NURS FPX 6021 Assessment 1 Concept Map

NURS FPX 6021 Assessment 1: Concept Map

Hypoglycemia

Hyperglycemia is a common condition among African Americans This condition shows how our body transfers what we consume into energy. When we exercise or become active, our pancreas releases insulin (U.S. Department of Health and Human Services Office of Minority Health, 2023). As the condition progresses, it brings along other side effects such as frequent urination, slow wound healing, impaired mobility, peripheral neuropathy, vision changes, weakness, and problems with our kidneys and our heart.  There currently is no cure for this condition, but there are things that can be done to minimize the symptoms of the condition. The purpose of this paper is to learn how diabetes affects African Americans, explore ways to assist our patients with treatment, educate pt on self-care maintenance,  as well as provide resources to assist patients in coping mechanisms as well as access to care.  Let’s delve into this condition, its symptoms, and ways to improve life living with this condition.

Acute Phase

Mr. Johnson is a 70-year-old male admitted to St Joseph Medical Center on May 1, 2023, with an acute complaint of loss of consciousness. He has a history of diabetes and hypertension. He lives alone in an assisted living facility and has been driving himself. It is now apparent to him that he may not be able to drive anymore, and that has caused a bit of anxiety. He is afraid because he is having difficulty seeing things clearly and has been diagnosed recently with a cataract in his left eye.  He states he has been urinating more frequently than ever before. He also states he has a sore on his great big toe, which is impairing his ability to ambulate. He states that his toe is in excruciating pain.

Initially, the nurse completes a full body assessment to address his complaints. He was found to have 3 main acute nursing diagnoses: (1) Hyperglycemia (Mayo Clinic, 2022). (2) Deficient Fluid Volume related to frequent urination (Wayne, 2019). and (3) Self-care deficit related to the wound on the great toe as evidenced by difficulty with ambulation (Yip, 2021). 

Hyperglycemia

During the initial assessment, the patient complained of frequent urination, lightheadedness, difficulty walking, dry skin, sweating, difficulty with vision, weakness, and a wound on his great toe. All these complaints are common signs and symptoms of hyperglycemia. Of all the complaints, the most acute was loss of consciousness, which is why the patient was admitted. He was found to have a blood sugar of 42 mg/dl, which is very low, and his HAIC was 10.6 % which is high. These lab values explain why the patient has been feeling weak and lost consciousness. So how do we assist the patient? First, the patient received a 4-ounce cup of orange juice; 15 minutes later, the blood sugar was rechecked, and his blood sugar had only increased to 50 mg/dl. During this time, the nurse places a peripheral IV line in, and the Provider administers one vial of 50 % dextrose in a bag of water over 15 minutes. Mr. Johnson stated that he started to feel much better. The nurse continued to monitor his blood sugar for 15 minutes for the next hour. His blood sugar progressed to 110 mg/dl, which is within normal limits.  Mr. Johnson stated that he began to feel much better. The nurse sat with Mr. Johnson to monitor him and discussed the importance of monitoring his blood sugar with his glucometer.

Mr. Johnson must learn the importance of monitoring his blood sugar regularly. We learned that his wife had recently passed away, and she was the primary caregiver. He stated she would check his blood sugar every day several times a day, and it would annoy him at times. However, now he states she’s who kept me alive, and now she’s gone. I just don’t want to be here without her anymore. I miss her so much, but she would want me to keep pushing through. So, that’s what I’m trying to do. He was very receptive to the education he received regarding the proper use of his glucometer. Education is very important because without education, his hyperglycemia could go undetected, and he could die.  Also, by providing this education, he will now be able to recognize the signs and symptoms of severe hypoglycemia and prevent irreversible possible brain damage. We want to always ensure the patient receives education on any new durable medical equipment or a new device, and then the patient should return the demonstration to us, so we know the patient has obtained a full understanding of what was taught. Mr. Johnson was able to return to the demonstration and was very cooperative. He was provided a detailed diabetic brochure for African Americans diagnosed with diabetes. This brochure entailed signs and symptoms to look for, dietary recommendations, and local community resources. He was appreciative and began to read the brochure. These Interventions proved to be effective.

Deficient Fluid Volume related to Frequent Urination

The second nursing diagnosis determined was Deficient Fluid Volume related to frequent urination (Wayne, 2019). Mr. Johnson complained of frequent urination. He was very concerned as he stated that normally, I go around 4-5 times daily. However, for the past few days, I’ve been going 9-12 times a day. When asked if he had been taking his insulin properly, he stated he was not taking it as prescribed. His urination needed to be minimized, so an order was placed for vasopressin. Vasopressin is an antidiuretic medication that assists with maintaining normal blood pressure, and it also decreases the excretion of water by the kidneys (Cleveland Clinic, 2023) After Mr. Johnson’s blood sugar was maintained, the nurse administered 5 units subcutaneously. Within 1 hour of administration of the medication, his frequent urination had decreased tremendously. The lab technician collected Mr. Johnson’s creatinine and BMP. He was catheterized, and his intake and output were collected. He was placed on fluid restriction as well as a low-sodium diet. He received teaching on the importance of his condition regarding taking his Lasix in the morning and checking his blood sugar regularly throughout the day and before meals. The dietician educated him on the importance of a low-sodium diet. Mr. Johnson was very cooperative with the staff with collecting his labs. He selected a low-sodium meal and decreased his fluid intake to 4 cups daily. He then explained to the nurse his understanding of taking his prescribed medications and maintaining an adequate low-sodium diet with fluid in moderation.

