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  • Assessment Part A - Word Count 1000 words. In part A you will collect cues and information regarding your selected patient, process the information to enable the formulation of hypotheses and then discuss the further assessments required to negate or

Assessment Part A — Word Count 1000 words. In part A you will collect cues and information regarding your selected patient, process the information to enable the formulation of hypotheses and then discuss the further assessments required to negate or Essay Example

  • Category:
    Nursing
  • Document type:
    Assignment
  • Level:
    Undergraduate
  • Page:
    3
  • Words:
    1739

ASSESSMENT

7

Assessment

Assessment

Introduction

Douglas is a patient and will be the subject for this study. Douglas Adams, a male aged 51, has had diabetes type 1 and hypertension in the past. He is also allergic to penicillin drugs. The medication he is on currently is: HumalogMix 25:26 units mane and 16 units nocte. Perindopril: 4mg mane, Aspirin: 100mg daily.

Data collection

Subjective data:

Douglas is not an alcoholic but he smokes one packet of cigarettes a day, his weight is 70kg and height is 190cm. A friend of Douglas went to see him in his house and found out that he was confused and disoriented at home. He was taken to hospital for further investigation. His Glasgow coma score was 14/15 in emergency.

Objective data:

Douglas was admitted in the hospital with his Glasgow coma score remained the same. His signs are HR-82bpm, BP-110/87mmHg, RR-18, T-36.8. Douglas was informed that a CT will be performed and tests done on that very morning. He had QID BSL’s and 4/24 neuro obs. Before breakfast his BSL was 5.2 mmol/L and administration of his mane medications were done as ordered. Douglas continues to show further symptoms when he has a slight sweat and also a slight hand tremor while trying to ask when he will be seeing the doctor. Douglas is not hungry, he appears pale and his speech is slightly slurred and he also does not know where he is. His vital signs are HR-88bpm, BP-105/80mmHg, RR-18, T-36.5.

Hypoglycemia

This is not a disease but a symptom and it is caused by low levels of sugar in the blood and it is found mostly in people with diabetes. When this symptom is found in the system it indicates that the body processes that deal with regulation is not responding. Hypoglycemia is caused by either liver disease or too much ingestion of alcohol (Boer et al., 2008, p. 1868). Symptoms include clod sweats, slurred or blurred vision, fast heartbeat, headache, tiredness and confusion or one may go into a coma. This was evident with Douglas who had a slight sweat and also a slight hand tremor. Douglas is not hungry, he appears pale and his speech is slightly slurred and he also does not know where he is.

Hypothesis:

Diabetes is a disease caused by common features where glucose in the blood are raised or are higher than normal. The main cause of type 1 diabetes is lack of insulin (Jeffcoate, 2006, p. 850). The long term complications of diabetes include: damage to the kidneys, eyes and nerves. It could also affect the heart, brain or feet. Hypertension is caused by the presence of renal disease and is common in diabetics. Most people have both diabetes and hypertension. The hypertension in people who are diabetic is often caused by nephropathy (Arauz-Pacheco, Parro, & Raskin, 2008, p. 140).

  1. High blood pressure:

It is the measured force that occurs in the arteries walls as blood is pumped by the heart. This disease is associated with type 1 diabetes. High blood pressure in type 1 diabetes is caused by kidney damage which may be as a result of smoking, too much alcohol intake, stress and caffeine (Irmak, Duzoz, & Bozyer, 2007, p. 62). Douglas was a smoker and therefore was likely to have high blood pressure as a result.

  1. Coma or unconsciousness:

Hypoglycemia when not treated can result in unconsciousness or coma. Hypoglycemia is an emergency that if not treated may cause permanent damage to the nervous system. Another name for hypoglycemia is insulin shock as it results in a coma (Jeffcoate, 2006, p. 855).

This is one of the widespread disorders experienced in patients with type 1 diabetes. This is due to patients not adhering to the self-care course of therapy. As a result, the risk linked to hyperglycemia and other related complications of diabetes increases. Chronic physical symptoms of anxiety in such patients include aches and pains, nausea, sweating, fatigue, and frequent visits to the bathroom (http://www.drrichardhall.com/anxiety.htm). A high risk associated with diabetes-related complications mostly affects women with less education. Research concludes that this disease is associated with an augmented psychological risk disturbance. Much of the risk differential among diabetic patients is accounted for by factors of socio-demography.

  1. Mood change

This is one of the symptoms most prevalent in patients with type 1 diabetes. They should be monitored in order to reduce the chances of them having high blood pressure. Therefore, patients with diabetes should not be irritated often so as not to have mood change. Regular insulin should be administered to such patients and monitoring undertaken to reduce the chances of having them irritable and having mood changes that affects their socialization process (http://hyper.ahajournals.org/content/49/1/13.full).

A patient while attending a medical facility should be asked some questions which include:

Do you understand what diabetes is and how did you become aware of their condition? Education is also important in the controlling and management of diabetes. All patients should have enough information concerning the short and long term effects and complications of diabetes (Goldberg, 2011).

What kind of treatment do you use? They should then be advised on how to take the correct medication and what to do in case of any side effects (Nathan, 2010, p. 2647).

Are you aware of your glucose levels and how often do you test their levels?

What problems has the disease caused and just how bad it is to be a diabetic? They should also be asked if the diet they take is restrictive and advised on how to eat proper, this is because diet is the major step towards the management of diabetes.The meals taken should have minimum glucose and fat (Escott-Stump, 2008, p. 482). Monitoring of blood glucose should be done frequently so that insulin doses in patients are easily adjustable.

