Coversheet and Feedback
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CODE HLTENN025 UNIT TITLE Implement and monitor care for a person with diabetes
Qualification Code HLT54115 Qualification Title Diploma of Nursing
Name 1. Case study with Short answer questions.
Student ID Number 5886478 Student Name Samjhana magar
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Signed samjhana Date
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1. Case Study and Short Answer Questions One week after delivery of refresher unit, on Sunday 2400.*Trainer to confirm exact date ? Learner will be emailed this assessment booklet. It must be downloaded, completed and emailed back to the trainer in word document form *Trainer to confirm submission method, alternative is for download and upload through Axcelerate.
? Learner must respond to ALL questions in the case study
? All answers must utilize in text citations and a reference list
If you disagree with the task result, you have the right to appeal the decision. Please refer to the student grievance policy found on the UOW College website.
HLTENN025 – Implement and monitor care for a person with diabetes
TASK 1 – Case study and Short Answer Questions
Due Date: Sunday 2400, One (1) weeks after completion of unit.
Word Count: Answers can be brief but must included all required information. Unless specified answers should be composed in full sentences with a logical progression of ideas.
Submission Method: Student Assessment booked
References: Harvard format, including in text citation and reference list.
Your answers do not need to be over lengthy, but do need to provide sufficient information and detail to demonstrate that your knowledge and ability is consistent with the following criteria:
• theoretical and practical knowledge and skills for specialised and/or skilled work and/or further learning
• broad factual, technical and some theoretical knowledge of a specific area or a broad field of work and learning
• broad range of cognitive, technical and communication skills to select and apply a range of methods, tools, materials and information to complete routine and non-routine activities
• knowledge and skills to demonstrate autonomy, judgement and limited responsibility in known or changing contexts and within established parameters
Your answers should reflect your learning in class and utilise the resources recommended by your trainer.
You may be required to provide examples, strategies, methods or give your opinion which may come from your nursing work, nursing training or other professional experiences.
You should be providing sufficient detail to demonstrate your underpinning knowledge, understanding, and also provide any additional information or knowledge which supports your recommendations.
Bob is a retired 69-year-old man with a 5-year history of type 2 diabetes. Although he was diagnosed in 1997, he had symptoms indicating hyperglycemia for 2 years before diagnosis. He had fasting blood glucose records indicating values of 6.1 – 7.8mmol/L, which were described to him as indicative of “borderline diabetes.” He also remembered past episodes of nocturia associated with large pasta meals and Italian pastries. At the time of initial diagnosis, he was advised to lose weight (“at least 10 kg”), but no further action was taken.
Referred by his general practitioner to the diabetes specialty clinic, Bob presents with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on glyburide Metformin, 500 mg/dayevery morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon.
Bob also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia (elevated LDL cholesterol, low HDL cholesterol, and elevated triglycerides). He has tolerated this medication and adheres to the daily schedule. During the past 6 months, he has also taken a “pancreas elixir” in an attempt to improve his diabetes control. He stopped these supplements when he did not see any positive results.
He does not test his blood glucose levels at home and expresses doubt that this procedure would help him improve his diabetes control. “What would knowing the numbers do for me?,” he asks. “The doctor already knows the sugars are high.”
Bob states that he has “never been sick a day in my life.” He recently sold his business and has become very active in a variety of volunteer organizations. He lives with his wife of 48 years and has two married children. Although both his mother and father had type 2 diabetes, Bob has limited knowledge regarding diabetes self-care management and states that he does not understand why he has diabetes since he never eats sugar. In the past, his wife has encouraged him to treat his diabetes with herbal remedies and weight-loss supplements, and she frequently scans the Internet for the latest diabetes remedies.
During the past year, Bob has gained 30kg. Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 3kg. He has never seen a dietitian and has not been instructed in self-monitoring of blood glucose (SMBG).
Bob’s diet history reveals excessive carbohydrate intake in the form of bread and pasta. His normal dinners consist of 2 cups of cooked pasta with homemade sauce and three to four slices of Italian bread. During the day, he often has “a slice or two” of bread with butter or olive oil. He also eats eight to ten pieces of fresh fruit per day at meals and as snacks. He prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by pasta. His wife has offered to make him plain grilled meats, but he finds them “tasteless.” He drinks 8 oz. of red wine with dinner each evening. He stopped smoking more than 10 years ago, he reports, “when the cost of cigarettes topped a buck-fifty.”
