CNA343 Strengths Based Nursing And Healthcare 2

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CNA343 Strengths Based Nursing And Healthcare 2

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CNA343 Strengths Based Nursing And Healthcare 2

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Course Code: CNA343
University: University Of Tasmania

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Country: Australia

The patient is a 36 years old man who has had type 1 diabetes for 15 years. He presents to the emergency room with hyperglycemia and concern for possible diabetic ketoacidosis after not taking his insulin for 3 days. The patient reports that he us currently homeless and has lost his supply of insulin, syringes, glucose meter, and related glucose testing supplies. he reports dark dark urine and voiding less 30cc/hr. vital signs T.98.3 P.85 R 21 B/P 210/96 BLOODCOSE 320

Care Plan For Patient With Hyperglycemia







He reports that he is suffering from type1 diabetes for 15 years and is not taking insulin for the past 3 days
Blood glucose- 320, frequent thirst, dry mouth

Blood glucose levels beyond 125 mg/dL confirms deficiency of insulin hormone in the body that contributes to diabetes

After an intervention period of 24 hours, blood glucose levels will be brought in the range of 125-200 mg/dL.

The patient will be subjected to an Insulin glucose tolerance test and the blood sugar levels will be checked every hour until the predetermined levels are achieved.
The patient will also be administered aspirin to lower risks of cardiovascular disorders

Individuals suffering from diabetes manifest beta-cell dysfunction and insulin resistance, which increases hepatic glucose production. Diabetes is also associated with abnormal cholesterol levels, obesity and hypertension that increases cardiovascular risks.

After 24 hours of the intervention, the patient will demonstrate reduced blood glucose levels

He reports having dark urine
Voiding less than 30cc/hour

Dark urine and urine output much less than normal 50-62cc/hour indicates that the patient suffers from dehydration.

Patient’s urine output will be close to the normal amount within 48 hours.

The patient will be started on intravenous normal saline at 150cc/hour for two consecutive days and the urine colour and amount shall be recorded. The patient will also be provided with fruit juices and adequatre amounts of water to replace the lost fluids.

Decreased urine output or oliguria most commonly occurs due to dehydration. This occurs due to inability of the kidneys to retain maximum amount of fluid. Pale yellow coloured urine indicates proper hydration. However, dark urine commonly occurs due to dehydration and indicates presence of potentially harmful waste products in body circulation.  High blood sugar is responsible for such dehydration.

After 48 hours of the intervention, the patient will demonstrate pale yellow colured urine and an output equal to 120-150cc/hour.

Subjective: He has lost his glucometer, insulin supplies
Objective: Vital sign measurements are as follows-
T- 98.3°F
P- 85
RR- 21
BP- 210/96

The patient’s respiratory rate is slightly higher than the normal range of 12-20 breaths per minutes, thereby indicating risks of hyperventilation.
BP measurement indicates hypertension due to the fact that the values are much higher than the normal range of 120/80-140/90 mm Hg

The patient’s blood pressure will be 120-130 (SBP) and 80-95 (DBP), within 24-32 hours.
The patient will also verbalise his understanding of not stopping from taking medicines, unless specified by a doctor. Patient will also report RR within normal range in 24 hours.

Vasodilator medications will be administered and titrated to meet all parameters for blood pressure.
The BP will be regularly monitored for every 4 hours, until it reduces. The oxygen saturation will be measured and patient will be made to sit in Fowler’s position. RR will be assessed every 30 minutes.

Vasodilator group of medicines help in opening or widening the blood vessels, thereby facilitating easy blood flow, without exerting pressure. Fowler’s position will facilitate chest expansion and improve RR.

Patient will show vital signs within the normal ranges after the intervention period.

Berti de Marinis, Giulia et al, “A 40-Year-Old Man With Recurrent Fainting, Hypotension, Lower Limb Edema And Oliguria With Body Weight Gain And Secondary Erythrocytosis” (2011) 7(5) Internal and Emergency Medicine https://link.springer.com/article/10.1007%2Fs11739-011-0692-6
Dellamonica, J. et al, “Effect Of Different Seated Positions On Lung Volume And Oxygenation In Acute Respiratory Distress Syndrome” (2013) 39(6) Intensive Care Medicine https://link.springer.com/article/10.1007/s00134-013-2827-x
Fu, Zhuo, Elizabeth R. Gilbert and Dongmin Liu, “Regulation Of Insulin Synthesis And Secretion And Pancreatic Beta-Cell Dysfunction In Diabetes” (2013) 9(1) Current Diabetes Reviews https://www.ingentaconnect.com/content/ben/cdr/2013/00000009/00000001/art00004
Hellsten, Y. et al, “Vasodilator Interactions In Skeletal Muscle Blood Flow Regulation” (2012) 590(24) The Journal of Physiology https://onlinelibrary.wiley.com/doi/10.1113/jphysiol.2012.240762/full
Pisprasert, V. et al, Limitations In The Use Of Indices Using Glucose And Insulin Levels To Predict Insulin Sensitivity: Impact Of Race And Gender And Superiority Of The Indices Derived From Oral Glucose Tolerance Test In African Americans (2018) https://care.diabetesjournals.org/content/36/4/845.short
Pruhova, Stepanka et al, “Two Cases Of Diabetic Ketoacidosis In HNF1A-MODY Linked To Severe Dehydration” (2013) 36(9) Diabetes Care https://care.diabetesjournals.org/content/36/9/2573.short
Sattar, N., “Revisiting The Links Between Glycaemia, Diabetes And Cardiovascular Disease” (2013) 56(4) Diabetologia https://link.springer.com/article/10.1007/s00125-012-2817-5

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