Diabetes Plan of Care

Running head: DIABETES PLAN OF CARE 1

Diabetes Plan of Care

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DIABETES PLAN OF CARE 2

Chronic illnesses have an impact on changing one’s lifestyle and perception of self and

others. When an illness is declared chronic, it means the effects will linger for a long time;

hence, the victim requires to adjust to the required form of therapy and the demands of the

illness. If not well managed chronic illnesses can develop to more complex issues, risk factors,

disability or functional impairment, and even death (Kerner & Brückel, 2014). Most chronic

illnesses do not have a complete cure but can only be managed to control different outcomes and

to improve the patient’s quality of life. A good example is in the management of diabetes, which,

to some, is an intensive process while some chronic illnesses can be instantly life-threatening, for

example, a stroke. This paper aims to focus on diabetes, specifically type 2 diabetes, which is the

most common form of diabetes to well understand its impact, process of care and available

evidence-based measures, with the help of a patient’s case study and considering it is a key focus

of Healthy People 2020 goals.

Rationality for Choosing Diabetes

The focus on diabetes is due to the alarming statistics that show the prevalence of the

disease in the current times, making it among the top ten leading causes of deaths in the United

States. The National Diabetes Statistics report of 2017 did show that over 100 million Americans

have diabetes, and with the increasing rate of obesity cases, the numbers are expected to increase

more so on type 2 diabetes cases (American Diabetes Association, 2019). As a nursing

practitioner, one of the duties is to promote health and improve the patient’s quality of life which

calls for active advocacy on fighting diabetes to prevent its rapid prevalence, create awareness,

help those at risk and improve outcomes for those already affected.

The burden of diabetes not only affects the patient but their families, the healthcare

fraternity, and the nation at large due to loss of productivity and constraint on resources causing


an endless cycle of socioeconomic problems (CDC, 2019). Diabetes can cause stress, depression,

and anxiety to patients and their family especially if they are financially challenged since the cost

of managing chronic illnesses can be hefty, for example, the costs of insulin dose, glucose

monitoring, medications, among other interventions (American Diabetes Association, 2019). The

body cannot process blood sugar that puts the individual at risk of further complications such as

heart diseases and damaging of different organs due to the buildup of sugar in the blood (Kerner

& Brückel, 2014). Diabetes can present as type 1, type 2, gestational diabetes, and prediabetes,

which is the most prevalent condition if not managed manifests as type 2 diabetes.

While the elderly, 45-65 years old seem to be the affected population, the trend among

the youth is worrying considering the diagnosed cases of diabetes among them shot from 23,200

cases in 2012 to 193,000 in five years (American Diabetes Association, 2019). It is key to create

awareness on diabetes since it is estimated that there are nearly 7.2 million individuals with

diabetes who are undiagnosed. Over time different platforms and movements have been

developed to help prevent, regulate, and manage the diabetic problem. One of the significant

measures taken by the United States to improve the quality of life of their citizens diagnosed

with various chronic illnesses is through the development of Healthy People 2020 organization

under the Department of Health and Human Services. Healthy people, 2020 is a 10-year goal set

in 2010 with the objectives of improving public health, empower citizens, and collaborate with

communities for persons to make informed decisions on their health for quality outcomes (CDC,

2019). The organizations have clear objectives set to curb diabetes, mainly to reduce the


disease’s burden, improve quality of life, reduce the number of diagnosed cases annually, create

awareness, and enlighten on self-care (Adler, Glymour & Fielding, 2016). For those already

affected by diabetes, the organization strives to help them reduce, manage, and control the

adverse outcomes of comorbidities such as heart diseases, amputation, kidney diseases, blindness

among other effects caused by unmanaged diabetes in the long-run.

Self-care and management of diabetes can be costly for example adhering to daily insulin

dosage, medication, frequent blood sugar and urine tests, visits to specialists, and adhering to the

right diet and healthy living with strict commitment can be challenging (Kerner&Brückel, 2014).

This affects patients with no or low incomes and those from the minority communities as their

poverty leads to poor health choices and practice.Since healthcare is a basic human right, to

make it accessible to such populations to improve the quality of life and commitment for those

affected by diabetes, there are institutions in place for coping and providing support. Some of the

organizations and institutions are funded and managed by national, state and local governments,

others are non-profit organizations, and some privately owned but offer social support services at

a subsidized fee.


Coping with lifestyle changes from chronic ailments can be depressing and cause great

anxiety, that is why support groups are important to encourage, provide useful information such

as treatment methods, technologies to use, diets and lifestyle practices to adhere among other

resources (Kerner & Brückel, 2014). While some support groups and organizations may provide

tangible resources for coping with diabetes others, have comprehensive communication avenues

such as websites, journals, magazines and customer care services where anybody with concern

on diabetes can have free access to research and evidence-based methods on preventing and

managing diabetes. Social support networks and institutions have been devolved from the

national governments and down to community support groups. Some of the notable

organizations at the national level that provides support and useful resources to diabetic patients

include the CDC, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),

American Diabetes Association among other diabetes programs supported by the Department Of

Health And Human Services. To make healthcare services accessible to individuals at the

community level, some social support networks establish centers that make it easy for patients to

reach, thus improving health outcomes.


