NURSING CARE PLAN

 What evidence-based protocols can the nurse utilize for prevention of pressure injuries?       Develop a nursing CARE PLAN for an older adult at risk for pressure injury using wellness and North American Nursing Diagnosis Association (NANDA) diagnoses. Including nursing diagnosis 

Class: NUR3400

Professor: Maikel Y. Portal APRN, FNP-BC

Miami RegionalUniversity

Abstract

Patient care has received much attention in today’s healthcare system. It enhances the treatment plan by involving different health specialistsincaringfor the patient. Interdisciplinary approach involves elements such as leadership, teamwork, patient-centered practice, and through communications. The care providers ensure effective assessment of the condition thus meeting patient’s desires and needs. The team pools their knowledge and expertise together towards the recovery of the patients not just the treatment of the disease. Ideally, effective patient outcomes can be achieved through a collaborative approach to the treatment plan. This reduces readmission rates and avoids duplication of duties during the treatment process. The future of health care delivery depends on how effectively the health providers implement the interdisciplinary approach. In this paper, the interdisciplinary care plan will bedrafted for McKay Johnson, a patient diagnosed with diabetes and heart disease.

Keywords:interdisciplinary, therapy, diabetes, heart disease.

Background Information

Patient Name:?

Age: ?

Sex: ?

Demographics: ?

Condition: (Diabetes and Heart Disease) or any other PMH

Situation: Patient is forgetful and lives alone

Medical History

Johnson was diagnosed with type 2 diabetes in 2013, but he reports he had symptoms one year before the diagnosis. The medical record shows that he had fasting blood glucose records showing values of 118-127 mg/dl, which categorized hiscondition as “borderline diabetes.” In 2016, he was diagnosed with heart problem. Johnson has been controlling diabetes until last year when his family physician referred him to our hospital for special treatment of the disease. His wife reports that her husband began to experience abnormal heartbeats, difficulties in breathing, and high blood pressure. The diagnosis shows that Johnson recorded a pulse of 115 per minute while the systolic blood pressure was 180 mm/Hg. He had bulging neck veins, swelling in the legs, and fluids in the lungs. He had been on glyburide (2.5 g every morning), Gymnema Sylvester, and chromium picolinate to control diabetes. Johnson was also given Angiotensin II receptor blockers and Statins to control heart disease.

Johnson’s physical examination results show a BMI of 33.4 kg/m2, Pulse of 85 bpm, fasting glucose of 164 mg/dl, blood pressure of 160/96 mmHg, JVP of 7 cm H2O, and 20 respirations per minute. He has lung crackles, no retinopathy, swelling legs, non-palpable thyroid, no carotid bruits, and diminishing vibratory sense to the forefoot. He reports regular wheezing and dizziness throughout the day. The lab results presented by the nurse show that Johnson has cholesterol-to-HDL ratio of 4 (normal < 5.0), HDL cholesterol of 46 mg/dl (normal < 40 mg/dl), triglycerides of 180 mg/dl (normal < 155 mg/dl), AIC of 7.5 % (normal 4-6 %), sodium of 137 mg/dl (normal 136-146 mg/dl), potassium of 4.0 mg/dl (3.5-4.3 mg/dl), blood urea nitrogen 34 mg/dl (normal 6.1-30 mg/dl) and Urine microalbumin of 42 mg (normal < 30 mg).

Medical Assessment

Based on Johnson’s medical history, physical examination, and lab tests, it is evident he has uncontrollable type 2 diabetes and heart disease. His hemoglobin level (7.5%) is slightly more than the normal indicators (4-7%). He has a BMI of 32. 4 kg/m2 anditis way above the BMI of a normal person. When an individual exceeds a BMI of 30, he is termed as obese (Pop-Busui et al., 2017). Johnson has elevated urine microalbumin and blood urea nitrogen. These are the indicators of heart problem and diabetes. Swelling legs, lung crackles, and regular wheezing are also thesigns of heart disease.

Care Plan

Johnson presents uncontrollable type 2 diabetes and heart disease, which require a coordinated treatment process from all nurses across the concerned disciplines. The first step of the interdisciplinary team is to select the most pressing health issue and prioritize his medical care in order to formulate an effective treatment plan. The team has to follow the care plan for the two diseases.

