Developing a Management Plan for Type 2 Diabetes

Developing a Management Plan for Type 2 DiabetesA long endpoint condition (LTC) is defined as an incur adapted syndrome. However, some(a) LTC lot be dod through with(predicate) medication (Goodwin et al 2010) whereas for others, it can be managed by health care providers facilitating health promotional support to unhurrieds in order to self-manage their conditions efficaciously (examples, maintaining rosy-cheeked diet and corporal activities) (Hutchison Breckon 2011). Additionally, for this assignment I leave alone use a case study to discuss my experience ab push through caring for a affected role with caseful 2 diabetes in the hospital. The discussion exit imply the de barrierine problems to support uncomplainings needs, the makes contributions to promote patients health and tumesce-being as salutary as the benevistas of working alongside with a multidisciplinary team up.According to Goodwin et al (2010) type 2 diabetes is as swell up k directn as insulin res istance. The syndrome is when an man-to-man consistency lacks the energy to produce sufficient insulin or the clay is incapable of controlling equal line of work glucose level. It is categorised as a LTC be relieve oneself it is incurable. Nonetheless, it can be managed depending on the mortalists conditions needs such as healthy aliment and fastness activities, or a conclave of medications and a healthy life style (Diabetes UK 2012).According to Nursing and midwifery Council (NMC 2010) Guidance on Professional Conduct, the patients identity will be maintained confidential and an unknown name (Jane) will be used. Jane 65, who has had type 2 diabetes for nigh deuce years, was suffering from kyphosis on her subscribe. As she has non been on medicatestore therapy since her diagnosis, she was advised to maintain her lading down within an ideal range. However, Jane has non been able to gain control over her weight (73 kg). She lives altogether and has no determina tion family members but she has a good relationship with her neighbours and friends. I met Jane while on placement on an aging admission ward. She was admitted via Accident and Emergency thinke section (AE) to an elderly ward referred by her General Practice (GP) with elevated blood glucose (11.5mmol) which was making her feel weak and was withal giving her severe headaches, fattenigue and recent weight gain (73.6kg). turn she was admitted to AE, her hyperglycaemia was stabilised with a dosage of metformin (500mg) (8.0mmols) prior to her transfer from AE to the elderly ward.Bakris (2011) suggested that nurses should carry out a comprehensive assessment on patients with type 2 diabetes as this will support the nurse to identify and address issues that can hamper and reduce problems that may affect the patients with type 2diabetes. Diabetes UK(2012), in addition recommended that a patients risk can be get it ond if healthcare professionals could promote an in-depth assessme nt. This includes blood glucose level, Hba1c, blood pressure, cholesterol, Body Mass Index (BMI) and cannonline circumference. The principle behind the assessment is to support healthcare professionals to make an appropriate severalize care plan considering the patients preference (Diabetes UK 2012).To classify all interrelated problem, the treat assessment was to look at Janes medical history before the admission and to observe what her current condition looked the like. The nurse along with the author admitted Jane and prior to carrying out the assessment they introduced themselves to the patient. To obtain Janes consent, a full detail of the information somewhat the process was explained to her (Nursing and Midwifery Council 2010). Janes vital signs presented a blood pressure of 138/80 mmHg, nubble rate 84, respiratory rate 16 and temperature 36 degree centigrade. While examining Janes nutritional assessment, her MUST s legal document top was (1.62cm), weight 73.6kg, and waist circumference 88cm. It was identified that she had a BMI of 27 giving her a cross (0). In addition to Janes assessment, her fasting glucose level was stable 6-7 mmol/ fifty her foot showed normal to sensation, no sign of lesions on toenails and skin.From Janes screening, the be cause for Janes hyperglycaemia is an change magnituded BMI 27, this indicates overweight as (British linkup for Parenteral and Enteral Nutrition 2010) recognised. Overweight is when an individual has more fat than normal in their body. However, an athlete with muscle mass or individual with swollen legs (oedema) could be overweight due to an increase in BMI (Heath tough 2009). According to Nazarko (2008) an individual with a BMI 25-30 is considered to be overweight. BMI is the most common evidence- ground dickhead used to analyse normal weight, overweight or obese in hospital when patients come for admission. It is calculated by dividing an individuals body weight kilogram by the square of bod y height (NICE 2006). waistline circumference is besides a reliable dent used to recognise overweight and obesity as it provides information with regards to the distribution of surfeit body fat in a persons abdomen (NICE 2006).Nevertheless, BMI has some weakness it is not suitable