University Project: Type 1 Diabetes Nursing Management Strategies

This project focuses on the nursing management of a 5-year-old female child, Clare, diagnosed with type 1 diabetes who is also exhibiting symptoms of gastroenteritis. The assessment includes physical examination, tests (stool culture, ECG, urine analysis, blood glucose, ketone level, and serum electrolyte tests), and consideration of symptoms like vomiting, diarrhea, lethargy, and varying temperature. The nursing interventions emphasize a family-centered care approach, including educating the family, especially the mother, about diabetes management, sick day guidelines, and supportive resources. Key management strategies involve monitoring fluid, electrolyte, and blood glucose levels, promoting self-management, and providing constant mental support to the patient and her family. Potential problems such as diabetic neuropathy and depression are addressed, along with developmental considerations. The pathophysiology and symptomatology of both type 1 diabetes and gastroenteritis are outlined, and an evidence-based approach is incorporated through a review of literature emphasizing patient education. The role of the nurse in collaborative care, organizing the healthcare team, implementing patient and family education programs, and involving a diabetic educator, dietician, and psychologist is also discussed.

Type 1 diabetes- nursing management
Clare is a 5 year-old female child with type 1
diabetes and showing the symptoms of
gastroenteritis at the same time. Type 1 diabetes
can complicate her situation more and this poser
reflects the nursing interventions required to
manage the gastroenteritis along with the type 1
diabetes.
•medical background
•history of any chronic disease
•medicines used
Backgroun
d
• electrolyte imbalance
• blood glucose level
• gastroenteritis symptoms such as vomiting, nausea,
energy level etc.
• severity of dehydration
• energy level
• Respiratory pattern
Physical
assessment
•Stool culture
•electrocardiogram
•urine analysis
•blood glucose
•ketone level test
•serum electrolyte test
Tests
Assessment criteria
Context
Claire’s symptoms:
•Vomiting and having diarrhoea
from last 24 hours
•Listless and reluctant to drink or eat
•Temperature varying between 37.8-
38.8
•Lethargy
•High blood sugar
Developmental considerations:
(Erikson,1968)
The patient is 5 years old and at this age, child prefers being
independent according to the developmental theory of Ericson. By
giving opportunity to the patient to choose her own injection syringe
colour or some similar tasks, it is possible to involve the patient in the
care plan which also helps in developing the self-independency of the
patient.
Nursing interventions and management
approach:
(Nazar, Bojerenu, Safdar & Marwat, 2016)
Managing fluid, electrolyte and blood glucose level
should be managed as Claire is at high risk of dehydration
and her blood glucose level can increase the complications
more.
Self-management in diabetes is highly essential as it
increases the confidence and participation of the patient in
diabetes management. In this case, age-appropriate
education of the patient will help in decreasing the diabetes
complications.
Constant mental support to the patient and her family is
important as according to literatures, emotional stress can
affect glycemic level of the patient and hence, stress as
well as anxiety reduction plays a major role (Brink et al., 2014).
Pathophysiology and symptomatology
(Bányai, Estes, Martella & Parashar, 2018)
Steps of type 1 diabetes
1. Ineffective immune response
2. 90% B-cell destruction due to autoimmune process
3. Lack of insulin
4. Type 1 diabetes
Symptoms of gastroenteritis
Ingestion of contaminated food and water
Malfunction of digestion system and bowel inflammation
Vomiting
Diarrhoea
Increased body temperature
Nausea
An important management
approach recommended
(Cheraghi, Shamsaei, Mortazavi & Moghimbeigi, 2015)
Family-centred diabetes care approach: A family
centred care approach increases the confidence of the
patient and it also helps in providing mental support to
the patient. In case of managing this patient, changes in
daily life including the food habits is required, and since
the patient is a child, educating her family members and
especially, her mother should be educated about the
strategies to control diabetes. In a study it has been found
that supervision as well as cooperation of parents in
managing diabetes among the children can result in better
metabolic control.
It is important to:
Teach the guideline for sick days.
To provide supportive resources to the parents.
Evidence based approach:
(Nazar, Bojerenu, Safdar & Marwat, 2016)
In a systematic review of literatures, importance of patients’
education in diabetes has been discussed. The main objective
was to find the importance of patient’s education in
managing diabetes. As the method of the research, 36
literatures have been reviewed in the study and in the result
the review indicated that the dietary advice is important in
controlling the blood glucose level. It also concluded that
proper education and knowledge to control diabetes can
reduce the risk factors associated with the disease.
Role of nurse in collaborative care approach:
A collaborative team care approach in managing diabetes
plays an important role. Contribution of the nurses is highly
significant in this regard. In order to manage the patient
Claire, a collaborative care approach for the nurses is
required. First of all, it is important for the nurses to organize
the healthcare team as per the requirement of the patient.
Organizing patients and family education program to
enhance their knowledge in implementing self management
strategies to manage diabetes is one of the important roles of
the nurses. Involving a diabetic educator and dietician in the
management of the disease is necessary in this regard. Also,
to assess the mental health status and depression, it is
important to include psychologists in the care. Promoting the
team interaction is also important to include a collaborative
care approach .
Potential problems
(Bányai, Estes, Martella & Parashar, 2018)
Diabetic neuropathy
Cues: Numbness, temperature change, diarrhoea, vomiting.
Nurse should monitor the temperature and assess urine.
Nurse should assess pain and help in self-management exercises.
Depression
Cues: Sadness, sleeping disturbances, loss of appetite.
Nurse should monitor and analyze the mood.
Nurses should refer the child to a mental psychologist if necessary

Works cited
Cheraghi, F., Shamsaei, F., Mortazavi, S. Z., & Moghimbeigi, A. (2015). The effect of family-centered care on management of blood
glucose levels in adolescents with diabetes. International journal of community based nursing and midwifery, 3(3), 177. Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495325/
Bányai, K., Estes, M. K., Martella, V., & Parashar, U. D. (2018). Viral gastroenteritis,The Lancet,392(10142), 175-186. Doi:
https://doi.org/10.1016/S0140-6736(18)31128-0
Brink, S., Joel, D., Laffel, L., Lee, W. W., Olsen, B., Phelan, H., & Hanas, R. (2014). International Society for Pediatric and Adolescent
Diabetes. ISPAD Clinical Practice Consensus Guidelines 2014. Sick day management in children and adolescents with
diabetes. Pediatr Diabetes, 15(Suppl 20), 193-202. Doi: https://doi.org/10.1111/pedi.12193
Erikson, E.H. (1968). Identity youth and crisis, New York: WW Norton.
Nazar, C. M. J., Bojerenu, M. M., Safdar, M., & Marwat, J. (2016). Effectiveness of diabetes education and awareness of diabetes
mellitus in combating diabetes in the United Kigdom; a literature review. Journal of nephropharmacology, 5(2), 110. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5297564/