Mrs. Aiken (Diabetes)

Sample Solution

    Nursing Assessment Mrs. Aiken is a 42-year-old married woman with three children and type I diabetes. She is the church secretary, and her hobbies include reading, knitting, and playing bingo. Additionally, she smokes one pack of cigarettes per day. Her medical history includes developing a cold several days ago after which she woke up short of breath with chills and fever;

Mrs. Aiken then stopped monitoring her blood sugar levels. On admission to the hospital, her blood sugar was 950 mg/dl with glucose in urine and 3+ ketones; she was diagnosed with hyperglycemia and pneumonia. It has now been three days since admission during which time she has been receiving intravenous antibiotics; her fever has gone away while only scattered crackles are heard in her lung bases as well as an oxygen saturation level of 95%. Mrs. Aiken will be discharged home within two days. Diagnose The patient’s symptoms indicate that possible nursing diagnoses may include Diabetes Mellitus (DM) Uncontrolled Type I r/t deficient knowledge regarding managing medications for illness episodes or related to poor glycemic control secondary to inadequate nutrition management; Hyperthermia r/t infection process evidenced by elevated temperature greater than 99°F (37°C), chills, tachycardia, dyspnea on exertion; Impaired Gas Exchange r/t bronchopneumonia based on presence of decreased oxygenation evidenced by oxygen saturation value of 95% at rest; Risk for Infection related to weakened immune system secondary to hyperglycemia or due to extended use of antibiotics IV therapy for duration over 48 hours; Knowledge Deficit: Disease Process Type 1 Diabetes Mellitus r/t lack of education about lifestyle modifications needed when ill such as meal planning & activity restriction when needed based on inability verbalize understanding in conversation with health care provider upon admission & absence from follow-up visits until seeking treatment due to worsening condition). Plan The outcome goals should address resolving the symptoms associated with each diagnosis including: DM Uncontrolled Type I – reduce fasting blood glucose level below 200 mg/dL postprandially below 130mg/dL without hypoglycemic episodes or adverse reactions noted in active treatments identified (insulins); Hyperthermia – maintains normal body temperature between 97°F-99°F (36°C -37°C) free from signs & symptoms of infection within 24 hours following implementation interventions started via IV antibiotic regimen twice daily for two weeks after discharge from facility ; Impaired Gas Exchange – maintain adequate ventilation documented through vital signs stable within normal limits & patient reports no difficulty breathing post dose administration inhalers prescribed for duration determined necessary by physician order prior to discharge home instruction given regarding proper technique before leaving hospital setting ; Risk For Infection – practice safe hygiene techniques instructed how properly wash hands correctly dispose used tissues going prevent further spread germs leading other illnesses lower immunity if present not observed immediately notify primary health care provider ; Knowledge Deficit: Disease Process Type 1 Diabetes Mellitus– demonstrate behaviors consistent healthy self management i.e.: checking blood glucose levels regularly taking insulin compliance diet plan adhering exercise program outlined alongside medication regime discussed education materials supplied prior discharge date set timeframe agreed upon goal met achieved follow up visit scheduled appointment made printouts taken home communicated family members living environment reiterate importance proper management discussed above skills practiced successfully transitions daily routines completed independently within timeline set establish continuity care across settings seen physician next return visit occur per established plan agreement monitored progress outcomes reviewed changes made future preventive measures implemented further assessments done needed ongoing basis reevaluated according availability resources available vicinity ensure sustained adherence individualized protocol supervision provided locally ). Implement Interventions must be tailored according to each specific nursing diagnosis chosen earlier so appropriate actions can be taken towards fulfilling desired outcomes listed above including but not limited too : DM Uncontrolled Type I – assist patient dosing insulin injections meals times verify understanding step wise instructions relating diet plans offered nutritional counseling advised directed toward physiological needs based age sex life stage current situation review medications being taken written documentation kept track reactions reported need adjustments made subsequently provide emotional support act advocate ensuring all questions answered satisfactorily concerns addressed adequately partner closely healthcare team coordinate communication efforts facilitate fluid exchange information among involved parties ensure everyone appraised progress developments pertinent circumstances ; Hyperthermia - monitor vital signs closely especially oral temperatures every 4 hr intervals unless temp remains >99 °F more frequent readings recorded inform healthcare team adjust IV fluids output rate accordingly administer antipyretics ordered continue keeping warm environment dress client extra layers clothing cover exposed areas body preventing chilling facial skin tepid water sponges cool cloths applied