for individuals with excess body fat or muscle mass as it does not differentiate between excess body fat and muscle mass (Heath Sturdy 2009). Diabetes UK (2012) argued that apply BMI alone to calculate a patients height and weight would not identify overweight or obesity. However, the combination of BMI and waist circumference will dish classify an overweight or obese person, and for this reason Janes waist circumference was measured because it is the go around way to measure abdominal muscle fat distributed around her waist as suggested by Diabetes UK (2012).Regardless BMI and waist circumference screening tool was used to classify Janes overweight, however, according to Ashwell et al (2012) studi es have proved waist to height ratio screening tool a better way of identifying overweight or obesity in adult than BMI and waist circumference. As a burden nurses should consider using waist to height ratio as a screening tool to recognize overweight or obese patients with diabetes. This is because the tool measures the ratio of an individual waist to his or her height (Ashwell et al 2012).Janes height and weight was measured using stadiometer and clinical scale, nevertheless, the use of stadiometer to measure Janes height was comparatively weak (BAPEN 2010). Jane is a 65 year old cleaning woman with a lowly kyphosis on her back and according to Hirani Aresu (2012) the military issue for an elderly with this condition may impair their actual height resulting to sour reading. This is because some battalion grow older with distort height like kyphosis, this as such will result in the individual to losing his or her real height. Kyphosis is a deformity of an individuals back wh ich can lead to hunched back due to a leaving of a spinal curvature from its normal shape (Kado et al 2013). and so the use of demispan measure tool could be an evidence based shape to consider when a patients actual height is distorted. As a result this might have worked for Jane as she has a small kyphosis on her back and the NMC (2010) emphasized that nurses should use their clinical knowledge, skills and opinion to classify factors that could impair individuals height.Consequently, Janes hypoglycaemia is part dependant on her overweight wherefore the main nursing interjection that needs to be targeted is Janes weight loss as it will lead to long term benefit for her. This is because overweight can cause hypoglycaemia, overweight is in addition associated to inadequate exercise and unhealthy eating behaviours considered to be primary factors contributing in the rising prevalence of type 2 diabetes and if not well managed, it could also lead to other complications such as obesity, heart attack or stroke (Diabetes UK 2012). As a result an effective weight management can improve Janes eudaemonia using nursing problem solving approach.According to Barrett et al (2010) nursing problem solving approach is about understanding the individual as a whole person. Therefore, using the problem solving approach delegacy nurses have to link the individuals illness to factors that could affect their indisposition. These look at psychological, emotional, social environment, spiritual and time and if theres any of these identified then it should be addressed as they form part of the individuals well-being (Wade 2009).Knol et al (2006) states economic crisis is common in spate suffering from type 2 diabetes. Knol et al (2006) also recognised that xxx seven percent of those people with a medical history of depression are prone to have type 2 diabetes. Evidently, Jane during her initial assessment mentioned that she had little knowledge on dietetic due to lack o f demand and her dietary history reveals having unhealthy pabulum such as restore meals and dessert while away with friends. Consequently, this has had an impact on her psychological wellbeing. She also recognised excesses carbohydrate usance and her normal dinner meals consist of pasta whereas during the day she often has rice with homemade sauce as well as walking exercise 10-15 minutes twice in a week.However, the nursing team worked with Jane to determine if Janes overweight was caused by her not complying with her dietary advice, as a result she agreed that a referral to a nutritionist and diabetes specialist nurse was her concern and this was made to deliver meal plan as well as maintain her corporeal activity. This is the best practice as suggested by NMC (2006) that nurses must work together with their patient to ascertain the patients understanding about risk associated with overweight. This is because if Janes nutriment pattern is left unattended it may lead to n evertheless ill health problems such as obesity, stroke and heart disease (Thomas 2008). The United Kingdom Progressive Diabetes Study (UKPDS 1990) recognised the majority of people with type 2 diabetes have ill health complications associated with their long term condition.In addition to this, the role of the dietician is to identify problems relating to an individuals nutritional status and once identified the dietician working in partnership with the individual will then formulate meal plan that adapt to the persons needs and preferences (British Dietetic Association 