The medical documents that Bob brings to this appointment indicate that his hemoglobin A1c(A1C) has never been 8%. His blood pressure has been measured at 150/70, 148/92, and 166/88 mmHg on separate occasions during the past year at his general practice clinic. Although he was told that his blood pressure was “up a little,” he was not aware of the need to keep his blood pressure =130/80 mmHg for both cardiovascular and renal health.
Bob has never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunisations are up to date, and, in general, he has been remarkably healthy for many years.
A physical examination reveals the following:
• Weight: 130kg height: 170cm body mass index (BMI): 32.6 kg/m2
• Blood pressure: Sitting, right arm 154/96 mmHg;
• Pulse: 88 bpm; respirations 20 per minute
• Eyes: corrective lenses, pupils equal and reactive to light
• Heart: Rate and rhythm regular, no murmurs or gallops
• Vascular assessment: femoral, popliteal, and dorsalis pedis pulses 2+ bilaterally
• Neurological assessment: diminished vibratory sense to the forefoot, absent ankle reflexes, monofilament (5.07 Semmes-Weinstein) felt only above the ankle
Results of laboratory tests (drawn 5 days before the office visit) are as follows:
• Glucose (fasting): 8.9 mmol/L
• Creatinine: 1.0 mg/dl (normal range: 0.5–1.4 mg/dl)
• Blood urea nitrogen: 18 mg/dl (normal range: 7–30 mg/dl)
• Sodium: 141 mg/dl (normal range: 135–146 mg/dl)
• Potassium: 4.3 mg/dl (normal range: 3.5–5.3 mg/dl)
• Lipid panel
• Total cholesterol: 5.3 mmol/L
• LDL cholesterol (calculated): 1.8 mmol/L
• HDL cholesterol: 1.5mmol/L
• HbA1C: 8.1% (normal: 4–6%)
• Urine microalbumin: 45 mg (normal: 30 mg)
Section 1. Identify diabetes care services in the Australian health care environment
1.1. Describe and briefly discuss three (3) diabetes care services available in New South Wales. Your answer must include information on funding of the service.
2.Diabetes NSW AND ACT Australia
1.2 Describe and briefly discuss three (3) members of the interdisciplinary team who provide specialist or complementary care to the person with diabetes (ie. In addition to medical and nursing staff). Your answer must include a description of the role of organization or provider.
1.deitician or nurse / pharmacist/ podiatrist
1.3 Describe and briefly discuss two (2) agencies or community organisations where you could refer Bob. Discuss how he could benefit from that referral.
1.comunity health center .
Section 2. Assess the needs of person with diabetes
2.1 Briefly explain the pathophysiology of diabetes. Your answer must include the key difference between Type 1 and Type 2 diabetes mellitus.
2.2 Based on the case study complete a holistic nursing assessment of Bob. Your answer needs to review his history, current results and observations and treatment regime. List and briefly describe six (6) issues that will need to be addressed when planning care for Bob.
4.nutritional assessment for diet plan
5.neuro vascular care for foot
6.physio assessment advising for regular check up 6
2.3 Discuss Bob’s current understanding of his condition, self-management strategies and medications. Your answer must include the strategies and assessments you would use to determine Bob’s level of knowledge.
- open eneded question: background adls,
a-h assessment blood pressure
Mediation review. Not taking his medication, metformin and lipto
2.5 1. How would you assess Bob’s wife’s understanding of diabetes? 2. How does her level of understanding impact Bob’s diabetes management? 3. How could you involve her in the care planning for Bob?
1. Knowledge and understanding
2. she is the carer of the bob,
3. we can ask open ended question to her wife abd assess her she got the understanding
Contribure in regrads to nutritional , medication on time.
Section 3. Perform complex nursing intervention to assist a person to achieve and maintain optimal diabetes health
3.1 1 a. List in order of priority Bob’s three (3) most important nursing care needs and then discuss why you prioritised these issues in this order.
