Case Study and Care Plan: Diabetes Management and Palliative Care

This case study and care plan focuses on a 60-year-old patient admitted to the hospital with uncontrolled type II diabetes, emphasizing the crucial role of nursing in managing the condition and providing palliative care. The assignment details the nursing interventions required to normalize blood sugar levels, implement dietary and exercise regimens, and monitor the patient's day-to-day sugar levels. It highlights the importance of patient education regarding diabetes management, including medication schedules, insulin administration techniques, and the recognition of hypoglycemic and hyperglycemic symptoms. Additionally, the case study addresses the significance of monitoring associated conditions like hypertension and renal function, while also emphasizing the need for a palliative approach to alleviate pain and discomfort, especially in end-of-life situations. The nurse's role extends to providing emotional support, facilitating communication with the patient and family, and ensuring the patient's understanding of their condition and treatment plan. The document also stresses the importance of hygiene, infection control, and the need for patients to maintain a structured routine to effectively manage their diabetes. The assignment underscores the holistic approach to patient care, encompassing physical, emotional, and spiritual support to improve the patient's quality of life.

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Assignment
Case Study and Care Plan
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The Nursing practice requires many qualities. It requires specialised skills, knowledge and
independent decision-making skills. There are many aspects of nursing practice. It includes
the type of client, different disease management, care and also rehabilitation. This relation is
based on mutual respect and trust. It is a helping relationship in which the nurse should be
sensitive to self and others . Providing physical, emotional, spiritual support to the patient and
their family.

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The palliative practise involves communication between nurses with officials , patients and
also their relatives. By effective communication, a comfort level with the patient is developed
by which patient conveys his pain, fear , shares anxiety. Listening is a very important mode
of communication. It requires nursing skills and attention. By this nurses can access the
situation and problems of the patient. By being a good listener nurses can provide care at all
levels of recovery.
Along with listening , speaking with the patient also becomes important .Conversations
should be held in appropriate condition. Each patient has its own way to discuss the problem.
After the nurse has listened to all the problems she can talk to the patient.
Physically palliative approach is followed to manage pain and physical discomfort in most of
the situations. Pain being the most important complaint in the palliative approach to
treatment. As the discomfort increases the need for palliative approach increases. It becomes
very important where treatment is painful .Old age people become prone to life-threatening
disease or their suffering increases due to the natural ageing process. In many countries,
palliative services are provided at home only. Mostly people by the end stage of their life
prefer to spend their time at home. The palliative approach helps patient’s family to cope with
the terminal illness of the patient. Palliative care leads to hospice care which includes
focusing on comfort and quality of life. A personalised action plan is required for every
patient for comfort and care. In this, it has been found that the survival expectancy is
increased by 6 months. In this, the main focus is on pain control which troubles the patient
most. Pain control is done by analgesics and comfort measures which can be achieved at
home.
It is important to develop an integrated care pathway for the dying patient. This is for the
patients whose diagnosis is known and loss of life is inevitable. In this symptoms are closely

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monitored and palliative approach is followed accordingly. In few cases, older people denied
access to palliative care. In these cases, their admission in hospital and nursing home
becomes very important. Specialised palliative care is required in many patients.
Proper symptom control is impossible in older adults without proper communication. An
accurate assessment of patient’s health requires effective communication. Communication is
the centre of all treatment. Communication will deliver a great amount of palliative care to
the older adults. In the society conversation about death is often very awkward and difficult.
Among the health care professionals, there is a requirement of improvement of techniques to
overcome these obstacles. In last two decades, there is awareness of the importance of
communication skills (Kinley et al, 2013).
A Patient age 60 years gets admitted to the hospital with uncontrolled type II diabetes.
Nursing is very much required in this area. As a patient with Diabetes type II may require
guidance, treatment and proper monitoring. Diabetes patients often stay on treatment for life-
long. Here the nursing plans include the treatment to normalise blood sugar. The blood
glucose should be around 120. More than these needs to be reported to the treating physician.
Also to implement a strict and balanced diet for the patient. Also, it is important to make sure
that adequate exercise regime is being followed. Also, it is important to monitor the day to
day sugar levels of the patient. As here we can see the patient is having unstable blood sugar
this can be due to many factors like inadequate blood glucose monitoring. There can be also
non-adherence to diabetic management. A nurse needs to keep a check on these. (Dunning,
2013). Also, it is important to manage the timely medication of the patient. Also, it is
important to give adequate knowledge to the patient regarding diabetes management. There
should be a proper chart formed on the day to day development of the patient. So that the
patient’s development can be monitored. Also, a nurse should be able to address any stress
related concerns. As in diabetes, the main factor is stress. Stress causes aggravation in