2012). department of Health (2005) emphasised that nurses should empower patients with long term condition so that the individual is capable to manage and live with their disease effectively. NICE (2008) also suggested this method of approach as the best practice as it helps the individuals to manage their condition.According to Thomas (2008) weight loss through dietary can be defined as a reduction of less nutriti on phthisis to that of the energy used by an individual. Therefore the dietician along with the nursing team main target was how Jane would lose weight through dietary behaviour change and in order to happen upon this she was seen a day after her admission. The initial approach considered was the motivational interview based on providing a solution to a suitable diet. Motivational interviewing is a collaborative patient centred approach in a form of back up a persons motivation to encourage and empower patients behaviour change (Resnicow Mcmaster 2012). This is to maintain the patients autonomy based on his or her needs for their condition and that any decision made is lastly up to the patient (Resnicow Mcmaster 2012).Jane agreed having a motivational interview and had the prospect to discuss her dietary plan with the main focus on the types of food she likes as mentioned above. In order for Jane to have an appropriate balance diet, the dietician and the nursing team worked wit h Jane by setting a realistic oddment. This is because for an individual to lose weight involves time and encouragement to achieve his or her goals effectively and therefore the best practice is setting an appropriate goal that suits Jane (Thomas 2008). It was grueling to set a short term goal for Jane as she was unable(p) to maintain weight loss due to lack of motivation and therefore a long term goal was set with smaller intake of caloric food so that Jane could gradually lose weight and also improve her glycaemic control (Diabetes UK 2012).Jane was offered the importance to a strict diet and she was provided food such as fish, vegetables, low starchy food per day a reduction of low sugary food was put in place. She was also encouraged to drink two litres of water daily. Her daily food intake was recorded to meet her dietary care plan needs as (Lang Froelicher 2006) recommended. Moreover, Jane during her admission was subjected to weight monitoring and repeating her MUST scree ning construct for any changes in her BMI (BAPEN 2010).Jane following a regular monitoring, on her one-fifth day on admission was still considered overweight however, evidence shows a minimal improvement of 900gms weight loss. A risk of any physical complications of diabetes was low and no episode of hyperglycaemia. Her symptom of severe headaches and tiredness was now resolved and she was more excited to go home.Following Janes consequent of her dietary care plan, if Jane can be convinced to increase her physical activity her need for hypoglycaemic drug will be minimised. This is because the combination of dietary and an increase in physical activity on a regular basis is recommended to be more effective for an individual to achieve weight loss in a long term goal (NICE 2006). As such Janes care plan was reviewed with the nursing team prior to discharge and from her assessment it was recognised that she does not need a psychological referral but to improve her knowledge with reg ard to her type 2 diabetes so that she can self-manage her diabetes successfully.Even though Jane was suffering from kyphosis, physically she was fit to increase her physical activity and following the discussion how significantly an increase in exercise can have positive effect on glucose management, Jane agreed to walk each day in the mornings 20 25 minutes.After reviewing Janes dietary and physical options, a discussion about the need to continue metformin helped to improve her glycaemic control therefore she was prescribe 500 mg twice a day. Metformin is an oral drug to lower glucose level in the blood. Jane will benefit from taking metformin as it is associated to weight loss this will prevent her from gaining more weight (NICE 2009). Other oral anti-diabetic agent such as thiazolidinedious and sulphonyureas were not recommended due to an increase of body weight caused by these agents.Prior to discharge Jane was informed about the importance of community nurse. The nursing t eam liaised with the community nurse for a regular monitoring of Janes glucose level as well as her weight. NMC (2010) highlighted that consent must be given to Jane before involving a community nurse thus it is the right of an individual to confidentiality and consequently is a must for a nurse to respect this.To sum up, Janes dietary plan did not make much significant changes in her weight, however, on discharge she was educated to continue recording her daily food and drinks intake, regular exercise, to closely monitor glucose level for symptoms of hyperglycaemic or hypoglycaemia. Further information about getting support from educational programme such as DESMOND was discussed with Jane. She was also given information leaflets which were easy to read as supporting interventions to help increase her knowledge about how to self-manage her diet.