Case Study of Diabetes Mellitus and Community Health Nurse

Case Study of Diabetes Mellitus and Community Health Nurse This paper is going to illustrate a case study, which has been chosen during the two weeks of clinical practicum. It will present the medical history of the patient, focus on current health status and discuss the main responsibilities of community health nurse. H.S is a 74 years old Emirati, female, married and has 3 daughters and 5 sons. She has been referred to health home care setting on 24/2/2011. The patients past medical history included mild intermittent asthma, irritable bowel syndrome, acute gastritis, esophageal reflux, acquired hypothyroidism, generalized anxiety disorder, essential hypertension, diabetes mellitus type-1, chronic diastolic failure, blurred vision and impaired hearing. The patient has allergies from dust and medication like penicillin. Her surgical history was significant for cholecystectomy. Also, she had grafting surgery that done to repair the wound at right forearm which resulted from road traffic accident. Current medications include montelukast (singulair); 10mg orally once daily, steroids 500mg orally once per day, insulin 34 units in the morning and 32 units on evening, and cozaar 50mg once daily. Currently, the patient is suffering from uncontrolled diabetes. The fasting blood glucose ranged from 239-455 mg/dl and the past prandial glucose and bed time glucose ranged from 240-598 mg/dl. This assignment will shed light on one of the chronic disease which the patient has, diabetes, including pathophysiology, sign and symptoms, risk factors, epidemiology, diagnosis and treatment. In addition, it will illustrate the community health nurse roles regarding diabetic patient. Diabetes mellitus is a worldwide epidemic disease. It is a metabolic disorder manifested by elevation of blood glucose level due to an absolute shortage of insulin production and action (American Diabetes Association, 2004). The two main classification of diabetes are type 1, this type represents insulin dependent diabetes, and type 2, non-insulin dependent diabetes (Meetoo Allen, 2010). Additional types of diabetes mellitus include gestational diabetes, maturity once diabetes of the young, diabetes resulted from cystic fibrosis, and cushings syndrome diabetes (Meetoo Allen, 2010). As our patient is suffering from diabetes type-1, the nurse must understand the pathophysiology of this type in order to provide optimal care. Type-1 diabetes is found to be a result of an autoimmune mediated damaging of B-cells, pancreatic cells responsible for insulin production. Destruction of these cells will lead to insulin deficiency, which will result in increase of blood glucose and glycosuria. Mainly it is symptomatic disorder unlike type-2 diabetes (Meetoo Allen, 2010). Type-2 diabetes is considered silent killer; most people with such disease are unaware because it is asymptomatic in many cases. It is characterized by abnormal insulin production, insulin resistance, and alteration in glucagon synthesis (Casey, 2011). Elevation in blood glucose caused by limitation of insulin in transporting glucose into the cells for energy synthesis. High glucose level enhances insulin production. So that, people with this type of diabetes often characterized by excessive insulin product ion (Casey, 2010). Diabetes symptoms might slightly vary according to the type. Hyperglycemia manifested by a number of symptoms such as polyuria, polydipsia, weight loss, in some cases associated with polyghagia; feeling hungry as a result of cellular starvation, and blurred vision. Polyuria occurs when the amount of glucose filtration by the kidney overwhelms reabsorption mechanism (American Diabetes Association, 2004). Fatigue may be presented due to metabolic changes (Casey, 2011). These symptoms could not be severe in type-2 diabetes as much as type-1 (Casey, 2011). Uncontrolled diabetes like in H.S case might lead to unpleasant consequences. These complications include retinopathy with loss of vision, nephropathy; which results in renal failure, peripheral nephropathy with high risk of foot ulcer and cardiovascular symptoms (American Diabetes Association, 2004). There are many risk factors that lead to hyperglycemia. Some of these factors are non-modifiable such as heredity and race factors. Other modifiable factors include obesity, lack of exercise, impaired glucose tolerance, cardiovascular disorder, and high level of triglycerides (Rodbard et al, 2007). Diabetes mellitus accounts for high epidemic percentage throughout the world. The total number of people with diabetes was significantly increased from 124 million in 1997 to 221 million in 2010 (Meetoo Allen, 2010). From a global thought, the highest three countries estimated to have the highest number of people with diabetes in 2000 and 2030 are India, China, and the United State of America. The most affected groups are people between 45-64 years old (Meetoo Allen, 2010). The risk of death for people with diabetes mellitus is twice that among individuals without diabetes of similar age (Rodbard et al, 2007). If patient diagnosed before age 40 years, the average reduction in life expectancy is 12 years for men and 19 years for women (Rodbard et al, 2007). There are a number of diagnostic procedures that have been used to determine the blood glucose level. These strategies include observation the symptoms of diabetes such as polyuria, polydipsia, and weight loss (Rodbard et al, 2007). In addition, diabetic patient could be identified with fasting plasma glucose concentration more than or equal 126mg/dl or plasma glucose concentration more than or equal 200 mg/dl in normal status. These measurements taken by using a 75-g oral glucose tolerance test (Rodbard et al, 2007). Applying appropriate intervention for patient with chronic disease like diabetes is an essential strategy to prevent any complications that might result from unstable condition (Pimouguet, Goff, Thiebaut, Dartigues Halmer, 2011). The aims of diabetes treatment