Person-Centered Education On Medication And Diabetes Management

The Goal Is To Provide Professional Focused Information On A Medication

Consider the patient situation

Jarrah Barrett is newly diagnosed with type 1 diabetes. Jarrah is 19 years old, weighs 70 kg (non-obese) and has always been very active in team sports. He is of Aboriginal descent and lives with his father in Cherbourg. He usually plays football at weekends. Over the last month, Jarrah has been constantly thirsty and often hungry. He has been passing urine frequently and having to get up to the toilet in the night. His father became concerned when he noticed that Jarrah has lost interest in sports because he was complaining of headaches and felt tired all the time.

Jarrah is an inpatient in Cherbourg Hospital. He has been reviewed by an endocrinologist and is prescribed a ‘basal-bolus’ regime of insulin aspart (Novorapid) before each meal, and insulin glargine (Optisulin) before bedtime (both types in cartridge form)Person-Centered Education On Medication And Diabetes Management.

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Collect cues/information

  1. As a nursing student, your clinical facilitator has allocated you to care for Jarrah. After the morning handover, you are asked to explain the pathophysiology of type 1 diabetes to the clinical facilitator. What is your response?
  2. Your clinical facilitator tells you that Jarrah would rather not have multiple daily injections. He wants to know why he cannot just have tablets to manage his type 1 diabetes like his friend who has type 2 diabetes. What is your response?

Responses:

  1. Type 1 Diabetes is considered to be one of the chronic autoimmune disorders where the beta cell destruction is evident and thereby reducing the ability of the pancreas to produce adequate amounts of insulin hormone in order to maintain the metabolism. Type 1 Diabetes mellitus occurs due to lymphocytic infiltration along with the destruction of insulin secreting cells in the pancreas while lowering the cell mass and increasing the unavailability of insulin hormone in the body which is required to maintain normal blood sugar level. The condition develops in three stages, such as in stage 1 asymptomatic sign which is characterized by normal glucose tolerance and presence of greater than 2 pancreatic autoantibodies is observed. In stage 2, more than 2 pancreatic autoantibodies were observed along with impaired fasting glucose level or glucose tolerance. In stage 3, the hyperglycemia is observed with more pancreatic autoantibodies present. Hence, it is the responsibility of the nurses to provide the nurses to provide proper education to the patient which can be done by various charts and videos (Wherrett et al., 2018).
  2. The type 1 diabetes patient faces the issue of hyperglycaemia and there is an increased risk of hypoglycaemia and hence, in order to avoid such sudden changes and lowering complication it is essential to take insulin for stablishing the level of glucose in the body. Another reason includes, insulin cannot be consumed orally die to the ability of the stomach to break the enzymes and preventing its action. Hence, it is recommended to take injections through insulin pumps or injections (Chiang et al., 2018)Person-Centered Education On Medication And Diabetes Management.

Process information

Jarrah is disappointed that he has to administer two different types of insulin. Your clinical facilitator asks if you can explain to her how Jarrah’s prescribed regime works to achieve glycaemic control.

  1. Explain the ‘time-course’ of formulations of NovoRapid and Optisulin.
  2. Explain the principles underpinning a ‘basal-bolus’ regime of insulin (see Bryant & Knights, 2019, p. 682 – 683).
  3. Explain the mechanism of the action of NovoRapid and Optisulin in attaining glycaemic control.

Responses:

  1. The time course of Novorapid is should be close to the meal time as it will should be consumed to the meal and the meal time must be 5 to 10 minutes after injection due to its fast action. The drug must be consumed by the patient before meal in order to lower the chance of developing hyperglycaemia or hypoglycaemia. The action of the drug will start after 10 to 20 minutes after consumption. The drug reaches maximum level after 1 to 3 hours. The drug optisulin is a type of long-acting insulin and it is consumed once in a day. It can be consumed at any time during day. The formulation of novorapid include 1 vital contains 10ml which is equivalent to 1000 units. Hence, in 1 ml solution 100 unit of insulin is present (Amini et al., 2019).
  2. The basal bolus routine is a long-acting drug which helps in keeping the blood glucose level within the normal range for a longer period of time and it also consist of shorter acting insulin for preventing the advanced rise of blood glucose level. The drug works by consuming slow-acting insulin in order to moderate the blood glucose level during fasting and the short-acting glucose helps in reducing the impact of dietary glucose in the body. The primary aim of this insulin is to keep the blood glucose level stable within the period of fasting. The drug is injected once in every day and the drug provides flexibility with the routine and timing of meals for lowering the incidence of hyopglycemia and hyperglycemia.
  3. The drug Novorapid works by lowering the blood sugar level after the injection as it has a faster onset upon the action of the soluble insulin. The drug takes within 10 to 20minutes after consumption. The insulin acts by binding with the glycoprotein receptor present upon the surface of cells. The receptor consists of alpha-submit which is found to bind with the hormone including the sub-unit known as the tyrosine-specific protein kinase. The drug optisulin helps in lowering the glucose level by stimulating the peripheral glucose uptake and inhibiting the hepatic glucose production. The drug also helps in inhibiting the proteolysis and lipolysis (Slattery et al., 2018)Person-Centered Education On Medication And Diabetes Management.

