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INTRODUCTION Nursing priorities are defined as the approach to ordering nursing problems or issues on the basis of urgency or importance so that nursing actions can be performed in preferential order (Ray & et.al., 2017). The report will provide the nursing interventions and their role in addressing prioritized health issues for the given case study. Patient health issue For this assessment case study of a 65-year-old woman named Evelyn Hansen is chosen. The patient was admitted to hospital in reduced state of consciousness due to higher level of blood glucose (44.2 mmol/L). On the basis of assessment and medical background the five major health issues identified are as follows: Hyperglycemia: It is defined as the elevated level of sugar in the blood and is quite common in the people with diabetes. Evelyn Hansen has been suffering from diabetes from the last 10 years and also has poor diabetic management.Due to presence of diabetes the issue is one of the major health issue which must be addressed as the priority because the uncontrolled hyperglycaemia can lead to clinical deterioration of the patient health outcome by further promoting other issues such as dehydration, stroke, cardiac risk and hypertension (Fritschi & et.al., 2016). Depression: The patient has medical history of depression. At the time of administration also she was less conscious. The depression and anxiety can lead to the other psychological complications for the patients which can even cause fluctuations in the blood pressure(Phelps, Hyde & Wolf, 2015). Dehydration due to urinary tract infection (UTI): The UTI leads to the dehydration which resulted in subconsciousness. The regular loss of fluid from the body must be controlled as the prevalence of hyperglycemia along with the UTI can make it worsen and it can be life threatening for the patient (Nichols & et.al., 2017). Hypertension: Among the patients of type 2 diabetes hypertension is common. The history of depression and elevated sugar levels in the blood can enhance the blood pressure. In addition to this the 1
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medications provided to patient for UTI can also cause increase in the blood pressure(Chen & et.al., 2019).Thus, this health issue must be taken into account for the nursing interventions. Diabetes management knowledge Evelyn Hansen has higher sugar level and her weight is also not managed. Thus, the improper management of the diabetes can act as potential health risk for the patient. On the basis of above identifications it can be analysed that for the patient the three most prioritized health issues are hyperglycaemia, dehydration and diabetes management knowledge. The other two issues of depression and hypertension can be managed after addressing prioritized health issues(Nichols & et.al., 2017). Rationale and ranking of three prioritized health issues According toChen & et.al., (2019)it is very essential for the nurses to formulate each intervention as per the nursing priority. In order to provide care for nursing priorities of Evelyn Hansen three chosen prioritized issues are ranked in the following order. Priority 1: Hyperglycaemia Hyperglycaemia is very complicated and life threatening situation for the patient.Egede & et.al., (2017)stated that the continuous and regular events of elevated sugar level give rise to cardiovascular issues, nerve and kidney damage as well as diabetic retinopathy. In the given study along with these risk factors the health issue becomes more dominant because patient is suffering from dehydration. The combination of both of these health issues is considered as one of the top most priority as it works in iterative loops and condition of the patient can deteriorate very quickly. Due to hyperglycaemia patient may also suffer from fever, diarrhoea which in turn worsen the dehydration because kidneys produce more amount of urine for unloading ketones and glucose. Though hypertension is also one of the sensitive aspects which must be managed as the priority health issue. However, the hyperglycaemia is given preference as the first priority over hypertension because it has been observed that hyperglycaemia can also act as one of the reason for elevating blood pressure. Thus nursing interventions and care provided for its treatment can also be effective in keeping blood pressure stable. The increased sugar level in the blood also alters the vascular functions and structures leading to hypertension. In support of this priority it has been also stated byInzucchi & et.al., (2015)that hyperglycaemia increases heart rate and generates the possibility or the risk factor for myocardial contractility, stroke and systolic heart failure. 2
