Prep and Plan Diabetes

Practical Nursing Diploma Program

Pre-Clinical Nursing Care Research Assignment

“Prep and Plan”

 

The Pre-Clinical “Prep and Plan” must be completed and submitted to your clinical faculty at the beginning of each clinical shift.  This information will ensure that you are adequately prepared for your patient assignment.

 

Medical-Surgical Diagnoses: 

Type 1 diabetes mellitus – the pancreas makes little or no insulin. Insulin is a hormone the body uses to allow sugar (glucose) to enter cells to produce energy. Type 1 diabetes has no cure. Treatment is directed toward managing the amount of sugar in the blood using insulin, diet and lifestyle to prevent complications.

 

Anticipated assessment data for this patient:

1. Vital signs              4.  Height and Weight
2. Skin                     5.  Urine Specimen
3. Intake and Output 6.  Blood glucose

 

List 2 priority “NANDA” Nursing Diagnoses based on the above assessment data:

 

1. Risk for unstable blood glucose level related to patient stopping to use Insulin pump

 

2. Risk for imbalanced nutrition: less than body requirements related to significantly decreased appetite for the past 4 days as evidenced by severe diffused abdominal pain, nausea, vomiting.

 

 

Identify specific nursing interventions to support these priority nursing diagnoses: (action plan)

1. Provide Diabetes education                      4.  Maintain adequate nutrition
2. Monitor Glucose                                          5.  Regulate glucose levels
3. Ensure adequate and appropriate nutrition. 6.  Promote skin integrity

 

 

Based on your prep & plan what will you pay special attention to: (What do you see as the patient’s priority issue?)

 

     I will pay special attention to patient nutrition and blood glucose levels. The priority will be maintaining blood glucose of the patient within a safe range.

 

 

 

What teaching do you think your patient will require?

 

Patient will require teaching on taking insulin as prescribed. Along with eating a balanced diet and checking their blood sugar levels. Also, the patient will require teaching on regulating their physical activity while maintaining safety precautions.

 

 

 

References:

 

https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011

 

Drug+Card+Regular insulin

Insulin Regular (short acting)	Classification:	Nursing Interventions
Action	Decreases blood glucose by transport of glucose into cells and the conversion of glucose to glycogen.	Fasting blood glucose, also HGB A1C may be tested to identify treatment. effectiveness every three months   urine ketones during illness   hypoglycemic reaction
Uses	Type one diabetes mellitus, type 2 diabetes mellitus, gestational diabetes
Expected Outcomes	Decreased blood glucose levels in diabetes mellitus
Side Effects	Blurred vision, dried mouth, flushing, rash, urticaria, warmth, lipodystrophy, lipohypertrophy, swelling, redness, Hypoglycemia, rebound hyperglycemia, peripheral edema, anaphylaxis.
Health Teaching	Always keep insulin equipment available.   advise patients that blurred vision can occur.   instruct patients to recognize hypoglycemia reaction.   teach patient the dosage route mixing instructions.   Teach patients the symptoms of ketoacidosis.	Cautions used in breastfeeding.   avoid use of beers   Inform patients that product does not cure diabetes but control symptoms.   advise patient to carry emergency ID as diabetic
Example Names	Humulin R, novolin R, relion R

 

Drug+Card+Insulin Aspart

Insulin Aspart   rapid acting	Classification:	Nursing Interventions
Action	Decreases blood glucose by transport of glucose into cells and the conversion of glucose to glycogen.	Fasting blood glucose, also HGB A1C may be tested to identify treatment. effectiveness every three months   urine ketones during illness   hypoglycemic reaction
Uses	Type one diabetes mellitus, type 2 diabetes mellitus, gestational diabetes
Expected Outcomes	Decreased blood glucose levels in diabetes mellitus
Side Effects	Blurred vision, dried mouth, flushing, rash, urticaria, warmth, lipodystrophy, lipohypertrophy, swelling, redness, Hypoglycemia, rebound hyperglycemia, peripheral edema, anaphylaxis.
Health Teaching	Always keep insulin equipment available.   advise patients that blurred vision can occur.   instruct patients to recognize hypoglycemia reaction.   teach patient the dosage route mixing instructions.   Teach patients the symptoms of ketoacidosis.	Cautions used in breastfeeding.   avoid use of beers   Inform patients that product does not cure diabetes but control symptoms.   advise patient to carry emergency ID as diabetic
Example Names	novoLOG, novoLOG flexpan, novoLOG penfill, novomix 30, novoRapid