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diabetic condition. Also, it is the duty of the nurse to encourage the patient for exercise. A
sedentary lifestyle causes weight gain and this will cause increased chances of uncontrolled
diabetes.
It is the duty of the nurse of access the sign and symptoms of hyperglycaemia through
regular blood glucose tests. Also, it is important to keep a check on blood sugar before meals
and along with blood sugar, it is important to access Hab1c values of the patient. It should be
between 6.5 -7. Being a nurse it is important to monitor its level in every 2-3 months. At
times the diabetic drugs cause immediate hypoglycaemia, There are few signs of
hypoglycaemia like anxiety, tremors, slurring of speech. A nurse should be able to recognise
these sign and symptoms. Also, it is important to keep a record of temperature and pulse of a
diabetic patient. In many cases the patient is diabetic but he does not have any knowledge
regarding diabetes. It is very important to inform and educate the patient about the changes he
needs to bring in his lifestyle due to diabetes. Exercise causes lowering of blood sugar. It is
important to educate the client about proper exercise regime. It will help managing diabetes.
Also, the old patient is on insulin, it is important to give him insulin on the prescribed
timings. Also once the patient is discharged from hospital he needs to teach how to monitor
his glucose levels at home. There are many cases that hypertension is also associated with
diabetes.
Along with blood sugar management, the patient has to monitor its Blood pressure. BP
control will prevent many diseases like stroke, retinopathy etc. Also, regular urinary
checkups are also important as it will help the patient to monitor the urine albumin levels. Its
increased levels are found in renal nephropathy. The oral medications and insulin schedule
need to direct properly to the patient. Also as the patient is on insulin there are few things
which you need to tell him. Insulin injection should not be given at the same site again and
again. Insulin needs to be refrigerated at 2 degrees to 8 degree Celsius. Check the expiry date

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of insulin every time before use. Also, it needs to be told to the client that insulin has to be
injected only once or twice daily. Regular prandial insulin which has been prescribed to the
client has to be injected 30 minutes before the meals. Also, it is important to mention the
patient that insulin dosages are to be reduced if he is fasting or not eating or when there is
hypoglycaemia. Rotation of insulin site is very important. Pushing injections on the same side
may cause fat deposits. Also, most important factor to be told is the injection should be
injected perpendicular to the skin. Also, it is very important to check that the patient
understands the demonstrations . Also patient needs to be taught to follow a low fat diet
which is high in fibre and low in sugar. There should be a proper balanced three meals daily
which can include a healthy evening snack. There should be an increase in fibres diet. Also if
hypoglycemic conditions set in then treat it with a snack or a glucagon injection.
Infections are very common in diabetic patients. As due to high blood sugar, these infections
don’t heal rapidly. It is important to observe the signs of infections. There are many signs of
infection such as fever, cloudy urine and wound drainage. Immediate hospital admission may
be required at this stage. It is important to follow some basic hygiene rules. The skin needs to
be dry. The linens have to be washed properly and kept in hygienic conditions. It is important
for the patient to monitor its vital signs during the stay at home. While instructing the patient
we need to check that he is aware of his time and orientation. It is important to call the patient
by name. This helps in gathering the attention of the patient. The instructions given to the
patient should be short. We need to speak slowly and clearly. Also, we ask the patient to
repeat in case he does not understand we need to explain him again. The patient needs to
follow a strict routine so that he does not forget his medications and injections. It is also
important to tell the patient that he need to avoid injury. Also, we need to access the problem-
solving capacity of the patient from the past experience. Is patient able to take care of himself
or there is a requirement of a home nurse. It is important to encourage the patient to take

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decisions, he should be able to take decision related to his care. Also, we need to schedule
appointments and other activities henceforth. It is important to encourage the patient to take
part in outdoor activities. It will keep his exercise regime good. Also, physical activity will
help him reduce his blood sugar and live a healthy life. It will also promote positive health
care in the patient and feeling of control over the situation.
A palliative care is an approach which reduces the stress and pain due to suffering from
terminal disease. This is adopted mainly in life-threatening diseases where the cure is not
possible. The palliative approach is utilised to improve the life of the patient from the pain
and suffering related to the disease. This also helps and supports the life of the patient who is
having a natural death. The life-threatening disease can be encountered at any stage of life.
Different type of palliative care is required for different age groups .Hence an age-related
palliative approach is required .The palliative approach is based on individual needs , it
differs in different age and medical condition. The palliative approach helps to comfort the
individual suffering from the disease (Aoun et al, 2015).
In palliative care a nurse should be able to carry out tough conversations with the patients
family. These conversations include patient’s current health , the progression of a disease and
anticipated death. The information provided should be honest and it should be provided in a
way that the family members should be able to understand the situation. Palliative care nurses
need to be knowledgeable and they should carry enough experience in nursing to deliver
sensitive information in a proper manner. The role of the palliative nurse is extremely
stressful . It is important for the nurse to focus on self-care along with the care of patient and
family members

