NURBN2026 Person Centered Nursing Practice B

Introduction

The case scenario presents the information about the patient which states that the patient named Shaun Cross who is a 15-year-old male and is currently completing his year 10 at secondary school and enjoys playing soccer and football. He is suffering from the disease of Type I diabetes. The patient was also admitted to the hospital because of an exploratory arthroscopy on his right knee because of the injury that he faced while playing soccer. It has been stated that the patient has fasted for the past 0600 hours and is continuing to fast for the preparation of the surgery. The patient has administered insulin to himself last 2000 hours ago in the previous evening. In addition to this, the medical history of the patient shows no allergies, and his suffering of diabetes is well controlled with various medications. Moreover, his social history states that he is living with his family consisting of four members, his mother Leanne, father Paul, and sister Kelsey.  

Pre-operative care

Shaun being the patient who has been admitted for exploratory arthroscopy on his right knee and is also a patient of Type I Diabetes, is advised to take and follow some of the procedures that will help him in his surgery.

The medical interventions for the surgery of Shaun along with considering his medical history and the disease that he has can include maintaining a healthy protein diet, and he must maintain his blood glucose level before going for the surgery (Sreedharan & Abdelmalak, 2018). The medical intervention to keep his blood glucose level normal before the knee surgery includes insulin therapy such as short-acting or regular insulins like Novolin R., Humulin R, and many more. In addition to this, his medical interventions will also include blood sugar monitoring (Simha & Shah, 2019). Even after taking the insulin to maintain the protein and carbohydrate intake, testing the sugar level of Shaun before his meals and before his surgery will help him in smooth and successful surgery and the medical errors will be prevented. The normal blood sugar level counts up to 140 mg/dL so these medications will help him to maintain this level (Garg, et al., 2018).

Assessment, prevention, and management of post-operative hypoglycemia

It is said that patients with Type I Diabetes often suffer from hypoglycemia which can show various symptoms like nausea, vomiting, and many more so it becomes very important to assess, prevent and manage postoperative hypoglycemia. In the case of Shaun, the nursing interventions that can be taken to assess, prevent and manage hypoglycemia can include:

Firstly, for the management of nausea and vomiting, Shaun can be asked to follow the infusion of glucose. Moreover, the re-introduction of diet and fluid for him can include taking oral (OP) medication along with the readily absorbable sources of carbohydrates such as fruit juice will be given (Kim, Kim & Schafer, 2018).

Secondly, to help Shaun in preventing hypoglycemia, the blood sugar should be monitored depending on the plan of treatment. The blood sugar level should be checked and recorded several times or multiple times a day and that careful monitoring will help Shaun in ensuring the blood sugar level is within his target range. Moreover, intravenous therapy will be considered for Shaun to prevent hypoglycemia. The therapy will contain an IV bolus of dextrose 10 percent which is 2.5 mL/kg and will be most appropriate for the prevention in the postoperative process (Salehi, et al., 2018). The prevention nursing intervention will also include the insulin administration using the route of subcutaneous insulin injections and the ways that will be considered to deliver the insulin will be syringes or insulin pumps.  

The signs and the symptoms that will be faced by Shaun at first during hypoglycemia will be that he will feel shaky, nervous, and anxious. He may also get the signs of irritability or impatience and he will suffer from confusion and a fast heartbeat and consecutively he will feel hunger (Schwaiger, et al., 2021). To manage all the symptoms and signs in the pre-operative process, nursing interventions that can be provided to Shaun are eating and drinking 15 to 20 grams of carbohydrates which are fast-acting. This diet will act as sugary food without fat or protein that will easily be converted to sugar in the body Shaun. He can also try glucose tablets and fruit juice to manage the symptoms (Lee, et al., 2018).

Education for sick day management

People with diabetes can get frequently even after trying their best to prevent it so the education for the sick day management that can be provided to Shaun is:

Shaun must always keep few things on hand like the glucose testing kit along with the strip. Moreover, he should also keep ketone testing supplies either special or urine strips for fingerstick testing with the help of a specific meter. Additionally, he should also be prepared with plenty of sugar-free beverages and water along with plenty of insulins which will help him in monitoring his blood glucose level (MacCallum & Senior, 2019).

He should focus on intaking fluids and carbohydrates appropriately should focus on carbohydrates like vegetables which are non-starchy like greens, carrots, peppers, broccoli, and many more. Fruits like oranges, melon, apples, and many more. Grains and proteins and dairy products are non-fat or low in fat (Zainudin, et al., 2018).

He should seek medical attention when he has been sick or has a fever for few days and is not getting better. Or when he feels like vomiting or suffers from diarrhea for more than 6 straight hours. And when the blood glucose values stay above 240 mg/dl even when he is taking extra insulin and when he is not sure what to do, he should seek medical attention by calling his diabetes team (MacCallum & Senior, 2019).

Education for exercise

According to the association of American Diabetes, people suffering from Type 1 Diabetes like Shaun should aim and focus on getting at least 15 minutes of moderate to vigorous-intensity aerobic exercises such as cycling, swimming, walking, jogging, playing team sports like soccer or basketball (de Melo Ghisi, et al., 2020).

The modification of the administration will help Shaun in producing more normal glycemia and the dosage for the patient is mixed with insulin regimen which is generally used to maintain the standard process of the dosage of insulin and considering this the patients who are controlled on some particular mixed insulin regimen should always maintain their standard process in preparing their doses of insulin.

Shaun must follow a routine of proper warm-up and cool-down period which should consist of 5-10 minutes of aerobic activities at a low-intensity level. These exercises will help Shaun and will make it easier for him to control and maintain the level of blood glucose and it will also help him in increasing the sensitivity of insulin for him (Ilkowitz, et al., 2020). Moreover, it is believed that the body of diabetic patients after following the routine of exercise does not need much insulin for processing carbohydrates.

