor in doing research so that better
intervention can be provided to patients with diabetes. promoting prevention and early detection
strategies and advocating for better standards of care. They have been working towards
enhancing health outcome of patients who are severely affected by this disease. There delivery of
care can improve wellbeing and quality of life of patients.
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7. role of General Practitioners in supporting and delivering diabetes care
General practitioners have huge responsibility in delivery quality care for successful
diabetes management (Pagano et.al., (2018). They have an important role in prevention and
detection of disease and also increasing competency of patients to self-manage the disease.
Various interventions can be used by GP’s in improving wellbeing of clients. There first priority
is to deal with patients fear and anxiety which can arrive because of disease. GP’s are also bound
to be aware about the impaired glucose tolerance. They have a huge role in early detection of
disease so that health aspects of patient can be improved.
8. role of an endocrinologist
Endocrinologist has provided with responsibility to set up effective system of care for
managing diabetic patients. They have a duty to make appropriate utilization of primary care
workforce so that highly efficient services can be provided to patients. These people also have a
responsibility to meet out educational needs of other health care professionals in community.
There main duty is to treat hormonal imbalance faced by diabetic patients and for successfully
managing patient’s condition, they also include dietician, primary care workers, ophthalmologist
and even cardiologist. All this for providing better delivery of care.
9. describe the role of National Association of Diabetes Centres (NADC)
NADC is basically Australian collective institute who are engaged in providing diabetes
care services either directly or indirectly. They are working towards enhancing service related to
this disease by implementing various evidence based policies and procedures. Their role is to
give higher standard of care by making use of benchmarking and quality assurance tools. NADC
is also providing services in regional areas so that health outcome of people in remote
community can be improved. They also provide assistance to allied health care practitioners and
pharmacy.
10.identify the family or carer’s understanding of and involvement in a person’s diabetes care.
The family and carer involvement can be identified by seeing situation of patient. If they
are unable to manage things at their own than it is really necessary, that support must be
provided by family members so that better delivery of care can be given to patients. It has also
been analysed that when patient has no understanding of disease then also family needs to be a
part in this process and they must make sure that awareness related to disease is been made.
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11. family or carer’s understanding of and involvement in the person’s diabetes care
Family member and carers can provide active support to patients suffering from diabetes.
So many studies have given evidence that households have great influence over managing
diabetic behaviour. Family and friends can be involved in improvising self-management and
behaviour of patients. Basically family members of patients provide instrumental support like
they drive diseased person to hospitals for appointments. If carers do not take care of all these
aspects, then patient can lose their self-esteem. So it is really necessary that family member have
understanding of disease.
PART B CASE STUDY QUESTIONS
1.
From the case study it has been identified that James has been prescribed T. Metformin to
maintain his blood glucose level. After one week he does not consume medication and his BGL
raised up tremendously. The factors which contributed includes Not taking enough insulin or oral
diabetes medications (Napoli et.al., (2017). BGL can also increase because of being inactive.
James has not been involved in any type of activity for about 3 weeks and he is constantly busy
in work and stressing out because of it. This has caused his BGL to increase which was low.
Patient was also engaged in consuming processed food, excessive amount of this type of food
can also increase BGL and can severely affect health outcome of patient. It has also been
analysed that blood sugar level can increase because of job stress. Body release a hormone when
person is stressed and it increases down their BGL and affecting their quality of life and well-
being negatively.
2.
In this case scenario The dietician and diabetic nurse educator rescheduled their timing for
the ward visit and also I have other patients at priority. In this circumstance communicating with
health care team will be appropriate so that proper coordination can be maintained in providing
delivery of care related to type 2 diabetes management (Lehrke & Marx, (2017). I can reschedule
my meeting with other ward patients and can also involve dietician and nutritionist team so that
proper and timely services can be provided to patients. Educator can also assist in monitoring the
BGL and by proper prioritisation of activities everything can be handled in this situation. This
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can also help in improving health outcome of patients at earliest. I can also visit patient at that
time when I am free so that equal time can also be given to other ward patients.
3.
Arnold and his wife needs to take essential self-care as they are suffering from diabetes.