 

Drug+Card+Insulin Glargine

Insulin Glargine (long acting)	Classification:	Nursing Interventions
Action	Decreases blood glucose by transport of glucose into cells and the conversion of glucose to glycogen.	Fasting blood glucose, also HGB A1C may be tested to identify treatment. effectiveness every three months urine ketones during illness hypoglycemic reaction
Uses	Type 2 diabetes mellitus in combination with diet and exercise in adults inadequately controlled on basil insulin or lixisenaide
Expected Outcomes	Decreased blood glucose levels in diabetes mellitus
Side Effects	Blurred vision, dried mouth, flushing, rash, urticaria, warmth, lipodystrophy, lipohypertrophy, swelling, redness, Hypoglycemia, rebound hyperglycemia, peripheral edema, anaphylaxis.
Health Teaching	Always keep insulin equipment available.   advise patients that blurred vision can occur.   instruct patients to recognize hypoglycemia reaction.   teach patient the dosage route mixing instructions.   Teach patients the symptoms of ketoacidosis.	Cautions used in breastfeeding.   avoid use of beers   Inform patients that product does not cure diabetes but control symptoms.   advise patient to carry emergency ID as diabetic
Example Names	Lantus, Toujeo Solostar

 

DKA – SBAR assignment

DKA – SBAR Assignment

Your patient Willow is getting ready to be discharged home. She is feeling better and is anxious to get home. As her nurse, you feel nervous for her discharge as you feel she may require additional education to ensure she does not end up being readmitted for another episode of DKA.  When talking with Willow you have heard her mention that she doesn’t always use her insulin pump as she should. She sometimes lets it run out and doesn’t refill it. She also has mentioned to you that she isn’t great at checking her blood glucose levels at home because she is often “to busy”. She also admits to smoking, she feels it helps her keep weight off.

You call the diabetic nurse educator to see she can help speak to Willow about some changes she could make to ensure she manages her diabetes in a more effective way.

S

B

A

R

 

While waiting for the nurse educator to come speak with Willow you see that she has only picked at her lunch.  You ask why, she says she is nervous to gain weight so she doesn’t eat “a lot”. You ask her about the things she likes to eat, she says she tries to eat healthy but sometimes ends up getting really hungry and eats too much. She seems to indicate that she ends up eating two meals a day.

You recognize that this isn’t an ideal eating pattern for someone with Type 1 diabetes so you also page the Registered Dietitian, what would you share with her about your concerns?

S – My patient Willow Rosenberg Is getting ready to be discharged today. I feel that she may require additional education to ensure she does not end up having another episode of DKA

B – Willow is a 23-year-old female who has diabetes mellitus type 1 and was admitted for DKA. She is currently using an insulin pump at home. she is able to check her blood glucose levels and she is also a smoker.

A – While talking with the patient she mentioned not always using the insulin pump, letting it runout, and then not refilling it. says she is often too busy to check her blood glucose levels at home. Patient also states that she smokes because she feels it keeps the weight of. Willow is nervous to gain weight but tries to eat healthy.

R – I recommend that we instruct the patient to a pamphlet to read on preventing DKA episodes and understanding   the   use   and   importance  of   her  insulin   pump.   To adhere   with   her   busy schedule, we will set up a time plan for her to check blood glucose levels at home. She should be recommended to a nutritional plan to help her eat healthy in a way that complies with her diabetes.

 

DKA Debrief Questions

DKA – Debrief Questions:

 

1. How did you feel during this simulation?

I felt it was a good experience that provided me with lots of information and knowledge.

 

 

 

2. What was a moment you felt you succeeded?

After making some wrong choices when I was able to make the right choice it showed me I was better understanding what was happening making me feel like I seucceded

 

3. What was a moment you felt unsure of your nursing care?

Sometimes when making the wrong choices. Although it taught to me to focus on what’s important in the moment for the patient.

 

 

4. How will you change your nursing practice based on this learning activity?

I will be able to recognize unsafe practices and conditions within patient environment and prevent near misses or errors.