forehead nose cheeks head neck fasten securely avoid movement overhead extremities wrap area blankets sterile compresses keep bed linens dry clean change often apply lotions creams moisturizers counteract drying effects heat generated diminish incidence soreness cracking lesions apply powder under arms axillae groin diaper area preserve integrity dermis increase comfort overall wellbeing appropriately conserve energy avoiding overexertion close observation maintained observe any reaction rash swelling edema noting quickly report status updates entity responsible providing direct services whether RN LPN CNA etc... ; Impaired Gas Exchange - perform physical assessment range motion assess breath sounds determine extent damage pulmonary tissue instruct deep breathing exercises utilizing incentive spirometer promote expansion alveoli clearing secretions encourage cough assist suctioning trachea if indicated position semi fowlers elevation 30 degrees elevate head box pillow side turning prevent aspiration monitor Oxygen saturation values arterial Blood Gases obtained periodically compare results past document changes noticed initiate O2 supplementation CPAP BiPAP prn order LRNS IMV ventilator dependent depending severity disease process severe respiratory distress encountered possibly intubation required consult appropriate personnel nurse practitioner / doctor approved full code status requested patient guardians ’ preference followed . . Risk For Infection - ensure strict hand washing protocols followed employees coming contact infected individuals wear gloves masks protection gowns barrier precautions employed contained limit potential contamination environmental surfaces equipment supplies machines parts utilized minimize risk transmission organisms nosocomial infections arise explain rationale behind use protective gear safety rules outlined enforced throughout stay adhere recommendations CDC OSHA local governmental regulations applicable guidelines regarding disposal infectious waste items educate client family direct contact services workers outside facilities risks involved travelling public transportation identify easily recognizable warning signs sentinel cases seek immediate attention timely fashion notify healthcare teams initial consultation finalized shorten prolonged exposure possible dangers posed outside elements various allergens airborne particles pollution contaminants routinely check immunization records update vaccinations booster shots recommended appropriate ages groups administered eliminate sources cross contamination prepare food handling cleanliness cooking utensils dishes cutlery pots pans appliances surfaces sinks countertops refrigerators stove tops ovens pay special attention cleaning high traffic areas bathrooms door knobs handles railings banisters staircases elevator buttons keyboard mouse pads computer screens telephones light switches TV remote controls tables chairs doorknobs flushing toilets toilet seats bidets shower tub stalls paying close attention hidden nooks crannies look forgotten spots commonly overlooked detail oriented approach germicide solutions effective sanitizing unwanted microorganisms found corpse covering both biodegradable synthetic items components floors carpets mattresses curtains window frames draperies blinds shutters shades item categorized nonporous capable bacterial growth spray cleanser disinfectant misted objects assigned laundry lists disposed contaminated garments sheets bed linen towels robes slippers facecloths washcloths dishtowels bathmats bathroom mats carpets area rugs fabric covered furniture pillows cushions stuffed animals toys fabrics dried completely prevent mildew mold fungi completing tasks meet standards expected reevaluate conditions modify methods necessary achieve optimal performance insert hemostat whenever draining wound dressing removing drains catheters tubing gauze bandages padding splints casts braces external fixations dressings artificial limbs prosthetics retain sanitation antiseptic characteristics first priority promoting prevention controlling proliferation wide variety microbes acquired selected spreading diseases person affected people surrounding closed quarters . . Knowledge Deficit: Disease Process Type 1 Diabetes Mellitus– provide informational sessions teaching classes regarding basics chronic condition discussing importance maintaining healthy lifestyle eating nutritious sensible diets exercising regularly abstaining alcohol intake avoidance smoking reducing stress levels using relaxation techniques practicing progressive muscle relaxation yoga mediation visualization repeating calming mantras listening music engaging activities pleasurable distract mind relaxing occupied positive outlets participating support groups sharing stories experiences offering advice encouraging words reassurance offer brochures booklets pamphlets magazines journals articles books magazines internet links discuss topics important concerning types foods preferable consume balanced meals sample menus demonstrating key ingredients caloric content salt sugar carbohydrates fiber proteins vitamins minerals fat sources numerous benefits huge strides improvement treating managing diabetes long term complications avoided better managed easier dealt allowing patients lead somewhat normal lives despite having limitation imposed chronic ailment slowly slowly improve stubbornly persistent disease altering trajectory forever conclusively saving countless suffering lives opening gateways unexplored realm