Arnold has also been admitted to hospital because of having casual attitude and also he was not
involved in using insulin pen. The five key areas on which patients needs to lay emphasis on
includes the following:
 Healthy eating: Patient and his wife must make sure that proper dietary plan prescribed
by health care professional is followed by them. Dietician can also provide education
related to importance of maintaining proper diet.
 Being physically active: Arnold and his wife needs to be involved in doing proper
physical exercise so that their BGL can be maintained and also their diabetes can be in
control because of this (Zimmet et.al., (2016).
 Taking timely medications: They need to take medication as prescribed by health care
professionals. Insulin pen should be used by them.
 Monitoring of blood sugar: Patient also must monitor their BGL level at regular interval
of time in order to enhance their health outcome.
 Not consuming alcohol: It is prescribed that diabetic patients must not consume alcohol
or even they must not smoke.
4.
In the present situation patient can be provided with glucagon injection. This hormone
assist liver to add glucose into blood. By this blood sugar level of patient can be instantly
increased. It is best prescribed to nurse in situation of hypoglycaemia. This injection can also be
used by nurses in several type of medical tests. This medicine is basically in form of injection
and it can be given into veins or arms. This injection can help in bringing unconscious patient
into conscious condition. After providing medication nurses also needs to make sure that they
monitor blood sugar level of patient regularly.
5.
From the case study it has been analysed that patient has tested positive for ketoacidosis and also
clients blood glucose level is really high. Following nursing diagnosis and care plan can be taken
in order to enhance health outcome of patient.
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Nursing diagnosis and intervention Rationale
Monitoring of BGL BGL more than 600 mg with serum osmolality
Keeping a check on temperature Dry skin and fever may also represents
dehydration
Checking heart rate peripheral vasoconstriction can appear because
of compensatory mechanism and with a week
pulse rate.
Checking BGL before food time and also at
bed time
In this BGL must be maintained at 140 and 180
mg. Less than 140 mg BGL must be
maintained for non-intensive care patient.
Peripheral perfusion can also be checked and
monitored (Landon, Catalano & Gabbe,
(2018).
Monitoring patterns based on physical
exercise.
Physical activity can lower down blood sugar
level and also it can save patients from
suffering cardiovascular problems in future.
These nursing care plan can assist in enhancing health outcome of patient and also by this
management patients BGL can also be maintained. This will also help nurses in enhancing health
and wellbeing of patients.
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ESSAY
INTRODUCTION
Diabetes mellitus basically known as diabetes is the condition defined as the persistent high level
of sugar in the blood. This situation can be explained as the disorder in carbohydrate
characterized as impaired ability of the body for producing or responding to insulin for
maintaining the proper level of sugar in the blood. In addition, diabetes is the major cause of
morbidity and mortality as the outcome of the disorder is not immediate. There are major tow
types of formation of the disease as their type 1 a type 2. The former on is referred to be insulin-
dependent diabetes mellitus or juvenile-onset diabetes which usually take place from childhood
and the latter on adult onset diabetes.
Australia is having the diabetes s major health problems which is associated form the varsity
of complications. it is the fasted growing chronic diseases as comparative to heart disease and
cancer. The report will have the major discussion on the description in relation of anatomy and
physiology related to the glucose metabolism and absorption in the human body. In addition to
that’s, there will be discussion on the pathophysiological changes occurring in type 1, type 2 and
gestational diabetes. the report will have identification of problems occur while providing the
nursing care to the person suffering with diabetes mellitus.
MAIN BODY
anatomy and physiology related to the glucose metabolism and absorption
Role of the pancreas in glucose metabolism and absorption: One of the main role of
pancreas is to regulate macronutrient digestion and also they release various type of digestive
enzymes. They also help in digestion by releasing secreting enzymes and also nutrient molecules
are cut into smaller parts (McIntyre et.al., (2019). These molecules can be absorbed in the blood
streams with the help of intestinal walls. Pancreas produces insulin and they also have
responsibility to release beta cells. It assists in storing glucose and helps in absorption (.
Roles of insulin and glucagon in maintaining the glucose level in our body: It has been
analysed that insulin and glucagon tends to perform together. They both assists in maintaining
blood sugar level in human body. Insulin can assist in absorbing glucose in body which can
assist in reducing down blood sugar (How Insulin and Glucagon Work, (2018). If the sugar level
in body is low, then at time pancreas releases glucagon that helps body in maintaining glucose
level. It guides livers to give stored glucose and this can assist in blood sugar level to increase.
