DX: 12 year old diagnosed with diabetes type 1

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DX: 12 year old diagnosed with diabetes type 1

Nursing Perspectives and Disease Management

Holistic Health Perspective

Analyzing the client's social, spiritual, physical needs and identifying necessary resources to facilitate healing. (e.g. IP team involvement, support groups for parents)

Strength Based Care

Involving both parents and patient in care as new information may be overwhelming due to age and knowledge level of pt. (e.g. setting up appointments with dietician so parents can learn healthy meals to prepare at supper for the diabetic child and whole family to enjoy)

Barriers To Health

Mental Health

Newly diagnosed patients especially under the age of 18 identified depression and anxiety as major barriers to health. Difficulty adjusting to their new condition or shame and fear of being bullied were also contributing factors.

Financial Barriers

- Most diabetes type 1 treatment is covered by OHIP with few exceptions: - OHIP coverage is limited to a certain amount of supplies per year (e.g. Only 820$ worth of lancets is covered annually, which is 75% of the annual cost).

Facilitators To Health

Health Literacy

Due to family history patients parents are well versed in treatment and equipment required to manage disease

- Family members: emotional and social support Interprofessional team assistance: - Dietician: identify healthy foods that can increase energy e.g. complex carbs and simple sugars from fruits/vegetables - Psychologist: Providing emotional support in order to cope with a lifelong disease. - Social worker: identify additional resources that would be helpful in disease self-management e.g.: support groups, needle disposal centres, additional inexpensive diabetes equipment resources.

Tanner's Clinical Judgement Model

Reflection on Action

Proper follow up care can be implemented after treatment, this includes: - Mental health and psych evaluation to determine new issues or coping mechanisms that require adjustment - Asking the patient and guardians/family present how the pt. has been self-managing, any concerns related to treatment. - Follow up wound and integumentary assessment

Reflection in action

Patient Monitoring: - Monitor for possible foot care needs, neuropathy is common and therefore pain management is also a clinical skill that should be implemented. - Monitor any wounds as diabetes slows healing process -Reassess patient's mental health prior to discharge Wound assessment: size, shape, drainage, location and edema.

Responding

Health Teachings: - Subcutaneous administration of insulin - how to and when to monitor blood glucose - Identification of S & S’s of hyperglycemia and hypoglycemia - Carry snacks or sugar on their person - Skin breakdown: rotate injection site - Effects of physical activity and stress can alter blood glucose level and insulin requirements. - Vigilance in oral and eye health and receive regular check-ups Treatment: - Due to constant fluctuation of blood glucose levels, treatment would be based on BG readings every 4 hours with the following interventions: - Administering insulin when blood glucose exceeds 8mmol/l - Advising sugary foods/snacks or administering glucagon when blood glucose is below 4mmol/l

Interpreting

Potential cause is genetics, patient-reported father’s side of the family having a history of diabetes type 1 and 2 Tests performed to confirm the diagnosis of diabetes. Urinalysis: This lab diagnostic test can help identify proteins, glucose and ketones found in the urine. These particular molecules are important to identify as they determine the extent of damage caused by the disease. Ketones: For diabetes type 1 patients, patients can metabolize fat in the absence of sugar in order to obtain energy. This is an anaerobic process causing a buildup of lactic acid hence the development of ketoacidosis Urine glucose exceeding 0.8mmol/l identifies a severe state of hyperglycemia Haemoglobin A1C test: This blood test is done to identify how much sugar coats a red blood cell. Higher scores on the A1C blood test indicate need for blood sugar control Electrolyte Imbalance test: Diabetes primarily affects potassium and sodium ions which are responsible for fluid balance.

Noticing

Clinical Presentation: Signs and symptoms that are common: The 3P’s: polyphagia, polyuria and polydipsia Blood glucose levels are often above the expected range of 4-8 mmol/L causing hyperglycemia, however; blood sugar can drop significantly low due to fluctuations causing hypoglycemia. Hypoglycemia S & S’s: fatigue, tiredness, cool and clammy skin, pallor, poor concentration Hyperglycemia S & S’s: dry skin, blurred vision, fruity breath