HLTENN025 Implement and Monitor Care for a Person with Diabetes

Hypoglycemia:

The patient who was 27 years old, was diagnosed with diabetes 1 when he was 19 years old. Hypoglycemia, or low blood sugar, is a potentially dangerous condition. People with diabetes who prescribe medication that raises insulin levels in the body can experience low blood sugar (Iqbal and Heller, 2016). The signs and symptoms include vision problems, a quick heartbeat, abrupt mood shifts, unexplained exhaustion, and sudden nervousness, headache with pale skin, hunger nausea dizziness, sweating problems Skin tingling while sleeping inability to think clearly or concentrate loss of consciousness, seizure, or coma. Since the patient was experiencing hypoglycemia symptoms, the patient should be doing the following: Fast-acting carbohydrates in the range of 15 to 20 grams should be eaten. Some foods are high in sugar, low in protein, and low in fat and are easily transformed into sugar in the body. Try glucose gel, fruit juice, regular — not diet — fruit juices, honey, and sugary treats to keep blood sugar steady.

Hyperglycaemia:

Hyperglycemia is the medical term for an increased blood sugar (glucose) level. It's a challenge that many diabetics face. In the case study, the patient was suffering from diabetes type 1. Hyperglycemia symptoms in people with diabetes usually appear gradually over a few days or weeks. There may be no signs until the blood sugar level is extremely high in certain cases (Duggan et al. 2017). Hyperglycemia can cause the symptoms such as a dry mouth and increased thirst, needing to go to the bathroom a lot, exhaustion, vision problems, unintentional weight loss, thrush, bladder infections (cystitis), and skin infections are all common recurring infections, tummy ache, feeling sick, or having a fruity breath. The patient was given Lantus 25 units at night and novarapid 2 units to control the blood glucose level.

Ketoacidosis:

Diabetic ketoacidosis is a serious diabetes problem that occurs when an individual produces too many ketones in the blood which was observed in the patient. Diabetic ketoacidosis causes signs and symptoms to manifest quickly, often within 24 hours. These signs and symptoms can be the first signs of diabetes for some people (Nyenwe et al. 2016). Excessive hunger, frequent urination, vomiting and diarrhea, stomach pain, exhaustion or fatigue, breathlessness, fruity-scented breath, and frustration are some of the signs and symptoms. The patient would need hospital care to replace fluids and electrolytes, as well as insulin therapy to manage that medical condition.

Psychosocial issues including the factors influencing self-esteem:

Diabetes is a chronic metabolic disorder that affects an individual's social, physical, and mental health, and also some of their psychological well-being of the patient. Psychosocial problems, which are most common in diabetes patients just like him, may also have a major negative impact on the patient's well enough and social life if left unaddressed. Addressing psychosocial elements of diabetes management, such as cognitive, mental, behavioral, and social influences, in treatment strategies will help reduce psychological obstacles to diabetes adherence and self-care; the latter being the primary objective of diabetes management. Psychological factors such as self-efficacy, self-esteem, diabetes managing, and social welfare have been linked to successful treatment adherence and glycemic (Young-Hyman et al. 2016). Everyday environmental factors and diabetes-related anxiety have been linked to poor glycemic control and non-treatment adherence in others. Depression and anxiety have also been linked to a rise in blood sugar levels.

Retinopathy:

Retinopathy is a vision loss disease in which the retina of both eyes is impaired as the patient who was 67 years old female had diabetes type 2 she was having this disease. Retinal vascular disease, or retinopathy, is the term for damage to the eye characterized by excess or irregular blood flow. Proliferative and non-proliferative retinal vascular disease are the two forms of retinal vascular disease. Retinopathy is often an ocular manifestation of underlying systemic disease, such as diabetes or hypertension as diabetes is a major cause of retinopathy (Wang et al. 2018). Signs of diabetic retinopathy comprise spots or dark strings floating in your vision or floaters, vision problems, distorted color vision, empty areas in your vision, varying vision, and loss of vision. Diabetic retinopathy disturbs both eyes in some cases. With diligent diabetes treatment, mild cases may be handled. In severe cases, laser therapy or surgery can be needed. The patient was given metformin for the control of her diabetes.