are to control blood glucose level to reduce the risk of long term complications and to help the patient with diabetes to live normal healthy life (Meetoo Allen, 2010). The choice of treatment depends on the type of diabetes. For instance, patient with type 1 and some cases with type 2, insulin is an appropriate treatment in maintaining nearly normal level of blood glucose (Meetoo Allen, 2010). Unlike type-2 diabetes, in which management processes are based mainly on life style modifications. For example, regular food intake, regular exercise, weight management and limited alcohol intake. Also, oral anti-diabetic agents are used to maintain normal level of blood glucose and to enhance the action of pancreatic cells (Meetoo Allen, 2010). Furthermore, one of the most effective methods which are essential for patients with type-2 diabetes or for people who are at high risk is regular monitoring of blood glucose level .This method helps to prevent acquiring diabetes for people who are at increased risk of hyperglycemia or for those who have poor glycemic control (Grant, 2010). The role of the nurse in delivering community health care is considered an essential part in managing patients condition at home sitting. As nurses working in community care, a number of responsibilities are involved in care of patient with diabetes including assessment and providing optimal intervention (Carey Courtenay, 2008). The nurse is considered the only professional who has a complete knowledge about patients medical status (OReilly, 2005). Effective assessment will enable the nurse to create appropriate plan regarding patients condition and provide best care (World Health Organization, 2001). For optimal care, the community nurse should has enough knowledge regarding patients health disorder include functional limitations, patients medical history, prognosis, physical assessment for all body systems and behavioral status (OReilly, 2005). In addition, it is important to assess other factors that could affect patients health such as safety of living environment, types of dail y living activities, medication awareness and compliance, equipment availability such as oxygen, intravenous therapy, and parenteral nutrition (Smeltzer, Bare, Hinkle Cheever, 2008). For diabetic patient, the nurse is responsible to assess specific factors that might interfere with glycemic control. One of these factors is age- related changes such as physiological functions. For instance, loss of taste and olfactory functions may lead to malnutrition intake. So, that will lead to abnormal metabolism and blood glucose maintenance (OReilly, 2005). Dehydration is also one of the complication that might occur due to loss of thirst perception which affected by age factor. The nurse must evaluate the condition carefully in order to meet the needs (OReilly, 2005). Also, the nurse must assess for the presence of neuropathies, because it increase the risk of fall and infection (Smeltzer, Bare, Hinkle Cheever, 2008). Furthermore, visual deficits and retinopathy must be assessed because the patient may be at risk of taking medication inaccurately and become unable to perform regular blood glucose test (OReilly, 2005). The nurse should ensure that the patient is aware about all medications and being compliance with. Also, identification and investigation of any complications are very crucial to protect the patient from life threatening condition (Diabetes Specialist Nurses, 2007). If the patient has diabetic foot, the nurse should assess the wound, regular dressing must be done and monitor for any further complications (Smeltzer, Bare, Hinkle Cheever, 2008). Moreover, accurate documentation is necessary to ensure patients need correctly (OReilly, 2005). Diabetes mellitus requires regular self care behaviors. Nurse is responsible to teach the patient about appropriate self management (Smeltzer, Bare, Hinkle Cheever, 2008). Physical and emotional stress could affect glycemic control negatively, so patients must learn how to balance among such factors. They should learn daily self care skills to prevent instability of blood glucose. In addition, patients must be aware about good nutrition by following a calorie- controlled diet (Smeltzer, Bare, Hinkle Cheever, 2008). They should know that they might need additional meals and snacks during various exercises or at bedtime to prevent hypoglycemia. Also, patients must have knowledge regarding medications side effects and disease progression. Patients and family members should be taught about the symptoms of both hyperglycemia and hypoglycemia in order to be able to provide a required care (Smeltzer, Bare, Hinkle Cheever, 2008). In conclusion, this essay has discussed a case study that has been chosen during the clinical practicum time. Mainly, it focused on one of current health problem in which the patient is suffering from, diabetes mellitus. It discussed the pathophysiology of the two types of diabetes, type-1 and type-2. Diabetes is characterized by a number of symptoms such as polyuria, polydipsia, weight loss, and polyghagia. There are many risk factors might cause diabetes such as obesity and sedentary life style. This paper has also presented statistical information regarding diabetes disorder throughout the world, it found that India is the highest country that account for the highest number of people with diabetes. Moreover, there are various diagnostic methods that are used to identify and investigate patients with diabetes or who are at high risk. Treatment strategies are varying with different types of diabetes. Type-1 is insulin dependent diabetes while type-2 is non-insulin dependent. Diabete s mellitus is considered a chronic disease that required regular appropriate care at home sitting. Community health nurse has a number of responsibilities regarding diabetic patients care include effective assessment and providing teaching plan that help the patient to maintain controlled blood sugar level. Finally, diabetic patients should be aware about daily self care.