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pathophysiological changes occurring in type 1 diabetes and the resulting symptoms.
Type 1 diabetes mellitus is being formed by lymphocytic infiltration. Pathophysiology of
diabetes is being linked with maintaining insulin level in human body and also it is connected
with ability of body to utilise insulin. This is because insulin level is really low in type 1 diabetes
(Kleinert et.al., (2018). Common symptoms which can be seen after this can include
hyperglycaemia. In this patient can also go through fatigue and anxious. It has also been
analysed that this can negatively impact health outcome of patient. Their health outcome and
well-being can be severely affected after this. In worsening condition patient can also face
consciousness. In order to enhance condition patient can be engaged in doing regular exercise
(What is the pathophysiology of type 1 diabetes mellitus (DM)? (2020).
The pathophysiological changes occurring in type 2 diabetes
Main pathophysiological features of type 2 diabetes can include impaired regulation
related to hepatic glucose, resistance in insulin, decline in function of beta cells. This can lead to
cell failure. It has also been analysed that in type 2 diabetes patients condition can worsen as the
human body loses their ability to make use of insulin in this situation. There are various signs
and symptoms that can be seen in this situation such as fatigue, restless, lost appetite. It can
severely affect the blood vessels and because of this patient can also suffer from various other
problems like heart disease. It can reduce quality of life and well-being of patients.
The pathophysiological changes occurring in gestational diabetes mellitus.
GDM is usually the result of β-cell dysfunction. In this there is resistance to insulin and it
is mostly seen during the time of pregnancy. In pathophysiology of this tissue incidence
resistance are been the main part of this pathophysiology. Gestational diabetes is developed
when pancreas is unable to produce adequate level of insulin. It basically occurs when the body
is unable to develop the needed insulin during time of pregnancy. It can affect health outcome of
mother and new born too. It means that sugar level also increases in body. This can severely
affect well-being of patient and their quality of life can be reduced.
Various problems that might occur when providing nursing care to a person with diabetes
mellitus
Hypoglycaemia: This is a condition in which BGL is lower and it cannot be considered as
normal. There are various signs and symptoms that can be seen in this situation like fatigue,
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anxiety, hunger, irritability. This conditions requires immediate treatment. When the conditions
worsen patient can also be seen with confusion, blurred vision and consciousness (Katsarou
et.al., (2017).
Hyperglycaemia: It is a situation where patients’ blood sugar level increases. This can
lead to severe health related problems in patient. This condition occurs when adequate insulin is
not being produced by body. If a person does not maintain their glucose level, then they can face
severe issue like ketoacidosis. They can also go into diabetic coma.
Ketoacidosis: It is a severe complication and usually appears when BGL of patient is high.
It can be faced by patients with type 1 diabetes. There are various risk factors related to this
disease such as diabetes mellitus type 1 and infection. In this situation body develops acidic
substance known as ketones and they are dangerous can severely affect health outcome.
hyperosmolar non-ketotic coma: It appears in type 2 diabetes situation and usually can be
seen when patients BGL is really high. Main cause of HONK can be undiagnosed diabetes which
may be increasing over the years. The signs and symptoms related to this disease includes
nausea, problem of frequent urinating, feeling thirsty etc.
Diabetic retinopathy: In this disease patient can feel problems in their eyes because of
diabetes. Light sensitive tissues presented in blood vessels are damaged. It also damages retina.
Patient can face mild problem in vision during starting period. Risk factor related to this disease
can include smoking tobacco and even patient can be diabetic.
Infection: patients suffering from diabetes can be at risk of facing infection because of
lower flow of blood to extremities and damage in their nerves. High level of sugar in blood can
allow growth of bacteria and because of which patient can face infection.
Psychosocial issues: There are various psychosocial issues because of which self-care of
patient is affected like for example they do not have proper access to treatment facilities. They
can even be depressed or anxious because of which they are facing adverse problems.
Microvascular and macro vascular disease: Diabetes issues are separated into micro and
macro vascular disease. If problem occurs in small blood vessels, then it is micro vascular and
when appears in large blood vessel then it is macro vascular.