Nursing Intervention Rationale

Assess the signs of hyperglycemia A patient who uses insulin to treat type 2 diabetes is at risk of developing hyperglycemia. Signs of hyperglycemia include headache, fatigue, tachycardia, dizziness, and visual changes.

Assess glucose level before and after the meals The glucose level should be between 140 mmHg and 180 mmHg. Non-intensive care patients should be maintained at less than 140 mmHg (American Diabetes Association, 2019).

Monitor patient’s hemoglobin level A level of 4-7% is desirable and shows the progress of the treatment process.

Monitor blood pressure, apical pulse and peripheral pulse Increased blood pressure is a sign of diabetes/heart disease. Low pulse is a sign of decreasing tissue perfusion.

Do not take an axillary temperature Elderly persons have poor peripheral circulation which contributes to the formation of pocket airs in axillary areas (Touhy,Jett, Boscart,& McCleary, 2018). This gives inaccurate results.

Assess feet for temperature, and swellings. Monitor the color of the skin This will help to monitor peripheral perfusion. Pale skin color is an indicator of decreased tissue perfusion.

Assess the pattern of physical activity Regular physical activities assist in lowering the glucose level (Naik, Dave, Stephens,& Davies, 2015). These activities prevent further complications of diabetes and cardiac disease.

Administer basal insulin Adhering to the prescribed medical regimens promotes tissue perfusion. This will keep glucose at a normal level.

Report BP of more than 155 mmHg (systolic) Hypertension is a common conditionfor diabetes and heart disease. Controlling blood pressure can prevent further complications such as stroke and retinopathy.

Monitor urine output as well as urine albumin Urine albumin is a sign of diabetes while urine output shows the control of both diabetes and heart disease.

Encourage Active ROM ROM prevents venous pooling and promotes tissue perfusion.

Encourage bedrest with the head of the bed elevated at 45 degrees This position prevents blood from returning to the heart thus increasing oxygenation and decreasing dyspnea responsible for cardiac attack (American Diabetes Association,2015).

Evaluate patient’s understanding of the medical conditions and treatment plan This reduces medication errors. Non-adherence to the prescribed medication can lead to more complications such as hypoglycemia and stroke.

Administer and monitor medication regimen Proper administration of prescribed diabetic and heart disease medication is important in stabilizing glucose level, hemoglobin level, and blood pressure.

Review the patients current diet and nutritional needs Proper diet helps maintain the normal level of glucose level thus sustain the smooth flow of blood.

Treatment Goal

At the end of the treatment, Johnson should have blood glucose level of less than 180 mmHg, BMI of less than 30.0 kg /m2, Hemoglobin AIC level of less than 7%, blood urea nitrogen less than 30 mg/dl, and Urine microalbumin of less than 30 mg/dl. These results will be an indication of the successful treatment plan.

 

References

American Diabetes Association. (2015). Cardiovascular disease and risk management. Diabetes Care, 38(Suppl. 1), 49-57.Retrieved from https://doi:10.2337/dc15-S011

American Diabetes Association. (2019). Cardiovascular disease and risk management: Standards of medical care in diabetes-2019. Diabetes Care, 42(Suppl. 1), 103–123.Retrieved from https://doi.org/10.2337/dc19S010

Pop-Busui, R., Boulton, A., Feldman, E.,Bril, V.,Freeman, R.,Malik, R. A.… Ziegler, D. (2017). Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care, 40(1) 136-154.Retrieved from https://doi:10.2337/dc16-2042

Naik, V., Dave, R., Stephens, J. W., & Davies, J. S. (2015). Evidence based prevention of type 2 diabetes: Role of lifestyle intervention as compared to pharmacological agents. International Journal of Diabetes and Clinical Research, 2(6). 49-56.Retrieved from https://clinmedjournals.org/articles/ijdcr/international-journal-of-diabetes-and-clinical-research-ijdcr-2-049.pdf

Touhy, T., Jett., K., Boscart, V., & McCleary, L. (2018). Ebersole and Hess' gerontological nursing and healthy aging(5th ed.). New York, NY: Elsevier - Health Sciences Division.