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Physically palliative approach is followed to manage pain and physical discomfort in most of
the situations. Pain being the most important complaint in the palliative approach to
treatment. As the discomfort increases the need for palliative approach increases. It becomes
very important where treatment is painful .
In end life patient involves the ability to both give and receive information. It is important for
the nurse to make the patient understand his/her condition. Also to prepare the family for the
near future events which will occur. However, In the case of old adults, it is sudden death.
Thos may come as a shock to the family. It is the duty of the nurse to explain the correct
situation of patient’s health to the family so that they can deal with any sudden emergency
. In this case, the nurse has to keep a clear communication (Katz et al, 2016). She needs to
keep patient’s relative about patient’s condition. For the patient’s family circumstances
change on a day to day basis depending on the patient’s health. Like in the case of older adult
the family may need to discuss something which is very difficult and emotive. Open and
sensitive communication works in the best way. It also depends on an appropriate situation.
This applies to nurse, patient and family members. Communication in nursing practice comes
naturally. It's not simple, it is always difficult to communicate with some terminally ill. It
required education and experience. The need of great communication skills is required by
nurses worldwide especially in a situation of serious illness or end life care. Nurses are the
one who spends most of their time with the patient and around them (Brinkman-
Stoppelenburg et al, 2014). Hence communication with them plays a significant role. Nurses
help patient and their family to interpret the bad news , they also play a crucial role in
listening to them post such information. In these case, nurses need to reflect positive care
towards the patient and their family .Patients and their families have concerns regarding the
dying process and death. In this stage, the patient is in great pain and many unrelieved

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symptoms. Nurses should actively participate in providing information and explaining the
medical terminologies
As the medicines have already played their role. It is a stage where a patient wants to say
want he actually feels and at the time someone who has knowledge and presence of mind is
required (Moir et al, 2015).
However, in many cases, the patient might take a good amount of time to understand the
approach of the therapeutic relationship and respond to it. To appreciate the effects of
therapeutic relationship we must look for its outcome. Researchers have shown that
therapeutic relation improves the quality of the life of the patient (Teno et al, 2013).
Moreover, they are able to communicate in a better way and therefore sharing their concerns
which are very important.
Nursing has a very strong impact on our society .Nurses can use their research knowledge
and skills to answer questions related to nursing diagnosis also they can prepare care plans
for patients. It includes learning about drugs and diseases. Obtaining information from the
patient which is a very crucial practice for nurses which will help them in their further
research. Through patient interaction, they can investigate new topics pertaining to their
interest. All this will promote the professional development. There are certain laws related to
nursing. Over 100 years ago these laws were made to ensure the safe nursing practice.
Caring is the term always associated with nursing (Larkin, 2013). The nurse's behaviour
should be holistic and the actions should aim at creating and maintaining an environment
which will support healing. To support the nursing profession the nurses need to engage
themselves in a broad range of activities when enacting professional roles. There should be a
deeper understanding of the term care. There are multiple levels of care. Caring comes with
professional experience. It may have a different meaning for different nurses. The concept of

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care depends on different factors. It depends on the amount of professional experience, the
level of nursing education, professional values and how and where the nursing skills and
concepts are being applied. The caring concept is central to the nursing practice. It requires
great amount of discipline and dedication to follow. There should be intentional and
conscious caring. This will bring out the best of the nursing practices from you. Being a nurse
means you have to be fully present in that moment and take proper care of the patient. It is
all about having a trusting, helping and caring relationship with the patient. This should not
be limited to the patient but also should be extended towards the other staff and most
important the caregivers of the patient (Anstey et al, 2016). This gives a positive feeling in
the patient and the caregivers. Caring is a very integral part of nursing. It is important to
engage yourself in genuine care by learning through various experiences with the patients.
This will come with years of practice and dedication. Caring is an art which has to be studied
but more than this it is an attitude in life which nurses should flow for the patients and also
the people around them. It is a there duty to create a healing environment. Researchers have
proved that if a patient is given adequate care and timely medication it can even have
miraculous results. For terminally ill patients care is the most important thing they required.
This may add few more months or years in their lives. Caring is the most important aspect of
the nursing profession. As we know that in old age many patients suffer from lack of care. A
proper caring institution can give relief to old age patient in many aspects (Gélinas et al,
2012)..
References
Teno, J. M., Gozalo, P. L., Bynum, J. P., Leland, N. E., Miller, S. C., Morden, N. E., ... &
Mor, V. (2013). Change in end-of-life care for Medicare beneficiaries: site of death, place of
care, and health care transitions in 2000, 2005, and 2009. Jama, 309(5), 470-477.

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Larkin, P. J. (2013). Listening to the still small voice: the role of palliative care nurses in
addressing psychosocial issues at end of life. Progress in Palliative Care.
Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of
advance care planning on end-of-life care: a systematic review. Palliative medicine,
0269216314526272.
Katz, R. S., Johnson, T. A., & Johnson, T. G. (Eds.). (2016). When Professionals Weep:
Emotional and Countertransference Responses in Palliative and End-of-life Care. Routledge.
Gélinas, C., Fillion, L., Robitaille, M. A., & Truchon, M. (2012). Stressors experienced by
nurses providing end-of-life palliative care in the intensive care unit. CJNR (Canadian
Journal of Nursing Research), 44(1), 18-39.
Moir, C., Roberts, R., Martz, K., Perry, J., & Tivis, L. J. (2015). Communicating with
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of Staff RNs. International journal of palliative nursing, 21(3), 109.
Anstey, S., Powell, T., Coles, B., Hale, R., & Gould, D. (2016). Education and training to
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Towsley, G. L., Hirschman, K. B., & Madden, C. (2015). Conversations about end of life:
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