Self-Care Deficit Related to the Wound on the Great Toe

His last diagnosis was a self-care deficit related to the wound on the great toe, as manifested by difficulty with ambulation. Mr. Johnson states he has been having difficulty getting around due to weakness and the wound on his foot. The wound care nurse completed a fu assessment of his wound and feet. His wound was measured and documented. It was noted that he was wearing dress shoes and tight socks. He was provided diabetic teaching regarding proper shoe wear and foot hygiene. He received medication before cleaning his foot; then, his wound was cleaned with normal saline; dried, and left open to air dry. He was referred to physical therapy and was given an outpatient referral to orthopedics for the fitting of diabetic shoes. Mr. Johnson returned the demonstration of proper foot hygiene and verbalized why it’s important to perform it. He contacted the Orthopedic office and scheduled his outpatient appointment.

Chronic Phase

Mr. Johnson was hospitalized for a total of 5 days. It took some time to level out his blood glucose as it would fluctuate quite a bit initially. He has now returned home to his assisted living apartment. Home health has been established with physical therapy and nursing. He continues to have some chronic symptoms of his condition. We will now discuss the 3 main nursing diagnoses to be addressed.

Risk for Infection related to the wound on the great toe

Mr. Johnson has not yet had his scheduled appointment with his podiatrist. His great toe continues to have a substantial open wound. His nursing diagnosis was noted as a Risk for Infection related to the wound on the great Left Toe (Carpenito, 2021). He must maintain proper hygiene, as he was taught at the hospital to prevent any further infection. His home health nurse (HHN) has just assessed his wound and believes it has worsened since his initial assessment in the hospital. She contacts the on-call home health provider and receives a stat Podiatrist referral. Mr. Johnson contacts the office and receives a next-day appointment. The HHN provided Mr. Johnson with a 2-wheel walker upon discharge from the hospital, but he stated he would not use it. He called the home health agency and requested the HHN bring a walker out when she came. The nurse provided him with the 2-wheeled walker and instructions on proper use. Mr. Johnson was very appreciative and stated that he understood why he required the walker. He returned the demonstration to the nurse. 

The HHN must complete a safe home assessment when she initiates the first visit. This evaluation affords the HHN the ability to see if there are any further services or equipment required in the home setting. The nurse will also educate the patient on any home modifications based on safety. 

Risk For Injury Related to Left Eye Vision Impairment

The second chronic nursing diagnosis is Risk for Injury related to left eye vision impairment. (Carpenito, 2021). During the initial home assessment, the HHN noted that the patient had several throw rugs on the floor. She recommended that the patient remove the throw rugs that are in the high-traffic areas because they can become a safety hazard. Mr. Johnson asked the HHN to remove them and place them in his storage closet. She also noticed that he was turning on lights in the home with the sun shining brightly through his windows. He stated that it is so dark in his apartment, and he needs to get brighter bulbs for his lamps. The HHN explained to him that the lighting was adequate, but because of his cataract and diabetes, his vision is impaired. She recommended that he schedule a follow-up appointment with his Optometrist. Mr. Johnson agreed that his vision had diminished over a period, and that is the reason he doesn’t drive anymore. He immediately sat down and contacted his Optometrist and scheduled a follow-up appointment. The National Institute of Health notes, Laser surgery helps to decrease the vessels in the patient’s eyes, enabling the patient’s sight to improve (National Institute of Health, 2023). This procedure will increase the patient’s autonomy to complete his ADLs and decrease the risk of injuries in the future.

The HHN saw that there were not many groceries in his refrigerator. He stated that since he no longer drives, he now must wait on neighbors and friends to bring groceries by. He is not computer savvy, so he has no idea how to order groceries through a phone app. He is reluctant to learn because he has difficulty seeing. So, the HHN sets up Meals on Wheels for him. She explained that this is a service that has dedicated volunteers who deliver nutritious meals, friendly visits, and safety checks that afford elderly Americans to live hunger-free within their homes and maintain their autonomy, independence, and dignity. The service also provides education funding, and advocacy for seniors across America (Meals on Wheels America, 2019) Mr. was surprised there was such a service and was agreeable to receiving the meals.  This assessment proved to be successful, as the patient was not receiving the adequate nutrition that is required for adequate healing.