Essay on Facing the Consequences in King Lear -- King Lear essays

King Lear:   Facing the Consequences      Ã‚  Ã‚  Ã‚   Shakespeare's tragedy King Lear is a detailed description of the consequences of one man's decisions.   This fictitious man is Lear, King of England, whose decisions greatly alter his life and the lives of those around him.   As Lear bears the status of King, he is, as one expects, a man of great power.   But, sinfully, he surrenders all of this power to two of his daughters, as a reward for their demonstration of love towards him.   This untimely abdication of his throne results in a chain reaction of events that sends him on a journey toward Hell, in order to expiate his sin.   Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   As the play opens one can almost immediately see that Lear begins to make mistakes that will eventually result in his downfall.   The very first words that Lear speaks in the play are:    Give me the map there. Know that we have divided/ In three our kingdom, and 'tis our fast intent/ To shake all cares and business from our age, / Conferring them on younger strengths while we/ Unburdened crawl to death. (I.i.38-41)       This gives the reader the first indication of Lear's intent to abdicate his throne.   He goes on further to offer parcels of his kingdom to his daughters as a form of reward for passing his test of their love:    Great rivals in our youngest daughter's love, / Long in our court have made their amorous sojourn, / And here are to be answered. Tell me, my daughters/ (Since now we will divest us both of rule, / Interest of territory, cares of state), / Which of you shall we say doth love us most? / That we our largest bounty may extend/ where nature doth with merit challenge. (I.i.47-53)   Ã‚  Ã‚      The most signif... ...      Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     All of this suffering that Lear endures can be traced back to the single most important error that he made, the decision to give up his throne.   This sin has proven to have massive repercussions upon the life of Lear and the lives of those around him, eventually leading to the deaths of almost all who were directly involved with his abdication.   After following Lear’s demise which was brought on by a single wrong turn, one cannot help but wonder what difficult corners lie ahead that may cause similar alterations in one’s own life.    Works Cited    Bloom, Harold.   Shakespeare: The Invention of the Human.   New York:   Penguin Putnam, 1998.    Boyce, Charles.   Shakespeare A to Z.   New York:   Roundtable Press, 1990.      Shakespeare, William.   King Lear.   Eric A. McCann, ed. Harcourt Brace Jovanovick.            

