A Nurse’s Role in a Care Plan for a Complex Patient

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Introduction

The patient is a 61-year-old Hispanic woman named A.J.L. who was taken to the hospital due to her complaining of feeling unwell: she had difficulty breathing, and experienced drowsiness, nausea, headaches, and dehydration. For seven years before the hospitalization, she had had diabetes, which resulted in an end-stage renal disease diagnosis in 2022. Her most recent blood glucose levels are 188 mg/dl, and her vitals on admission are the following: the temperature at 98°F, SpO2 at 90% on room air, BP at 159/93, RR 24 rpm, and HR 74 bpm. A.J.L. needs her medical test results stabilized and her treatment corrected. Moreover, she needs to be provided instructions for proper self-care, which include not skipping dialysis sessions, taking prescribed medication, adhering to a specific diet, and maintaining an active lifestyle.

Case Description

A.J.L.’s end-stage renal disease is concomitant with hypertension and type II diabetes. According to Cobo et al. (2018), end-stage renal disease (ESRD) is stage 5 of chronic kidney disease, which is characterized by kidney/s gradually losing function over some time from months to years. It is well known that ESRD is most often caused by diabetic nephropathy, sometimes combined with hypertensive nephropathy, the latter being the case with A.J.L.

A.J.L became obese due to improper nutrition and increased carbohydrate intake. As a consequence, her cells’ sensitivity to insulin decreased, which resulted in enhanced blood glucose levels and the development of diabetes mellitus. A.J.L. comes from a poor Hispanic neighborhood, and she cannot always afford medication. However, when she does have money, A.J.L. prefers to give it to her daughter, who struggles with raising a toddler on her own. In addition to that, she tends to skip her dialysis sessions but only because A.J.L. needs to babysit her granddaughter sometimes. The patient needs proper medication to improve her condition and education on the importance of taking care of herself.

Management of Care

To reduce the pressure on the patient’s respiratory system, a nurse or several nurses should place her either on the side of the abdomen. Since A.J.L.’s SpO2 levels are at 90%, she is recommended oxygen therapy via nasal cannula. As for medication, Diabetes Care (2019) lists Metformin as a first-line drug to be taken in a dosage of 500 mg twice a day. Among the fast-acting insulins, Apidra is one of the good choices for treating type II diabetes, with a starting dose of 4 units for someone with A.J.L.’s test results. Moreover, at the hospital, the patient is to be given 50 mg of Cozaar; all this medication is to be taken by A.J.L. after her release from the hospital.

In that regard, she needs to be educated on how important it is to take medication as prescribed and prioritize buying it over another spending. In addition to that, A.J.L. must monitor her blood glucose levels during the day and understand how to manage her condition when the levels are out of the norm. Moreover, as per Reisi et al. (2017), a diabetic is to adhere to a healthy diet and start leading a more active lifestyle. In terms of a diet, basic tips are to include choosing healthy carbohydrates and beneficial fats, as well as foods good for the heart.

Safety and Infection Control

When delivering patient care to A.J.L., a nurse is to follow standard precaution guidelines and adhere to strict hand hygiene and use of personal protective equipment due to an increased risk of infection. Diabetes Care (2019) recommends instructing the patient on basic safety measures when self-administrating insulin. In addition to that, A.J.L. is to constantly assess her condition on all fronts, including the quality of vision and skin integrity, and seek help from a professional in the case of its deterioration.

Health Promotion and Maintenance

A.J.L. is to follow all the recommendations provided by the specialists: eat healthily, be active, and not skip dialysis sessions or appointments with her physician. According to Reisi et al. (2017), diabetics are also to constantly control their blood sugar level and blood pressure and know how to manage dissatisfying results. Moreover, A.J.L. is to take her medications as prescribed and ensure she never skips doses.

Psychosocial Integrity

A competent nurse always respects the patient and their wishes and does their best to establish and maintain a therapeutic relationship, creating a strong bond while keeping appropriate boundaries. Taylor et al. (2018) note that it is essential for any patient, especially those with chronic conditions, to have a support system, and a nurse is to be a part of it. Additionally, a nurse is to be understanding and patient: it might be complicated to manage someone whose quality of life is reduced due to disease, and a professional must be prepared for that.

Basic Care and Comfort

A nurse is to discuss with A.J.L how she is to manage to afford her medication and change her lifestyle taking into consideration the patient’s financial situation and current way of living. The patient is to be encouraged to be more physically active and to prioritize her health before anything or anyone else. Moreover, a nurse is to help A.J.L learn how to reduce stress in case of needing to reduce her blood pressure.

Pharmacological and Parenteral Therapies

With A.J.L.’s oxygen saturation at 90%, a nurse is to place her on oxygen therapy via nasal cannula. Metformin, Apidra, and Cozaar are some of the drugs A.J.L. is to be prescribed to take in doses appropriate to her condition. That means 500 mg of Metformin twice a day, 4 units of Apidra per day as a starting dose, and 50 mg of Cozaar per day. These means will help treat A.J.L.’s high blood pressure and glucose levels.

Reduction of Risk Potential

It is essential that A.J.L constantly monitors her blood pressure and glucose levels, as well as evaluates her general condition for signs of deterioration, for it will ensure the treatments goes as planned. A nurse is to instruct A.J.L to continue with dialysis procedures and not skip them as they help keep electrolytes and fluids in balance and remove waste from the blood. Additionally, a nurse must be able to assess the patient’s situation and choose the best intervention considering all risks.

Physiological Adaptation

A nurse’s role in ensuring A.J.L.’s physiological adaptation to treatment is in making certain they understand the pathophysiology of her condition. By knowing what physiological changes A.J.L.’s body systems go through, a nurse can evaluate the effects her interventions have on the patient. Constant monitoring is needed to assist a nurse in that, as well as in knowing when to apply corrective interventions.

Conclusion

A nurse’s role in a hospital setting is to not only provide care directly to the patient but to also communicate with other healthcare team members. According to Fraze et al. (2020), it includes doctors, physician assistants, and therapists, as well as emotional support providers in some cases. Each member of their team does their job to ensure the patient is recovering and achieving their health goals. Through monitoring, evaluation, education, and support, a nurse improves their patient’s health by providing beneficial interventions, reducing risks, and delivering care for them.

References

Cobo, G., Lindholm, B., & Stenvinkel, P. (2018). Chronic inflammation in end-stage renal disease and dialysis.Nephrology Dialysis Transplantation, 33(3), 35-40. Web.

Diabetes Care. (2019). Standards of medical care in diabetes – 2019.Diabetes Care, 42(1), 81-89. Web.

Fraze, T. K., Briggs, A. D., Whitcomb, E. K., Peck, K. A., & Meara, E. (2020). Role of nurse practitioners in caring for patients with complex health needs.Medical Care, 58(10), 853. Web.

Reisi, M., Javadzade, H., Sharifirad, G., Mostafavi, F., Tavassoli, E., & Imanzad, M. (2017). Effects of an educational intervention on self-care and metabolic control in patients with type II diabetes. Journal of Client-Centered Nursing Care, 3(3), 205-214. Web.

Taylor, C. R., Lynn, P. B., & Bartlett, J. L. (2018). Fundamentals of nursing: The art and science of person-centered care. Wolters Kluwer.

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