Diabetes diagnosis is different in many cases; some may take shorter time others may take long. The diagnosis is done by taking blood samples that will be used to measure the glucose levels in the patient’s blood. There are different types of tests used to diagnose diabetes and each doctor has their own preference (American Diabetes Association). Some side effects can either be undiagnosed or over diagnosed and the effects may include heart attacks. The treatment of this type of diabetes is by using insulin, which is a hormone. Insulin is injected under the skin so that it be absorbed and transported through all the cells by the blood (Boer et al., 2008, p. 1870).

Assessment:

The physician taking care of Douglas was able to carry out the standard physical examination before interviewing him. This examination included checking his blood pressure, skin, and eyes. From the audio we are able o deduce that, Douglas is pale and hungry. For this reason, one is only supposed to give the patient sweet drinks, which helps in boosting their glucose levels. Therefore, their symptoms will be controlled and managed as they wait for the doctor to come and examine him fully.

A complete neurological examination on Mr. Douglas was performed by the nurse in order to check the following issues: his mental state (general movement, coma, and lethargic); cranial nerves, motor (tone, tremor + rigidity, and abnormal movements); sensory (double simultaneous stimulation); and his reflexes (http://crashingpatient.com/miscellaneous/b-neuro.exam.htm).

Hypoglycemia assessment needs to be carried out in order to establish whether the level of blood glucose is normal (Irmak, Duzoz, & Bozyer, 2007, p. 60). This will reduce the chances of him having hypoglycemic episodes that may lead to him being going to a coma.

Recommendations:

The adults who suffer from type 1 diabetes and they smoke should be given advice on the methods and services to use.

Regular exercise should be encouraged because during exercise (Regensteiner, 2009, p. 118), lower insulin or extra calories may be required to prevent any side effects and risks.

Patients with blood pressure caused by type of diabetes should be given information on the type of lifestyle to lead so that they can control their blood pressure levels.

Conclusion:

For the case of Mr. Douglas, tests indicate that he has hypoglycemia or a cardiovascular disease. Before the doctor comes in, the nurse performs a thorough physical assessment on the patient in order to give the doctor a conclusive summary of the findings. This examination is necessary because it helps in handling of emergency cases prior to the doctor’s assessment report and examination. The right diagnosis for any patient is reached by assessing the patient accurately.

References

American Diabetes Association. (2006). Hypertension Management in Adults with Diabetes.

Diabetes Care, Vol. 27, 565-567, Supplement. Retrieved 8th August, 2011 from <

http://www.sdl.academic.chula.ac.th/Misc/Offline%20Resources/Diabetes/DM%20hyper

tension.pdf >

Arauz-Pacheco, C., Parrott, M., & Raskin, P. (2008). The treatment of hypertension in adult

Patients with diabetes (Technical Review). Diabetes Care 25:134–147.

Augustina, M et al. (2007). The Effects of Type 1 Diabetes on cognitive Performance. Diabetes

Care, Vol. 28, No. 3: 726-735. Retrieved 8th August, 2011 from <

http://care.diabetesjournals.org/content/28/3/726.short>

Boer, I et al. (2008). Insulin Therapy, Hyperglycemia, and Hypertension in Type 1 Diabetes

Mellitus. Arch Intern Med. Vol. 168, No. 17: 1867-1873. Retrieved 8th August, 2011

from <
http://www.nutrociencia.com.br/upload_files/artigos_download/DM%201.pdf>

Diabetes Mellitus Case Study. (2008). Retrieved August 8, 2011 from

<http://nursingcrib.com/case-study/diabetes-mellitus-case-study/>

Escott-Stump, Sylvia. (2008). Nutrition and diagnosis-related care. Philadelphia, PA:Lippincott

Williams & Wilkins.

Goldberg, Gary. (2011). The Importance of Understanding Hypertension: The Role of a

Registered Nurse as an Investigator. Journal of Nursing. Retrieved August 8, 2011 from

<
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Irmak, Z., Duzoz, G., & Bozyer, I. (2007). The effectiveness of a follow-up program on blood

pressure and cardiovascular risk factors for hypertensive patients. Australian Journal of

Advanced Nursing, Vol. 28, No. 2: 60-66. Retrieved August 8, 2011 from <

http://www.ajan.com.au/Vol28/28-2_Irmak.pdf >

Jeffcoate, William. (2006). Type 1 diabetes. The Lancet, Vol. 367, Issue 9513: 847-858.

Retrieved August 8, 2011 from <

http://www.sciencedirect.com/science/article/pii/S0140673606683414 >

Nathan. (2010). Intensive diabetes treatment and cardiovascular disease in patients with type 1

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8th August, 2011 from <
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Riddell, M. & Perkins, A. (2006). Type 1 Diabetes and Vigorous Exercise: Applications of

Exercise Physiology to Patient Management. Canadian Journal of Diabetes, Vol. 30,

Issue 1: 63-71. Retrieved August 8, 2011 from <
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final.pdf >

Regensteiner, Judith. (2009). Diabetes and Exercise. NM: Springer.

Zimmer, P., Alberti, G, & Shaw, J. (2008). Global and Societal implications of the diabetes

Epidemic. Nature, Vol. 414, 782-787. Retrieved 8th August, 2011 from <

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http://www3.vghtc.gov.tw/meta/DM&Hypertension.htm

http://hyper.ahajournals.org/content/49/1/13.full

http://www.drrichardhall.com/anxiety.htm