“Ishmael” by Daniel Quinn Essay

In the book Ishmael, Daniel Quinn argues claims about our culture and beliefs through Ishmael, the gorilla. He somewhat effectively argues his claim, I say somewhat because he doesn’t adequately use all three parts of an argument: ethos, pathos and logos. Quinn’s intended audience is very clearly every Taker/human that is living everyday without really realizing the destruction of the environment and society around them. His rhetorical purpose is to show these people what they’re doing wrong and not necessarily tell them how to fix it, but telling them how they should inform everyone and essentially start a revolution. He does this because the world is very quickly being destroyed by humans because of our lack of energy to do something about it. Quinn puts into perspective how the world is slowly being ruined through the character of Ishmael. The reason I don’t think Quinn’s argument was extremely effective is because he didn’t use very much ethos. In the beginning he used Ishmael’s captivity in the zoo then the menagerie to give Ishmael some credibility with being able to observe humans from the outside of our world. Ishmael also taught himself how to understand humans which gives him some credibility as being very smart. Quinn does mention a few books Ishmael read to further his knowledge about humans, one being the Bible, but that is about all the ethos he uses. He doesn’t use any ethos while arguing throughout the book to back up his claims which is where I see most of his faults. Daniel Quinn mostly uses logos to support his claims throughout the book. On almost every page there was logical evidence to back up his claim he was currently making. He did this a lot through stories he told that put many things we see every day in a different perspective hence making us think about it in a very different way. For example, my favorite story was the one about the creation of man and he ends with â€Å"then man appeared† (Quinn 53). Ishmael says the same thing with â€Å"finally jellyfish appeared† (Quinn 56). He did this to show that creation did not end with man like we previously thought. Throughout the book Quinn uses very few examples of pathos. He mostly tells stories that made me feel guilty, for example on page 80 he discusses how we’ve â€Å"poured our poisons into the world† (Quinn 80) and he goes on to say there is almost no way for the world to recover because we’ve damaged it so much. This makes me feel very guilty and angry to the CEO’s and people that have come before me because they haven’t done anything to stop it. There have been people to try but no one has ever stopped drilling for oil and driving giant semi-trucks that are destroying the earth. Quinn doesn’t use pathos often, but the few times he did it was very effectively used. Daniel Quinn presents Ishmaels arguments in a very philosophical style and it feels as though the student, who is never named in the story is the reader. I could really see myself as the student, when he was confused I was often confused as well and I think that is why Quinn never gave him a name because it made it easier to put yourself in that position since we are essentially learning as the student is. I think Quinn’s argument needed more pathos and ethos to be truly effective. He uses mostly logos which is very effective for this type of argument, but there is not much emotion or credibility to back up the logical statements he is making. At times I was angry at society and humans in general because of the destruction and I think if there was more of that pathos it would have been much more effective of an argument for me.

Communicable Diseases And Its Effects - 962 Words

Over the years, communicable diseases have created a host of serious problems. These diseases cause physical, emotional, and even financial problems in our societies today. A communicable disease refers to a sickness that passed through the transmission of infectious illnesses. People, food, animals or water can pass many infections from humans to humans or animals to humans. Humans can pass infectious diseases to each other from touching or exchanging body fluids. In 1981, the human immunodeficiency virus (HIV) marked the official start of the HIV epidemic which became one of the world’s most deadly communicable diseases (Kaiser Family Foundation, 2015). The widespread of the human immunodeficiency virus has affected approximately 1.2†¦show more content†¦Other efforts to help control HIV is to practice safe sex by using condoms, reducing sexual partners, getting tested and checking for other sexual transmitted diseases, never share needles with anyone or use equipme nt that is not sterile. Minimize the amount of alcohol and drugs as it tends to impair the ability to think clearly. â€Å"As a part of its overall public health mission, CDC provides leadership in helping control the HIV/AIDS epidemic by working with the community, state, national, and international partners in surveillance, research, and prevention and evaluation activities† (CDC, 2015, para 1). Environmental Factors The environmental factors contribute to the outbreak of HIV. Culture and poverty appear to play an essential role. The environment in which one lives can determine the education and exposure to the HIV/AIDS virus (Alfsen, 2004). Also, demographics such as age, income, and education, and gender are also crucial in identifying HIV outbreaks. Lifestyles, Socioeconomic Status, and Disease Management The lifestyle has the greatest influence on the management of HIV/AIDS. HIV/AIDS primarily transmitted through sexual intercourse. The majority of HIV infections acquired through unprotected sexual relations where one partner has HIV (CDC, 2015). The disease management depends on the severity of the virus and what treatments are necessary. Education, household income, and education level are elements of socioeconomic status.