Priority 2: Dehydration The second health issue priority chosen for the patient is dehydration.Urinary infection has been observed as the rationale for the excessive fluid loss. The infection affect lungs and bladder and thus body tend to release more fluid than the amount consumed. It results in dehydration.The issue has been categorized as the second priority after hyperglycaemia because when body gets dehydrated in excess then it can even lead to death of patient. However, hyperglycaemia is given priority over this issue because hyperglycaemia enhances the extent and intensity of dehydration. The issue has been included in the top 3 nursing priorities for the patient because for the patients with type 2 diabetes mellitus regular fluid loss result in transitory insulin resistance. It worsen the diabetes and stability of the patient can be put under risk. During dehydration episodes the body tend to produce more glucose which in turn cause the hyperglycaemia. Thus, it is very essential for the safety of patient that the integration of dehydration and hyperglycaemia must be treated. Priority 3: Diabetes management knowledge The first nursing priority is to make patient stable and to assure that safety of the patient is sustained. Since diabetes management is long termed intervention it is prioritized after hyperglycaemia and dehydration. The intervention will help Evelyn Hansen to manage her weight and hypertension as well so that the episodes of hyperglycaemia and diabetic risks can be controlled and managed. As per the view ofFritschi & et.al., (2016)intervention is given priority over hypertension and depression because with the self care plan of diabetes patient will lead to a more active life style. It will improve her clinical outcomes and issues of hypertension can be minimized to a significant extent.When diabetes is managed through life style improvement then it maintains the sugar level in control and hyperglycaemia risks are prevented and easy to manage. Role of nurses in addressing patient health issue Nurses play vital role in providing care services by addressing issues. Also, it is very important for nurse to address health issues in proper way. This can be done by using assessment such as analysing patient lifestyle, past record, etc.By this it is easy for nurse to develop care plan and give medicines (Harper & Maloney, 2016). Moreover, in assessment nurse role is to find out symptoms of hyperglycemia. This will give nurse an insight about why sugar level is 3
increasing very high.A nurse ensures that they follow practice as per standards to treat dehydration. They identify her diet, meals taken, previous health issues, etc. in assessment. It gives an overview of patient health condition. Coordination of care state that nurse is role is to role is to give proper medicines according to health issue.So, in Evelyn Hassen case among three health issues, nurse should regularly check hyperglycemia level and monitor it. This is because it will support in checking if there is increase in sugar level or not.Thus, it will help in ensuring that correct medicines are given in righttimeandprecautionsaretakenbeforeproceedingfurther.However,nurseshould communicate with family members of Evelyn Hassen to bring change in lifestyle, diet, etc. They need to coordinate with multidisciplinary team to evaluate condition of patient. They can take suggestion from them regarding health services (Chen & Grabowski, 2015). In this way health issue of diabetes and dehydration can be addressed. In provision of care, nurse role is to follow guidelines and policies related to nursing practice.In RN, SWSLHD policy must be used. It enables nurse to follow specific standards and facilities. The policy restricts individual to publish information without being consent. So, nurses are bounded to follow ethics and standards.They should follow practices and RN standards for practice. They are critical analysing and thinking, planning and regularly communicating with patient regarding dehydration.The nurse needs to think and develop plan of treatment to ensure that she is not dehydrated and meal is given as per plan. They should give safe response to her related to diabetes level that will be useful in identifying needs. Similarly, regular monitoring of hyperglycemia is essential to address health issues. The nurse note reading, check diabetes level, etc. in order to provide medicine and treatment on basis of situation. Moreover, in NSHQS there are certain standards as well such as nurse must communicate with Evelyn Hassen family and check her condition (Phelps, Hyde & Wolf, 2015). Furthermore, in case of Hyperglycemia if her condition gets deteriorate then immediate care is provided. In dehydration and diabetes nurse must regularly monitor and check her health condition. It is required for nurse to ensure clinical governance in order to improve her condition. The following of all these policies and standards in provision of care enables nurse to address Evelyn Hassen three health issues. It will support in taking proper care and providing high quality care services. 4
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