Exercises like swimming, cycling and walking will help Shaun in lowering his blood sugar level as these exercises will give the heart, muscles, and lungs of Shaun a workout while putting a little stress on his joints (de Melo Ghisi, et al., 2020). Additionally, team sports will motivate Shaun to exercise more, and socializing with the teammates along with the commitment that he will make to them will help him in finding the motivation that he needs to show up each week. This helps in a good aerobic workout which turns out to be important for patients suffering from diabetes (Ilkowitz, et al., 2020).

• Avoid sedentary activities like watching TV or using the Internet.
• Take the stairs
• While watching Television, do some stretching or leg press.
• After supper, go for a walk with your friends or family.
• Take the lift one level up and walk up the very last flight towards your location.
• Before you go shopping, take a walk all around the mall's periphery.
• Set a time with your family to be doing something active.

Moreover, the emergency management of hypoglycemia can be done by consuming quick-acting carbs 15 grams of quickly acting carbohydrates, such as sugar tablets or glucose gel, should be consumed or consumed. a half-cup of fruit juice or a can of non-diet soda (Ilkowitz, et al., 2020). Lastly, the educational resources for Shaun can be diabetes home, native diabetes program, state, local and national partner diabetes program and many more.

Conclusion

From the above case scenario, it can be concluded that a patient named Shaun was suffering from Type 1 diabetes, and considering his situation, some pre-operative medical interventions were provided to him and it was stated that the medical interventions for the surgery of Shaun along with considering his medical history and the disease that he has can include maintaining a healthy protein diet, and he must maintain his blood glucose level before going for the surgery. Moreover, the patients after the surgery often suffer from hypoglycemia, and assessment, prevention, and management were also discussed which included that for the management of nausea and vomiting, Shaun can be asked to follow infusion of glucose. Secondly, to help Shaun in preventing hypoglycemia, the blood sugar should be monitored depending on the plan of treatment. And to manage all the symptoms and signs in the pre-operative process, nursing interventions that can be provided to Shaun are eating and drinking 15 to 20 grams of carbohydrates which are fast-acting. Along with this, education for sick day management and education for exercise was discussed wherein it was mentioned that he should focus on his diet and seek medical attention when in confusion and should more focus on the exercises like cycling, walking, and many others to maintain the blood glucose level in his body.

References

de Melo Ghisi, G. L., Aultman, C., Konidis, R., Foster, E., Tahsinul, A., Sandison, N., ... & Oh, P. (2020). Effectiveness of an education intervention associated with an exercise program in improving disease-related knowledge and health behaviours among diabetes patients. Patient education and counseling, 103(9), 1790-1797.

Garg, R., Schuman, B., Bader, A., Hurwitz, S., Turchin, A., Underwood, P., ... & Lortie, M. (2018). Effect of preoperative diabetes management on glycemic control and clinical outcomes after elective surgery. Annals of surgery, 267(5), 858-862.

Ilkowitz, J. R., Wu, F., Chen, Y., & Gallagher, M. P. (2020). Perspectives on the role of exercise in the treatment of pediatric type 1 diabetes. Pediatric diabetes, 21(3), 466-472.

Kim, T. Y., Kim, S., & Schafer, A. L. (2018). Medical management of the postoperative bariatric surgery patient.

Lee, C. J., Brown, T. T., Schweitzer, M., Magnuson, T., & Clark, J. M. (2018). The incidence and risk factors associated with developing symptoms of hypoglycemia after bariatric surgery. Surgery for Obesity and Related Diseases, 14(6), 797-802.

MacCallum, L., & Senior, P. A. (2019). Safe use of metformin in adults with type 2 diabetes and chronic kidney disease: lower dosages and sick-day education are essential. Canadian journal of diabetes, 43(1), 76-80.

Salehi, M., Vella, A., McLaughlin, T., & Patti, M. E. (2018). Hypoglycemia after gastric bypass surgery: current concepts and controversies. The Journal of Clinical Endocrinology & Metabolism, 103(8), 2815-2826.

Schwaiger, E., Krenn, S., Kurnikowski, A., Bergfeld, L., Pérez-Sáez, M. J., Frey, A., ... & Hecking, M. (2021). Early postoperative basal insulin therapy versus standard of care for the prevention of diabetes mellitus after kidney transplantation: A multicenter randomized trial. Journal of the American Society of Nephrology, 32(8), 2083-2098.

Simha, V., & Shah, P. (2019). Perioperative glucose control in patients with diabetes undergoing elective surgery. Jama, 321(4), 399-400.

Sreedharan, R., & Abdelmalak, B. (2018). Diabetes mellitus: Preoperative concerns and evaluation. Anesthesiology clinics, 36(4), 581-597.

Zainudin, S. B., Abu Bakar, K. N. B., Abdullah, S. B., & Hussain, A. B. (2018). Diabetes education and medication adjustment in Ramadan (DEAR) program prepares for self-management during fasting with tele-health support from pre-Ramadan to post-Ramadan. Therapeutic advances in endocrinology and metabolism, 9(8), 231-240.

Looking for affordable assignment help online? Need someone to offer you prices that would go easy on your pocketbook? Bothered, “Can I pay someone to do my assignment at the best industry price?” Of course, you can. MyAssignmenthelp.co.uk has the finest paper writers. They are dedicatedly available to back you up with well-knit assignment papers at the best industry price. 

Sign up for finance assignment help or management assignment help and enjoy a flat 20% off along with an additional $20 sign-up bonus. How cool is that? So, think no more and count on our expertise for affordable assignment help in the UK.