Infection:

A leg ulcer is a split in the skin of the leg that permits bacteria and air to arrive at the original tissue so it was the infection that the patient had for the past nine months. An injury, typically a mild one that damages the skin, usually causes this. Poor circulation is the most common cause of this disease, but it may also be caused by several illnesses. Open wounds, pus in the area which is affected, uneasiness in the affected area, cumulative wound size, leg bulge, swollen veins, sweeping pain, or heaviness in the legs are some of the signs and symptoms (Saco et al. 2016). Compression bandages are also used to assist with swelling, wound closure, and infection prevention. The nurse might also advise her to apply an ointment to the ulcer. In extreme cases, the doctor could prescribe orthotics or braces to improve walking and prevent potential ulcers.

Microvascular and macrovascular disease:

Hyperglycemia has two types of harmful effects: myocardial infarction (MI) complications (diseases of the coronary artery, diseases like peripheral vascular disease, and also stroke) and microvascular complications (diabetes). The patient had a past medical history of MI at age 50 years as well as insertion of 6 stents for coronary artery occlusion 2 years ago happen. Chest pain, irritation (angina), and squeezing which can intensify during everyday activities and periods of stress, shortness of breath, discomfort in the left arm, throat, or abdomen associated with chest pain, chin, tiredness, and loss of energy are all signs and indications or symptoms of microvascular disease (Mohammedi et al. 2016). Since the patient's signs and symptoms haven't gone away after the operation and stents for coronary artery disease, the patient might still have small vessel disease. This disease could be managed by reducing low-density lipoprotein cholesterol levels, smoking cessation, healthy diet, daily physical activity, strict glycaemic and blood pressure regulation, and no alcohol consumption.        

Hyper osmolar non-ketonic coma:

In a patient with usual ketone levels, a coma is triggered by excessively high blood glucose levels is known as hyperglycaemic hyperosmolar non-ketotic coma (Pasquel et al. 2020). Ketoacidosis is a condition that occurs when blood glucose levels are extremely high and ketone levels are extremely high as the patient’s LDL and triglyceride levels were not normal. Blood glucose levels of over 600 milligrams per deciliter (mg/dl) are common symptoms, as are regular urination, intense thirst, dry mouth, confusion or sleepiness, and wet, dry skin without sweating. Intravenous (IV) is often used to rapidly rehydrate the body. It might also be necessary to use IV insulin to lower blood sugar levels and the patient was also given metformin to control the blood sugar.

References:

Duggan, E.W., Carlson, K. and Umpierrez, G.E., 2017. Perioperative hyperglycemia management: an update. Anesthesiology, 126(3), pp.547-560.

Iqbal, A. and Heller, S., 2016. Managing hypoglycaemia. Best Practice & Research Clinical Endocrinology & Metabolism, 30(3), pp.413-430.

Mohammedi, K., Woodward, M., Hirakawa, Y., Zoungas, S., Williams, B., Lisheng, L., Rodgers, A., Mancia, G., Neal, B., Harrap, S. and Marre, M., 2016. Microvascular and macrovascular disease and risk for major peripheral arterial disease in patients with type 2 diabetes. Diabetes care, 39(10), pp.1796-1803.

Nyenwe, E.A. and Kitabchi, A.E., 2016. The evolution of diabetic ketoacidosis: an update of its etiology, pathogenesis and management. Metabolism, 65(4), pp.507-521.

Pasquel, F.J., Tsegka, K., Wang, H., Cardona, S., Galindo, R.J., Fayfman, M., Davis, G., Vellanki, P., Migdal, A., Gujral, U. and Narayan, K.V., 2020. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care, 43(2), pp.349-357.

Saco, M., Howe, N., Nathoo, R. and Cherpelis, B., 2016. Comparing the efficacies of alginate, foam, hydrocolloid, hydrofiber, and hydrogel dressings in the management of diabetic foot ulcers and venous leg ulcers: a systematic review and meta-analysis examining how to dress for success. Dermatology online journal, 22(8).

Wang, W. and Lo, A.C., 2018. Diabetic retinopathy: pathophysiology and treatments. International journal of molecular sciences, 19(6), p.1816.

Young-Hyman, D., De Groot, M., Hill-Briggs, F., Gonzalez, J.S., Hood, K. and Peyrot, M., 2016. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes care, 39(12), pp.2126-2140.

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