Identify problems/issues

You are on a night shift and Jarrah rings his bell at 0200hrs and states he feels unwell. You take his blood glucose level (BGL) and find it to be 3.0mmol/L. This is the second consecutive night this has happened.

  1. What are the registered nurse’s responsibilities relating to the Nursing and Midwifery Board of Australia (NMBA) Registered Nurse Standards for Practice in providing safe care to Jarrah? Identify one standard and apply it to your responsibility in this situation.
  2. Identify two possible causes of his hypoglycaemia.

Take action

  1. What are the appropriate nursing actions after taking Jarrah’s BGL? Give a rationale for the nursing actions.
  2. If Jarrah appears to have altered consciousness, explain the nursing actions you would take and provide a rationale.

Responses:

  1. It is the responsibility of the nurses to implement proper care for the patient in improving the quality of care. It can be stated that According to NMBA standard 5, it is the responsibility of the nurses to provide the patient with proper care by effective planning. The sub-standard 5.1, needs to be addressed in this case which implies that it is the responsibility of the nurses to use the assessment data in order to implement best evidence-based practice within the healthcare. The nurse in this case must also adhere to the sub-standard 5.5, which aims at coordinating the available resources efficiently and effectively in order to implement proper care plan (NMBA, 2022)Person-Centered Education On Medication And Diabetes Management.
  2. The two most possible cause of hypoglycaemia includes- consuming too much of insulin and lack of proper diet or skipping meal. It is also stated that the patient’s develops this condition due to change in the schedule of drug consumption. The condition develops due to sympathetic activation and brain dysfunction which decreases glucose level. It is also stated that the condition impacts the stimulation of the sympathoadrenal nervous such as sweating, anxiety, palpitations and hunger. This results in the reduction of the plasma glucose concentration by arising the abnormalities in the homeostasis of glucose (Mathew et al., 2021).
  3. The nurse in this case must provide the patient with IV dextrose which will help in preventing the chance of developing severe hypoglycaemia and even coma. The nurse must provide proper meal to the patient such as 15gm to 20grams of fast-acting carbohydrate which will help in rising the glucose level. The nurse in this case must also provide the patient with glucagon in order to treat the patient with hypoglycaemia as the patient was treated with insulin. The intervention helps in releasing the stored glucose in the bloodstream (Farina & Anderson, 2018).
  4. The nurse in this case must provide the patient with proper support such as elevating the head of the bed by 30 degree which will help in preventing aspiration. The patient must be provided with IV fluids which will help in meeting the fluid need and it will lower the intercranial pressure (Cruz et al., 2017)Person-Centered Education On Medication And Diabetes Management.

Integrate the ACQHS Quality Use of Medicines principles into any of your responses below

Jarrah and his father require information and education about diabetes and medication management before discharge. Standard 3.2 of the NMBA Registered Nurse Standards for Practice requires nurses to ‘provide the information and education required to enhance people’s control over health’ (2016, p. 4).

Criterion 4: Application of social justice principles and the Quality Use of Medicines when describing mechanisms of action, adverse effects, benefits, risks and management of pharmacotherapy using person-centred approaches

Take time to educate

  1. Jarrah is struggling to come to terms with his type 1 diabetes diagnosis and the need to have multiple daily injections. What information would you give him about the long-term benefits of having the insulin and closely monitoring his BGL?
  2. What information would you provide to Jarrah and his father about recognising symptoms of hypoglycaemia?
  3. What education would you provide regarding techniques around self-administration of insulin?
  4. Identify one aspect that you would have to consider in relation to social justice. How could this impact Jarrah’s ongoing health needs? What solution might you offer to address this?
  5. What issues could affect Jarrah’s ongoing glycaemic control in relation to a) his age and b) engagement in sport once he is discharged?

