Patient Management Using the Nursing Process

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Table of Contents

Introduction
Assessment
Nursing Diagnosis
Management
Conclusion
References

Introduction

Nursing process provides a patient centered approach of management (Bruner, Smeltzer,& Bare, 2009). The nurse uses holistic approach of care to address all the priorities of the patient to tailor interventions to the individual patient, not just the disease or medical problem (Fewcett & Runciman, 2008). In this situation, the order of management entails assessment, diagnosis, goal setting, implementation and evaluation (MantiK & Heitkemper, 2010).

Mr. Douglas who has a clinical diagnosis of type I diabetes and hypertension needs management using the nursing process to ensure a comprehensive patient centered care is given. During assessment, both subjective and objective data is collected. Diagnoses emerge from the collected data. This leads to goal setting followed by intervention and evaluation.

Assessment

During assessment of Mr. Douglas, it was possible to collect a comprehensive data that was useful for his management. Demographic history revealed that he is 51 years old male who weighs 70kg with a height of 190 cm. past medical history exposed that he is a known diabetic and hypertensive patient who is currently on treatment. Besides, he has allergy to penicillin. Social history disclosed that he stays alone, does not take alcohol but smokes cigarette.

On observation, he was confused with slurred speech and restless. Upon interview he raised complained of feeling weak with no energy. In addition to that, he did not know where he was and what year it was. Investigations done included assessment with coma scale that revealed a score of 13 and blood sugar that revealed 2.1 m/l.

Nursing Diagnosis

When life-threatening problems do not exist, the nurse uses the patient and his professional judgment to plan for the patients care (Carrolle, 2009). It is from these priority problems that nursing diagnoses emerge. Although Mr. Douglas has presented with a variety of problems, not all of them require urgent measures. Based on the priority problems, the following diagnosis came out.

Acute confusion related to hyperglycemia as evidenced by patient disorientation of time and place and coma scale of 13. Fatigue related to hypoglycemia as evidenced by patient verbal complains of feeling weak and having no energy and low blood sugars of 2.1m/l per liter. Impaired verbal communication related to hypoglycemia secondary to lack of glucose for the brain tissues as evidenced by slurred speech when answering questions. Activity intolerance related to hypoglycemia as evidenced by complains of feeling weak and having no energy. Knowledge deficit related to lack of information regarding the disease process as evidenced by smoking and not taking food after insulin administration. Risk for infection related to the procedure of insulin administration secondary to puncturing of the injection site. Risk for injury related to patient not remaining in bed and verbal complain of feeling weak and no energy.

Management

Acute confusion related to hyperglycemia as evidenced by patient disorientation of time and place and coma scale of 13. Hyperglycemia means there is too much sugar in the blood system (Sheeetz & Kings, 2010). When excess sugar encounters brain tissues, it irritates the brain cells confusing (Barry & Eastman, 2010). Confusion is the priority problem because it is the main reason that brought the patient to the hospital. It puts the patient at a risk of fall and injury that can lead to other physical problems like fractures. Confusion can impair the normal body function leading to a psychiatric condition (Diamond, 2007). The goal of management is that the patient will be properly oriented to time, person and place after one hour. The intervention is administration of insulin and psychotherapy. The rationale is that insulin is a hypoglycemic hormone (Rorsman, 2009). It will reduce the amount of blood sugar by allowing glucose to move in to the cells to make energy (Mari, Baldi, & Guarino,2008). Low blood sugars mean less amount of sugars reaches the brain cells hence alleviation of confusion state. On the other hand, psychotherapy allows the patient to be well oriented after the blood sugar levels have come to normal. Evaluation is hourly because insulin functions at approximately the same duration of time (Akira & Gulnisa,2009). During evaluation, blood sugars analysis helps to determine whether it has been reduced. Questions about time, place and persons evaluate the patient’s level of orientation. Besides, a repeat of coma scale evaluates the patients’ conscious level that has direct connection with confusion level (Diamond, 2007).

