Introduction
This paper is aimed at developing a nursing care development plan for Douglas Adams, a 51-year old male. Douglas has a history of diabetes and hypertension. He is also said to have allergies to penicillin. Douglas does not take alcohol but he smokes at least one packet a day. This paper provides a nursing diagnosis of Douglas, based on his health statistics. This analysis will be followed by a nursing diagnosis and an identification of the three highest priority nursing diagnoses. A conclusion summarizing the findings of the study will thereafter be provided.
Collecting Data
Douglas was found in a disoriented state which was informed by a Glasgow coma score of 14/15 (after a medical examination was undertaken). During the medical examination, Douglas talked in a slow and slurred speech, and often complained of weakness (no energy). During the same medical examination, Douglas appeared to be very restless. His GCS dropped to 13 and he has no recollection of what year or date it was. The medical examination also revealed that Douglas took his dose of insulin in the morning (which recorded a blood sugar reading of 2.1 mmols and 26 units of humalogmix). After consultations with the medical officer, 15-20 grams of carbohydrates in 125 mls of orange were administered to Douglas (which revealed a GLS of 15).
Nursing Diagnosis
Considering the above statistics regarding Douglas, it is inevitable to disclose that, he is at risk of secondary hypoglycemia because there was a drop in his blood sugar levels (after a careful medical examination was undertaken). This diagnosis is supported by impairment in neurological function, which is also supported by a fall in glucose levels (associated with secondary hypoglycemia) (Rubin, 2010). This observation is also supported by the fact that, during the medical examination, Douglas could not recall what day or year it was. Moreover, he was very restless. Douglas is also at risk of falling down because of hypoglycemia. This observation is supported by the fact that he was excessively weak and powerless during the medical examination. These symptoms are normally caused by a drop in glucose levels (Hay, 2010, p. 53). At the same time, Douglas is at risk of suffering from increased anxiety because of his current predicament and the fear that he is unable to control diabetes. He is also at risk of developing hyperglycemia because of the over-treatment of hypoglycemia, and at the same time, his vital organs are at risk of malfunctioning because of his unstable blood glucose level (Chow, 2007).
Highest Priority Nursing Diagnoses
The three highest nursing diagnoses are the patient’s risk of developing secondary hypoglycemia related to a drop in blood glucose levels (again), the patient’s risk of developing an impaired neurological system (related to secondary hypoglycemia), and the patient’s risk of falling down due to hypoglycemia (Herrin, 2003). In addressing the first nursing diagnosis, the main aim of the nursing interventions (to be administered) will be to prevent the development of secondary hypoglycemia by increasing blood glucose levels. The four immediate nursing interventions center on stabilizing the blood glucose level (Life Tips, 2011, p. 1). The first nursing intervention involves administering readily absorbable sugar (which is found in orange juice). In the short term, this process ensures the glucose level is stabilized to a relative degree because it causes a sudden increase in blood glucose level. Secondly, since Douglas’s situation is acute, glucagon will be injected into his blood to start the production of sugar by the liver. This is a hormone therapy that has the opposite effect of insulin, but still, emergency services should be sought after the administration of glucagon (DBSS, 2011, p. 2). Thirdly, a protein-rich diet should be administered to stabilize the blood sugar levels because Douglas is at the risk of experiencing a repeated episode of hypoglycemia, 20 minutes after the administration of the first course of treatment (Mericle, 2011). Fourth, regular meals will be scheduled around insulin peak times so that a mid-term stabilization of blood sugar level is achieved (Raymond, 2011). This intervention is supported by the fact that hypoglycemia may be caused by eating little food and at irregular time periods (Agency for Healthcare Research and Quality, 2011).
The evaluation criteria for the first priority nursing diagnosis will be centered on the elimination of symptoms related to the condition. First, a sense of rest by the patient will be a good indicator that the interventions work because it will also be an indication that the blood glucose level has stabilized. Secondly, the normalization of speech and sight will also be a good indicator that the medication is working. Lastly, a lack of anxiety, coupled with shakiness, sweating and rapid pulses will also be a good indication that the nursing interventions are effective (Saunders, 1989).
The second high-priority diagnosis is related to the impairment of the patient’s neurological system, which can be corrected in several ways. The goal of the nursing interventions (to be administered) will be to ensure the patient does not suffer any neurological impairment. The first nursing intervention will be the administration of intravenous sedation which will help to calm the patient and reduce his anxiety levels (ATD, 2011, p. 1). This intervention will also act as a deterrent to the impairment of the patient’s neurological system because it induces a sense of deep relaxation (Dental Fear Central, 2011). The second nursing intervention will be the administration of valium because it will stabilize brain activities and prevent the impairment of the patient’s neurological system (Cerner Multum, Inc., 2011, p. 1). This course of treatment is especially useful because it affects chemicals in the brain by balancing them and reducing anxiety. The third nursing intervention will be the administration of glucose powder to the patient because this procedure would see an increase in blood sugar levels, on an immediate basis. The last nursing intervention will be securing the patient in a tightly-watched clinical environment where he can be watched for progress. Here, an expected stabilization of the neurological activities is expected.
The evaluation criteria for the above nursing interventions will be centered on observing that the patient does not experience any neurological impairment. As a result, a lack of shock and seizure will be an indication that the patient is responding well to the treatment. A deep sense of calmness in the patient and the comprehension of reality will also be a good indicator that the nursing interventions are working. Lastly, if the patient is able to carry out normal human functions like talking, seeing and responding well to basic questions; it should be assumed that the nursing interventions have worked.
The last high-priority nursing diagnosis is the patient’s risk of falling, due to hypoglycemia. The goal of the nursing interventions (to be administered here) is to ensure the patient maintains a good posture (Hollis, 1999, p. 260). The first nursing intervention that may be implemented is, securing the patient in a flat position (lying on his back). This intervention would ensure the patient does not suffer any injuries if he loses balance (Farlex, Inc., 2011). The second nursing intervention would be to keep the patient engaged always. This involves talking to the patient and ensuring he does not fall into dizziness. The third nursing intervention would be to ensure the patient is in constant movement so that he maintains his balance (Gormley, 2005, p. 184). This intervention is justified by the fact that sedentary postures are likely to cause a fall. Lastly, the patient should be administered fast-absorbing glucose tablets to stabilize his blood glucose levels.
The evaluation criteria for the above nursing interventions would be centered on ensuring the patient maintains a good balance. The lack of staggering (stability) would be a good indicator that the nursing interventions are working effectively. Also, a sense of strength (lack of fatigue) would also be a good indicator that the nursing interventions are working properly.
Conclusion
This paper shows that Douglas stands a high risk of developing secondary hypoglycemia, experiencing neurological impairment and falling down (due to a decrease in blood glucose levels). However, this paper shows that most of the nursing interventions to be made in preventing the above eventualities depend on stabilizing the patient’s blood sugar levels. This is a remedy that solves the problem, at least in the middle term. In the short term, each nursing intervention should be tailored to the risk posed.
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