Responses:

  1. It is the responsibility of the nurses to provide the patient with effective knowledge in order to understand the importance of long-term medication adherence and preventing the chance of developing complications.  The patient in this case must be explained with the long-term benefit of insulin as it will help in improving the glycemic control without any significant effect upon the patient’s body weight. The long-term intake of insulin therapy will help in preventing the chance of developing anti-inflammatory effects and thereby preventing the chance of developing various complications which is common among the patients suffering from Type 1 Diabetes. On the other hand, the patient must be explained with the benefit of insulin therapy upon the blood glucose level by explaining the mechanism of action as the insulin helps in observing the glucose and thereby reducing the blood sugar level by increasing the energy of the cell.  On the other hand, the patient must be provided with proper guidance related to continuous monitoring of the blood sugar level as insulin therapy results in the development of hypoglycemia which requires effective management and clinical support (Feigerlova et al., 2020).
  2. The patient must be provided with proper education in order to understand the signs of hypoglycemia and take adequate interventions such as glucose or dextrose.  The nurse in this case must provide the patient with proper handouts by mentioning the signs of hypoglycemia such as irregular heartbeat, pale skin, fatigueness, anxiety, sweating, irritability and shakiness. The nurse must also provide the patient including the family with education in order to deliver the first line of treatment in case of hypoglycemia emergency. The signs include palpitation, blurred vision and dizziness. The nurse must also advise the patient to monitor the blood glucose level effectively and to take sufficient precaution in case of hypoglycemia which will help in preventing the chance of developing complications (Cryper, 2021)Person-Centered Education On Medication And Diabetes Management.

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  3. The patient must be provided with proper information related to the steps of insulin administration.  The nurse in this case must demonstrate the steps of self-administration of insulin with the help of videos.  The nurse must advise the patient to check the insulin bottle to identify the expiry date, and proper measurement of insulin needs to be taken in order to prevent the risk of developing hypoglycemia which is common among the patient adhering to insulin therapy due to fluctuations of glucose. The nurse must advise the patient to choose an area most preferably thigh or abdomen in order to insert the insulin.  The nurse must also advise the patient to rotate the daily administration site and insert a needle at an angle of 90 degree which will help in easy administration. The nurse must also advise the patient to maintain proper documentation and monitor the blood glucose level in order to alter the doors of the drugs (Yosef, 2019).
  4. The social justice which might be provided to the patient includes- peer support which will help in preventing the chance of developing depression and anxiety. The nurse must provide the patient with proper support in order to lower the treatment cost which can be done by preventing the chance of developing complication. The patient must be provided proper motivational therapy which will help in improving the patient’s engagement (Holzer et al., 2022).
  5. (a) The glycaemic control might be affected by the patient’s age as the peer pressure might increase the chance of changes in food habit, increase the consumption of alcohol and it might impact the patient’s health.

(b) The engagement in sports will help in providing positive support to the patient by improving the health condition. The engagement in sports helps in lowering the free fatty acids, decreases abdominal fats and enhances the insulin-sensitive skeletal muscle and improves glycemic control (King et al., 2021)Person-Centered Education On Medication And Diabetes Management.

References:

Amini, F. G., Nia, A. F., Sharbafi, M. H., Khandari, A., & Gargari, S. S. (2019). Comparison between the effect of regular human insulin and NPH with novo-rapid and levemir insulin in glycemic control in gestational diabetes. Human antibodies, 27(4), 285-289. DOI: 10.3233/HAB-190385

Chiang, J. L., Maahs, D. M., Garvey, K. C., Hood, K. K., Laffel, L. M., Weinzimer, S. A., … & Schatz, D. (2018). Type 1 diabetes in children and adolescents: a position statement by the American Diabetes Association. Diabetes Care, 41(9), 2026-2044

Cruz, P., Blackburn, M. C., & Tobin, G. S. (2017). A systematic approach for the prevention and reduction of hypoglycemia in hospitalized patients. Current diabetes reports, 17(11), 1-6. https://doi.org/10.1007/s11892-017-0934-8

Cryer, P. E. (2021). Hypoglycemia. In Endocrine Emergencies (pp. 27-35). Springer, Cham. https://doi.org/10.1007/978-3-030-67455-7_3

Farina, N., & Anderson, C. (2018). Impact of dextrose dose on hypoglycemia development following treatment of hyperkalemia. Therapeutic advances in drug safety, 9(6), 323-329. https://doi.org/10.1177/2042098618768725 Person-Centered Education On Medication And Diabetes Management