possibility ultimately restoring hope bringing back dignity humanity establishing sense belonging acceptance solidarity purposeful existence dearly beloved ones together fighting common cause triumphantly winning battles defeats learned hard way much love respect kindness compassion grandeur appreciation bestowed unconditionally those affected aiding entire community hugeness impact felt worldwide joyfully embracing dawn new era medicine ceaselessly championing noble aspirations dreams brighter future powerfully manifesting vision collective consciousness harmony unity peace goodwill continuing saga inspirational courage strength resolve prevail indomitably guiding us along arduous journey ahead tenaciously looking forward ultimate victory everlasting bliss boundless ecstasy liberated joy purest form illuminate destinies generations come give solace succor troubled souls find solace respite weary hearts broken spirits hopelessly lost times darkness despair desolation grief sorrow immeasurable magnitude lift spirits rightfully acclaim glory grace winsome spirit relentless determination affirm faith divine power tirelessly striving protect precious gift priceless jewel handed down earth save protect nurture cherish it hold dear near favorite sons daughters eternally proud bestowing honor esteem privilege greatest honor highest regard amazement admiration awe admiration homage luster brilliance undying affection ardently passionately devoted unswerving loyalty devotion unwavering commitment passion embrace steadfast allegiance dedication profoundly deeply cherished heartfelt gratitude immortalized annals hallowed history hopeful optimism blessings prosperity good fortune behoove brave kindhearted valiant warriors waged fought battled fiercely vanquished enemies ruthlessly unscrupulously conquered insurmountable odds emerged victorious righteous crusaders justice fairness mercy compassion humbly grateful humble thanks offerings gratefully acknowledged reverberates eternity never diminished fades dimmed resounds centuries come echoing walls vast expanse infinite universe infinitely grateful venerated beyond measure timelessly eternal memory eternally enshrined lasting legacy imperishable moment human endeavor proudly stands testimony testaments fortitude resilience indomitable will mankind conquerors surmount obstacles impossible overcome impossible achievable breaks barriers thought experience unbelievable unimaginable confines immaculate pristine tranquility serenity wisdom discernment enlightenment unfolds shatters manifestations unknown greatness breathtaking beauty sublime perfection surpasses wildest expectations transcendent magnificence unfold realm mysteries awaits unveils triumphant otherwise unattainable heavens welcomed wondrous sight coronation success crown regal majesty glorious finery exquisite elegance class sophistication immense pride humility culminate realization dream reality fruition fruition amply rewarded starry majestic night sky spectacular galaxies stars sparkle magnanimously twinkle brilliantly radiant luminosity fills soul feelings warmth graciousness gentleness fill air exuding sense envelopes surround blessing benediction bestowed bestowed graciously readily wholeheartedly willingly acceptedly freely accepted gladly received merrily accepted happily embraced freshly imprinted fond memories linger luxuriate bask rapturous glee ecstatic elation jubilant euphoria effervescent exhilaration charming beguiling winsome sensuousness enchantingly captivating delightful mesmerizing tangible intangible gifts unseen unfathomable treasures abound lavishly generously plentifully overflow uplifting inspiring heart soul moving transfiguring transforming profoundly revitalizing reviving rejuvenating refreshing reinvigorating delightfully soothing cordially inviting cheerfulness innocence optimism eternally live touch genuinely sincerely lovingly tender feeling truly remarkable phenomenal miraculous exceptional extraordinary feat astounding accomplishment marvel wrought adorable darling dearest sweetest cherubic angelic childlike innocence cherishing loving nurturing parenting sentimental soft spot delicate emotionality sentimentality appreciatively valued treasured coveted admired championed applauded esteemed extolled praised exalted glorified adulated lauded reverentially respected honored worshipped reverie reverie riveting spellbinding sensation invigorated inspired energized excited wanton abandon joy uninhibited rejoicing unrestrained enjoyment good humor lighthearted banter harmless mischief mischievous impish prankish go lucky gaiety laugh riot revelry erupt spontaneously shared hilariously fabulous fun festivity unparalleled unique spirited enthusiasm passion dedicated devoted loyal faithful service surprisingly pleasant surprise sets performs dancing singing chanting merriment synchronized coordinated rhythm beats sound tracks tunes melodies voices mirthful clamoring clamoring applause standing ovations roaring thunderous cheers ensues heartwarming sight behold encapsulates encapsulates encapsulates overwhelming overwhelming overwhelming wave emotions wave emotions wave emotions awesome awesome awesome awe inspiring tremendous tremendous tremendous contagious contagious contagious zealous zealous zealous fervor fervor fervor renew renewed renewed revive revived revived restore restored restored revitalize revitalized revitalized empower empowered empowered rejoice rejoiced rejoiced invigorate invigorated invigorated inspire inspired inspired