Htn affect cardiac and renal
Foot care -reflexion, injuries,
Health ducation for diabetes , diet, self management
1.monitir bld sugar
3. remonitored after 30 ,min and record
Rationale for Prioritisation:
At 3pm Bob is returning from the toilet. You note he is unsteady on his feet. He looks pale and sweaty and complains of having a headache and feeling dizzy. He tells you he is trying a new diet where you fast intermittently and he hasn’t in fact eaten anything since 6pm the previous day. You take his blood glucose level and it is 3.4mmolL His urinalysis shows SG 1035, +++glucose, +ketones.
3.1.1.b How does this new information impact how you would prioritise Bob’s nursing care?
Fluid, obesravation related to bgl
2.4 Explain in relation to your knowledge to diabetes, the likely cause of Bob’s signs and symptoms.
Starvation = dehydration= glucose krtonr hypo
3.4 Describe your clinical actions in response to Bob’s signs and symptoms.
I will do monitor blood sugars and give him something to eat likelollies to raise his blood sugars, fluid hydration
3.5 1. Evaluate and interpret Bob’s blood and urine test results. Briefly discuss the findings.
2. Using the ISBAR model communicate findings to the interdisciplinary health care team.
3.6 Your interventions are effective. Describe how you would continue to liase with the registered nurse while providing ongoing support for Bob.
Section 4. Evaluate the care plan for a person with diabetes, and support a person’s self-management.
3.2 Using the template below develop a care plan for the management of Bob’s diabetes for the next six months. Your answer must include four (4) Nursing diagnoses and both short term and long term goals for Bob. It also must include interventions that support self management of diabetes.
Nursing Diagnosis Goals Interventions
2.education on diabetes
3.3. Discuss how would you assess Bob and his wife’s understanding of his new care plan, particularly relating to his new self-management strategies?
Open- ended question
6 Months later Bob returns to the clinical and you are asked to review his diabetes management. He has lost 7kg. His BP is 120/80, PR 70, RR 18. He demonstrates independently taking his blood sugar level and his random BSL is 6.7mmol/L. You review his BSL readings and find that he has had readings of 3-4 2 or times a week. He has been compliant with his medication telling you he takes it first thing of a morning, before his morning walk and before breakfast so that he never forgets. Bob tells you his wife is still very support and no longer makes him take the supplements. He does state that she insists he eats 3 pieces of fruit every day to support his vitamin intake.
Bob asks you if you know of any good support groups for people with diabetes and somewhere so he can -go exercise with people my own age-
4.1 Review Bob's care plan. Suggest a modification according to the person s progress toward planned outcomes in and who you would consultation and collaboration with from the interdisciplinary health care team.
Consult local gp in regards to medication for further education to medication
Refer back to dietician to review their plans for the updates
Send to diabetic educator f he wills for review or follow up of the plans.
4.2 Compare your nursing interventions and their outcomes against evidence-based best practice in diabetes nursing care. Briefly discuss any commonalities or differences.
4.3 Identify and discuss two (2) opportunities for Bob and his wife and provide information on available community resources and how to access them.
2.community nurses/ community health care center
4.4 From the information in the case study discuss whether you feel Bob's understanding of his condition, medications, regimes and self - management has improved. Your answer must include the strategies can you utilise to check his understanding.
- re-evaluating ,
Bob has zero knowledge first
Nursing care plan
Check his weight
4.5 Discuss how would you help and support Bob in providing correct information to his wife.
4.6 Write a brief progress note relating to Bob's uptake by the person of specific health promotion initiatives to support hi self-management. Your answer must include: Weight/BMI, exercise, diet, self- monitoring, compliance with treatment regime.
Bob is demonstrating his weight and maintaining and looks healthy
Knows how to check BSL and checking 3 times a day
Taking medicine at the correct time
Working on regular exercises
Wife knows how to cook the diabetic food and they are happy with each others.
Brown, D., Edwards, H. 2014 Lewis’s medical-surgical nursing: assessment and management of clinical problems, Chapter 48: Nursing Management of Diabetes, Elseveir, Chatswood.
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