Fatigue related to hypoglycemia as evidenced by patient verbal complains of feeling weak and having no energy and low blood sugars of 2.1m/l per liter. Hypoglycemia is low blood sugars (Plessma & Juriaan, 2008). Low sugars cause body cells starvation hence fatigue due to lack of energy. Fatigue means general body weakness (Salmon & Phill, 2010). It is of second priority as it interferes with the patient’s ability to perform any task. Body weakness leads to activity intolerance and immobility (Braunwald, 2009). Immobility is a health hazard as it puts the patient at a risk of developing pressure sores that exposes someone to infection (Selley, 2008). Besides, it makes a person to be dependent on others, as he cannot perform activity of the daily living on his own. The goal of management is that the patient will be free from fatigue after thirty minutes. The intervention is administration of simple sugars like glucose. The rationale is that simple sugars are readily absorbed in to the blood system (Allbright,2009). This provides energy to the body cells hence reduction of fatigue. In evaluation, blood glucose monitoring ensures that blood sugars are within the acceptable range. The patient interview determines if the feeling of weakness is over. On observation, patient stability is an indicator of fatigue reduction (Weinger,2010).

Impaired verbal communication related to hypoglycemia secondary to lack of glucose for the brain tissues as evidenced by slurred speech when answering questions. Altered speech is a priority problem because speech is the common means of communication by human beings. Lack of speech can lead to lack of understanding between two people (Titler,2008). If Mr. Douglas cannot communicate properly, He will not be in a position to express his feelings and views hence difficulties in provision of care will be encountered. The goal of management is that the patient will have a coherent speech within one hour. The intervention is administration of simple sugars. The rationale is that the sugars will provide the brain tissues with energy (Parkerton, 2010). The parts of the brain responsible for speech will receive energy thus function properly leading to coherent speech. In evaluation, the patient interview will determine the coherency of his speech.

Conclusion

Holistic care of a patient is a very critical component in the nursing profession and it needs precautions to avoid careless mistakes that can be harmful to the patient. Patients may have the same condition but present differently therefore, the care need to be individualized according to ones necessities (Bruner, Smeltzer, & Bare, 2009). It is very important to use the nursing process in management of a patient because it alleviates the risk of forgetting patient’s problems hence leading to a patient centered approach of holistic management.

References

Akira, N., & Gulnisa, P. (2009). Insulin Sensitivity and Endothelial function in hypertension. America Journal of Hypertension, 3-4.

Allbright, M. (2009). Diabetes Self Care: A Challange to Nursing. Journal Of Diabetic Nursing, 45-46.

Barry, M., & Eastman, A. (2010). Hyperglycemia enhances DNA Fragmentation After Transient Cerebral ischaemia. Journal of Cerebral Blood Flow and Metabolism, 312.

Braunwald, A. (2009). Management of Hypoglycemia with insulin Medication. Journal of Healthy Life Span in Diabetic Patients, 4-5.

Bruner, L. S., Smeltzer, S. c., & Bare, B. G. (2009). Bruner and Suddarth’s textbook of Medical Surgical Nursing. New York: Lippincott Wiliams and Wilkins.

Carrolle, J. R. (2009). Nursing Diagnosis and the Methods Appropriate to research it. Journal of the North American Nursing Diagnosis Association, 28.

Diamond, R. (2007). Psychiatric Presentation of medical illness. America Journal of Psychiatry, 11-12.

Fewcett, J. N., & Runciman, P. J. (2008). Nursing Practice: Hospital and Home: The Adult. Philadelphia: Radcliffe Publishing.

MantiK, S. L., & Heitkemper, M. (2010). Medical Surgical Nursing: Assessment and Management of Clinical Problems. London: Mosby.

Mari, A., Baldi, S., & Guarino, D. (2008). The role of beta Cells Function and Insulin Sensitivity in the remission of type 1 diabetes. The Journal of Clinical Endocrinology and Metabolism, 27.

Parkerton, L. (2010). Diabetic care: The Need For Change. America Journal Of Nursing, 98.

Plessma, J., & Juriaan, K. (2008). Hypoglycemia: An Unnamed Medical Condition. Journal of Chronic Fatigue Syndrome, 87.

Rorsman, P. (2009). Insulin Secretion: Function and Therapy Of Pancreatic beta- Cells in diabetes. The British Journal of Diabetes and Vascular Diseases, 183.

Salmon, P., & Phill, G. (2010). Malaise and Fatigue in Diabetes. Journal of the Royal Society of Medicine, 5.

Selley, Z. (2008). New Advancement in Diabetic Management. Journal of Diabetic Nursing, 75.

Sheeetz, M., & Kings, L. (2010). Molecular understanding of hyperglycemia’s adverse effects for diabetic complications. Journal of American Medical Association, 19.

Titler, W. (2008). A Diabetic Self Management Education Program: Creating one that is sustainable. America Journal of Nursing, 31.

Weinger, T. (2010). State of the Science of Diabetic Self Management: Strategies for Nursing. America Journal Of Nursing, 34.

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