CONCLUSION
From the above file it a be concluded as diabetes is the one of the fasted growing chronic in
Australia. the country has identified diabetes as epidemic for the 21 century and the biggest level
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of challenge for the Australian health system. The diabetes has the overall negative impact on
the development body. The chronic disease has damage to the blood vessels and nervous
systems. This have the adverse effects of functioning of differ organs and ability of respond over
different stimulus. There are various signs and symptoms seen in the case of diabetes such as
fatigue, restless, lost appetite. This have adversely effect on the blood as the patient have various
other problems like heart disease. It can reduce quality of life and well-being of patients.
Diabetes is getting the major effect on the pancreases as it is unable to produce adequate level of
insulin during Gestational diabetes. Risk factor related have the inclusion of smoking tobacco
and even patient can be diabetic. In addition to that High level of sugar in blood can allow
growth of bacteria which can make patient can face infection. Their health outcome and well-
being can be severely affected by the insulin. In worsening condition patient face the situation of
consciousness. In order to enhance condition patient can be engaged in doing regular exercise
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REFERENCES
Books and Journals
Fang, L., Karakiulakis, G., & Roth, M. (2020). Are patients with hypertension and diabetes
mellitus at increased risk for COVID-19 infection?. The Lancet. Respiratory
Medicine.8(4).e21.
Katsarou, A., Gudbjörnsdottir, S., Rawshani, A., Dabelea, D., Bonifacio, E., Anderson, B. J., ...
& Lernmark, Å. (2017). Type 1 diabetes mellitus. Nature reviews Disease primers.3(1).
1-17.
Kleinert, M., Clemmensen, C., Hofmann, S. M., Moore, M. C., Renner, S., Woods, S. C., ... &
Bakhti, M. (2018). Animal models of obesity and diabetes mellitus. Nature Reviews
Endocrinology. 14(3). 140.
Landon, M. B., Catalano, P. M., & Gabbe, S. G. (2018). Diabetes mellitus complicating
pregnancy. Gabbe's Obstetrics Essentials: Normal & Problem Pregnancies E-Book.300.
Lehrke, M., & Marx, N. (2017). Diabetes mellitus and heart failure. The American Journal of
Cardiology.120(1). S37-S47.
McIntyre, H. D., Catalano, P., Zhang, C., Desoye, G., Mathiesen, E. R., & Damm, P. (2019).
Gestational diabetes mellitus. Nature Reviews Disease Primers.5(1). 1-19.
Muniyappa, R., & Gubbi, S. (2020). COVID-19 pandemic, coronaviruses, and diabetes
mellitus. American Journal of Physiology-Endocrinology and Metabolism.318(5). E736-
E741.
Napoli, N., Chandran, M., Pierroz, D. D., Abrahamsen, B., Schwartz, A. V., & Ferrari, S. L.
(2017). Mechanisms of diabetes mellitus-induced bone fragility. Nature Reviews
Endocrinology.13(4). 208-219.
Pagano, G., Polychronis, S., Wilson, H., Giordano, B., Ferrara, N., Niccolini, F., & Politis, M.
(2018). Diabetes mellitus and Parkinson disease. Neurology.90(19). e1654-e1662.
Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C. (2018).
On type 1 diabetes mellitus pathogenesis. Endocrine connections.7(1). R38-R46.
Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018). The
pathophysiology of gestational diabetes mellitus. International journal of molecular
sciences.19(11).3342.
Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes
mellitus and its complications. Nature Reviews Endocrinology.14(2). 88.
Zimmet, P., Alberti, K. G., Magliano, D. J., & Bennett, P. H. (2016). Diabetes mellitus statistics
on prevalence and mortality: facts and fallacies. Nature Reviews
Endocrinology. 12(10).616.
Online
How Insulin and Glucagon Work. (2018). [ONLINE] Available through: <
https://www.healthline.com/health/diabetes/insulin-and-glucagon>
What is the pathophysiology of type 1 diabetes mellitus (DM)? (2020). [ONLINE] Available
through: < https://www.medscape.com/answers/117739-42275/what-is-the-
pathophysiology-of-type-1-diabetes-mellitus-dm>
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