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Kerry is a 52 year old woman of Aboriginal decent. She was diagnosed with type 2 diabetes at the age of 40.

She is obese with a BMI of 32.5; she has a history of complications which include a prior myocardial infarction a year ago with the introduction of a stent, mild retinopathy and previous foot ulcers.

Kerry has had multiple admissions to a large public hospital for episodes of both hypo and hyperglycaemia due to poor blood glucose control.

Her current admission to an acute medical ward was due to hyperglycaemia. She arrived at emergency feeling nauseous, with a severe headache and confused.

Pathology

BGL reading recorded 27 mmol/litre

HbA1c of 13.1%.

Positive for Ketones in her urinalysis

Her current medication regime was Mixtard 30/70 twice daily.

She was given NovoRapid whilst in emergency and then transferred once she was stable to the acute medical ward for further review.

Kerry has a IV cannula insitu, therefore she is on a fluid balance chart.

Kerry is allowed to mobilise with supervision.

Kerry’s condition is further complicated by several social, financial and physical factors. Her only child whom Kerry gave birth to at 17 was diagnosed with Type 1 diabetes at the age of 6 and died several years ago from a serious metabolic condition related to diabetes.

Kerry does not know if it was DKA or HHS.

She lives alone in a rented flat and has no immediate family close by to assist her, so is usually housebound. Kerry also has a mild learning disability and is stressed, she recently lost her job in a call centre which she states occurred because of workplace bullying. Shortly after losing her job she had a car accident which resulted in the loss of her car because she was not insured.

Kerry’s mild learning disability impacts on her ability to self-care and adhere to a regular medication regime. When she is feeling good she does adhere, however in light of her recent stressors she has not been adhering to her regime.

Furthermore, over the past several weeks she has felt very depressed and said that when she feels sad she no longer bothers with her medications or recording her BGL’s.

Whilst in hospital Kerry was started on NovoRapid 3 times per day prior to meals and Lantus at night before bed.

Kerry has been under the care of the diabetic unit at the hospital for the past four years however her attendance at appointments is very erratic.

She is to be seen by the hospital’s diabetes educator whist in hospital.

14a.  From your clinical placements so far you have been exposed to nursing care plans for day to day activities for your patients, therefore you should be familiar with the following Nursing care plan.

Complete the following daily care plan (initial plan of care column only) from the information in the case study, making sure it reflects Kerry’s complex needs, this would be completed in conjunction with a RN – in this case your marker

Unit Record No: 2345678                                           Surname: Jones                                                   

Given Names: Kerry                                                   D.O.B: 23/5/75                                  _ Sex: F          

 

AFFIX PATIENT IDENTIFICATION LABEL HERE

SIMULATED HOSPITAL NURSING CARE PLAN

Indicator

Initial Plan of Care Outcome & Revised Plan

Date: …………….. Date: ………………..

Specific Nursing Treatments

(Wound care, pathology specimens,

pain assessment, peak flow, spirometry, ECG)

Technical Activities

(O2 therapy, TED stockings, BSL’s

, Height/weight)

IV Therapy

(Site check, dressing, number of lines)

Observations Oxygenation & Circulation

(Temp, pulse, respirations, blood pressure,

O2 sats)

Eliminating

(Urinalysis, IDC, uridome, bowel chart,

continent, incontinent)

Activity and Rest (Independent/assist/supervise,

confined to bed,

sit out of bed, deep breathing/coughing exercises,

type of mobility assistive device)

Pressure Area Care

(Frequency required, aids, air mattress,

frequency of Waterlow)

Hygiene

Bath (Independent / Dependent)

Shower (Independent / Dependent)

Sponge (Independent / Dependent)

Eye / ear / nose / toilets

Nutrition and Fluids

(Diet, assist full/partial,

nasogastric preparation for a procedure,

fluid balance chart)

Discharge Plan / Patient Education

(Expected date of discharge …………………………..

Special Needs

(Info from Patient Assessment Form)

Care Planned By:

Nursing Duties Completed by

AM

PM

ND

14b.  Kerry has now been in hospital for 3 days the focus has switched from initial stabilisation of blood glucose levels to looking at strategies for how Kerry can be supported with adherence to a management plan

Part of the ENs role in conjunction with the interdisciplinary health care team is to collect data that is used to review and modify the care planning process.

You have completed a Nursing care plan as per above (Q14a) now you are to modify this into a management plan. In the table below outline 6 outcomes with interventions you can suggest to the team.

 

NURSING DIAGNOSIS: Risk for unstable blood glucose

levels related to inadequate blood glucose monitoring

and lack of adherence to diabetes management plan

PATIENT GOAL: Maintains a balance of nutrition,

activity and insulin availability that results in stable, normal blood glucose levels

Desired Outcomes Interventions and Rationales Evaluation Statement

Diabetes Self-management Example – Teach patient to use kerry will record her follow recommended diet food diary to record dietary   food intake in the

ntake for at least 2 days. diary for 2 days

1.

2.

3.

4.

5.

6.

14c, All nurses are required to undertake continual professional development; this is often undertaken in the format of in-services in the workplace.

You are a 1st year graduated EN and your Nurse Unit Management has asked you to present a short in-service to your colleagues in regards to evidence-based practice relating to Kerry’s outcomes as noted in the management plan in Q14b 

Therefore to be able to present your in-service you need to choose one outcome (Q14b) and discuss how it is supported by evidence based practice. (You may use a journal article, credible research from an online site or textbook and you must show the reference

SCIENCE
HEALTH SCIENCE
NURSING
HLT 54115

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