This is the first of part of an evolving concept map assignments. Use the template provided below to develop the following sections of the concept map on the disease process of your choice:
- Pathophysiology
- Risks/Diagnostics
- Complications/Actions to prevent Clinical Manifestations
- Assessment
- Nursing Diagnosis
- Goals
- Interventions
Topics to choose from:
- Diabetes Mellitus, type 1 or 2
- Diabetes Insipidus
- Hypothyroidism
- Pancreatitis
- Multiple Sclerosis (MS)
- Chronic obstructive pulmonary disease (COPD)
- Diverticulitis
Essay Answer
Nursing Diagnosis: (2)
Nutritional Imbalance: An imbalance in the nutritional needs of a person occurs when the individual’s metabolic and nutritional demands are not sufficiently met.
Impaired skin integrity: A breach in the continuity of the skin e.g., foot ulcer
Goals: (4) (1 STG and 1 LTG for EACH Nursing Diagnosis
Nutritional Imbalance
Short term goals
Catch-up feed for pediatric who are underweight
Regular eating of a balanced diet and fruits
Long Term Goals
Proper weight gain to age
Impaired skin integrity
Short term goal
Proper wound dressing regularly and maintenance of blood glucose levels
Long term goal
Prevention of further injuries by increasing physical activities, and use of loosely fitted shoes.
Nursing Intervention: (8)
Ensure adequate and appropriate nutrition by providing the required nutrition for normal growth while maintaining the blood glucose at near normal levels;
Prevent skin breakdown. Teach the caregiver and child to inspect the skin daily, and promptly treat even small breaks in the skin and ensure hygiene.
Prevent skin infection.: Signs of infections should be reported and treated
Regulate glucose levels. The child’s blood glucose levels must be monitored to maintain them within normal limits
Provide child and family teaching in the management of hypoglycemia and hyperglycemia.
Encourage a healthy lifestyle by promoting physical activity and a balanced diet.
Educate the client on proper medication management, foot care, and blood glucose monitoring.
Monitor the client’s progress and adjust the care plan accordingly.
Complete Assessment
First -Time Patient
Assessment will include a good history taking for risk factors such as a family history of diabetes, ethnicity, and increased age (>40 years old).
Physical assessment involving calculating the body mass index and possibly a visual inspection for acanthosis nigricans in pediatric patients. Further assessment will include laboratory testing using the random glucose test kit.
For a known diabetic
Physical assessment may involve inspecting the skin for wounds, examining the eyes with an ophthalmoscope to determine retinal damage, and performing microfilament testing to determine the presence of peripheral neuropathy
Diagnostic (3-5 in details):
- Fasting Blood Glucose
A blood sample is taken after an 8-hour overnight fast. Fasting plasma glucose (FPG) level of more than 126 mg/dL (7.0 mm/L) is consistent with the diagnosis.
- Two-Hour Oral Glucose Tolerance Test (OGTT):
In this test, the plasma glucose level is measured before and 2 hours after the ingestion of 75 gm of glucose. DM is diagnosed if the plasma glucose (PG) level in the 2-hour sample is more than 200 mg/dL (11.1 mmol/L).
- Glycated Hemoglobin (Hb) A1C
This test gives an average of blood glucose over the last 2 to 3 months. Patients with a Hb A1C greater than 6.5% (48 mmol/mol) are diagnosed as having DM.
Pathophysiology
Beta-cell dysfunction is a component of T2DM, an insulin-resistance syndrome. Initial compensation involves a rise in insulin release, which keeps blood sugar levels within the usual range. As the illness worsens, beta cells alter, making insulin secretion unable to keep glucose homeostasis in check, leading to hyperglycemia. The majority of T2DM patients are obese or have a greater body fat percentage, which is primarily distributed in the abdominal area. Through numerous inflammatory processes, including increased FFA release and dysregulated adipokines, this adipose tissue itself encourages insulin resistance (Goyal, 2023)
Complications (3) & Actions to prevent (3)
Short term complications
Hypoglycemia
Diabetic ketoacidosis
Long-term complications
Diabetic foot ulcer
Diabetic Nephropathy
Prevention
Lifestyle modifications such as exercise, loss of weight, not smoking and drinking.
Regular check of blood sugar and keeping it within normal range
Adherence to drugs and medications
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