Chronic Pain as Manifested by Impaired Mobility

Lastly, the final nursing diagnosis was discovered; Chronic Pain manifested by impaired mobility (Carpenito, 2021). Mr. Johnson states he continues to have constant pain in his left great toe, which radiates into his foot and left leg. He describes the pain in his foot as numb and tingling at times. However, he states that most of the time, he has a constant throbbing pain in both feet. He has not made it to his Podiatry appointment yet. However, the HHN has brought a pair of Velcro shoes that are easy to get on and off and a 6-pair pack of diabetic socks. Mr. Johnson tries on the shoes and notices an immediate difference in the feel and fit of the shoe. 

The HHN started to complete a full pain assessment and noticed that each time she touched his left foot, he would grimace in pain. She stopped the assessment and administered the patient with ibuprofen. She then provided him with a pill box for the week. She explained the importance of remaining compliant with all medications. The pill box is an easy way to stay on track for days and times. Each week you start over. He was appreciative completed filling the pill box and verbalized the importance of taking all medications as prescribed. So, the pill box is a mechanism that keeps the patient on track. At the end of the pill box demonstration, Mr. Johnson stated that his pain had decreased to a 2/10. The HHN completed the pain assessment and explained that ibuprofen is an anti-inflammatory that aids in decreasing inflammation and pain, and it should be taken every 6-8 hours as prescribed on the onset of pain. He stated understanding.

Music therapy was discussed as a distraction from pain. Something Mr. Johnson stated he had never thought of. Certain types of music assist with pain, and the different genres were listed for him (Hanser & Mandel, 2020).  Music has a way of addressing our body holistically by influencing our emotions and feelings, mentally and spiritually (Hanser & Mandel, 2020). Mr. Johnson discussed how he enjoys gospel music and how it has helped him change his mind; before he knew it, he stated he had forgotten about the pain. He agreed that music is therapy.

Interprofessional Collaboration Strategy

An Interdisciplinary team is imperative when treating patients. Patients must be treated holistically and require several disciplines to develop a collaborative comprehensive treatment plan. Mr. Johnson’s care plan includes 15 different disciplines/ departments or agencies. He had nurses to administer meds and provide care, a nurse case manager to collaborate between all disciplines and assist with any needs, a provider to evaluate and order medications and treatments, lab techs to collect urine and blood, a podiatrist to evaluate the feet for a definitive diagnosis, a wound care nurse to evaluate and treat his wound, an orthopedic to evaluate his feet and legs, an optometrist to evaluate his eyes, and the home health agency to provide the care he requires at home. For a patient to receive quality care we can see it requires mitigation between disciplines. Imagine if one disciple was not included; the patients would not receive the required care. Because he has diabetes, he will require discipline, and we must all work together to improve his quality of care and his life. By implementing this strategy, we can see it is beneficial in achieving the desired outcome of interprofessional collaboration.

Conclusion

According to the US Department of Health and Human Services, African Americans are 60% more likely than non-Hispanic white adults to receive a diagnosis of diabetes (U.S. Department of Health and Human Services Office of Minority Health, 2023). Therefore, education is essential for all African Americans, male and female, at the earliest age possible. The earlier, the better. Education can save lives. Nursing assessments need to be comprehensive, and the nurse needs to pay close attention to small intricate details to determine what services the patient will need. A condition such as hypoglycemia affects many systems and will require an interdisciplinary team. Collaboration with treatment is essential in providing quality care and developing a detailed patient-centered care plan. Henceforth, this care map proved effective by breaking Mr. Johnson’s condition down and viewing him holistically. We were able to provide additional services to him that he would not have been able to benefit from had we not completed a thorough assessment. Therefore, he has expressed his deepest gratitude.

References

Carpenito, L. J. (2019). Handbook Of Nursing Diagnosis. Jones & Bartlett Learning.

Cleveland Clinic. (2023). Vasopressors: Types, Purpose and Side Effects. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/23208-vasopressors

Gil Wayne. (2017, September 23). Self-Care Deficit – Nursing Diagnosis & Care Plan. Nurseslabs. https://nurseslabs.com/self-care-deficit/

Hanser, S., & Mandel, S. (2020, June 3). Music Therapy for Pain Management. Practical Pain Management; Practical Pain Management. https://www.practicalpainmanagement.com/treatments/complementary/music-therapy-pain-management

Mayo Clinic. (2022, August 20). Hyperglycemia in Diabetes – Symptoms and Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631

Meals on Wheels America. (2019). National Office. Mealsonwheelsamerica.org. https://www.mealsonwheelsamerica.org/learn-more/national

National Institute of Health. (2023). Laser Treatment for Diabetic Retinopathy | National Eye Institute. Www.nei.nih.gov. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy/laser-treatment-diabetic-retinopathy

U.S. Department of Health and Human Services Office of Minority Health. (2023, February 17). Diabetes and African Americans – The Office of Minority Health. Minorityhealth.hhs.gov; U.S. Department of Health and Human Services Office Of Minority Health. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=18#:~:text=Diabetes%20and%20African%20Americans.%20African%20Americans%20are%20almost

Wayne, G. (2019). Deficient Fluid Volume – Nursing Diagnosis & Care Plan. Nurseslabs. https://nurseslabs.com/deficient-fluid-volume/

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