Question

please use scenario and use the nursing process to determine each step

An Older Adult male is assigned to an RN, admitted for exacerbation of Diabetes Mellitus and Chronic Obstructive Pulmonary Disease (COPD). The dient has a history of Depression and multiple hospital admissions for the past 6 months. He has a wife who does most of the cooking and 2 adult children living in another state. The dient is a fireman and does not follow his treatment plan. He skips breakfast and only eats a sandwich and soup for lunch with snacks and dinner consists of meat, potatoes, and occasional canned vegetables. He drinks 5 cups of coffee and minimal water. Alcohol intake is during social events; he denies use of nonprescription drugs, substances, or street drugs. His concerns are: "..not being able to catch my breath, always coughing after walking and all night...can't sleep..they want me to see a pulmonologist because it may be something more serious..." The medical record shows his blood sugar and A1C are elevated. Ex: Concept: Nursing Process

Answer 1

#. Nursing process for diabetes :-

Subjective data - elevated glucose and A1C

Objective data - hyperglycemia

Goal - to maintain normal blood glucose levels

Nursing Interventions and Rationales:

Blood sugar monitoring: Normal range 70-180 mg/dL *patient may have a different target blood sugar level, make sure to know what each patient’s target is.

The physician will make a target blood glucose level. Teach the patient that they need to monitor their blood glucose.They need to call their primary care physician if they have blood glucose levels higher than their target for multiple days or if they have 2 readings of greater than 300 mg/dL.

Teach the patient how to use their glucometer and record their results.

Insulin administration -Rapid Acting: Humalog Novolog -Fast/short Acting: Regular -Intermediate Action: NPH -Long Acting:’ Lantus Levemir

It is important to know which insulin to give and how they work. Each institution has guidelines and each insulin has guidelines. Following the guidelines, make sure you know the onset, peak and duration of each type of insulin.

-Rapid Acting

Onset: 10-30 minutes

Peak: 30 minutes- 3 hours

Duration: 3-5 hours

-Fast/short Acting

Onset: 30 minutes-1 hour

Peak: 2-5 hours

Duration: Up to 12 hours

-Intermediate Action

Onset:1.5-4 hours

Peak: 4-12 hours

Duration: Up to 24 hours

-Long Acting

Onset:1-4 hours

Peak: minimal peak

Duration: Up to 24 hours

To administer insulin, teach the patient to rotate injection sites and to clean the site with alcohol prior to inserting needle.

Educate about nutritional changes and monitoring

This would be a good time to get the dietician involved. The patient needs to learn at a minimum, how to count carbs and which foods to avoid such as beer.

A patient’s glucose should be checked once when the patient wakes up, before meals, and before going to bed.

If the patient is hypoglycemic, and they are able to eat or drink, give them some OJ and graham crackers with peanut butter.

Increase water intake if the patient has hyperglycemia

Monitor feet and educate about monitoring feet

Both decreased blood flow to the feet as well as neuropathy occur to make the feet something the patient really needs to watch. Wounds are hard to heal so if they are having a hard time feeling their feet and they become injured, the wounds will be worse than with someone without diabetes.

Teach the patient to check their feet everyday. Washing their feet, cutting their toenails straight across, and scrubbing off calluses gently are a couple of points to make with the patient.

The patient may have a podiatrist involved in their care as well.

As a nurse, you will need to be checking the patient’s feet as well and monitor any wounds.

Monitor Blood Pressure (BP) Normal Blood Pressure: 120/80 mmHg

It is vital to keep someone with diabetes within normal limits for their blood pressure.

Placing strain on the cardiovascular system wrecks havoc on other organ systems. Being diabetic makes the chances of that system having issues worse. A patient can lose their vision, kidney function, have a stroke or heart attack.

Educate about maintaining a healthy weight and keeping active

With a healthy weight, the patient is likely also implementing a healthy diet as well as implementing more movement. These three things (weight, diet, exercise) can help to manage or even reverse diabetes.

Healthy weights are calculated based on height and sex of the patient. Other ways to monitor the size of the patient is to use a BMI calculator or measure waist circumference.

Nursing process for COPD :-

Subjective Data:

Difficulty Breathing

Chest tightness

“I can’t breathe”

Objective Data:

Cough

Use of strenuous muscle

Nursing Interventions and Rationales

Avoid irritants:

Quit smoking or being around secondhand smoke

Be mindful of the weather (very cold weather can aggravate the bronchi)

Allergens like dust or pollen

The key to avoiding a flare up of COPD is to avoid