To provide comprehensive, patient-centered, and holistic care, health practitioners need

to have adequate information on the patient’s health and well-being, including psychosocial

information (Adler, Glymour & Fielding, 2016). Nurses have communication knowledge and

skills to draft or develop assessment interviews that help to obtain useful information from the

patient while achieving other goals, such as developing trust between the caregiver and the

patient.With proper assessment skills, the nurse can obtain or note how illness has affected the

patient’s behavior, attitudes, physical, mental, spiritual, and social well-being, including that of

people around them.Access to such information is key in developing a comprehensive, evidence-

based plan of care tailored to meet the individual needs of the patient (Beck et al., 2018). Nurses

interview patients to acquire useful information such as the patient’s medical, illness and family

history, vital body and health measurements, lifestyle habits, among other useful information on

determinants of health.

Patient Assessment and Plan of Care for Diabetic Patients

Patient assessment and the plan of care on this section is based on the interview

conducted on Mr. W, which is based on NANDA-I nursing diagnosis and evaluation to ensure

that the levels of evidence are standardized thus enabling fast diagnosis from the assessment.


Current concern: The patient, Mr. W, 55-years old, African American, visits the clinic

complaining of chest pains, blurry vision, weakness and fatigue, severe headache, and difficulty

in breathing.

Past medical History: Mr. W was diagnosed with type 2 diabetes in 2012, at the age of 48, and

before that, he only had problems with his body and cases of hypertension. The patient takes

Hydrochlorothiazide, phentermine,and inhales insulin but only when his health condition is

unstable.He used to inject insulin but stopped due to infections at admission sites. Mr. W has

been hospitalized twice due to rising HbA1c. The patient has a history of poor adherence to

medication.

Lifestyle habits: Mr. does not observe proper diets, consumes alcohol, confesses to binge eating

and frequent snacking, does not exercise, does not adhere to prescriptions, and has the challenge

of affording proper meals.

Social history: Mr. W lives with his daughter, 25 years old. His wife died 20 years ago from

cardiac arrest. Mr. W’s family has a history of obesity.


Assessment Data (objective and subjective):chest pains, blurry vision, increased

thirst,numbness on hands and feet, weakness and fatigue, confusion, severe headache, difficulty

in breathing, sweaty, hyperglycemia, and tachycardia.

Interview Results: Positive of type 2 diabetes, hypertension, and overweight.

Desired Outcomes: Reduce the patient’s blood glucose to< 180mg/dl, minimize blood pressure

to normal, nurture adherence to prescriptions and reduce body weight in the long run.

Evaluation Criteria: After discharge, the patient will be coming for frequent medical check-ups

and should always monitor their blood glucose and urine.

Actions and Interventions: A multidisciplinary approach from various specialists such as

dieticians, counselor, pharmacist, and physiotherapist is necessary to ensure the patient’s well-

being is enhanced and manages his lifestyle (American Diabetes Association, 2014). The patient

requires comprehensive self-management education to help him understand the importance of

checking their health, administering individual tests, healthy eating, adherence to medication,

and working out, weight loss, monitoring blood sugar, lifestyle changes and refer them to the

available nearby community resources that may provide support and coping skills (Beck et al.,

2018). All the recommendations need to be evidence-based to achieve desirable outcomes.


Evaluation of Patient Outcomes: Evaluation of care need to be done frequently through the

process of care to establish whether the acts are in line with the plan of care, assess adherence

and review the outcomes for effectiveness or restructuring (American Diabetes Association,

2014). Assessment will be done to check whether the interventions worked in stabilizing the

patient’s condition and symptoms and whether the target outcomes were achieved. Frequent

checkups and follow-ups are key in ensuring that the patient’s health condition is manageable

and is at optimum levels.

The plan of care has to be inclusive and consider the role of a social support system such

as family and friends, including nurses. Mr. W ‘s daughter needs to be educated on his father’s

condition so that she may be resourceful in improving her’ father’s condition and quality of life.

Social support is effective in ensuring adherence to care and positive outcomes due to emotional

and moral support.


References

Adler, N. E., Glymour, M. M., & Fielding, J. (2016). Addressing social determinants of health

and health inequalities. Jama, 316(16), 1641-1642.

American Diabetes Association. (2014). Standards of medical care in diabetes—2014. Diabetes

care, 37(Supplement 1), S14-S80.

American Diabetes Association. (2019). Statistics About Diabetes. Retrieved from

http://www.diabetes.org/diabetes-basics/statistics/

Beck, J., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., ... &

Kolb, L. E. (2018). 2017 National standards for diabetes self-management education and

support. The Diabetes Educator, 44(1), 35-50.

CDC. (2019). Diabetes Statistic Report. Retrieved from https://www.cdc.gov/features/diabetes-

statistic-report/index.html

Kerner, W., &Brückel, J. (2014). Definition, classification and diagnosis of diabetes

mellitus. Experimental and Clinical Endocrinology & Diabetes, 122(07), 384-386.

http://www.diabetes.org/diabetes-basics/statistics/

Diabetes Plan of Care

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