Question

Levels of children and young people diagnosed with type 1, type 2, and other variants of diabetes are increasing and this has become a priority issue for commissioners in the area where Na’ema works as a diabetic nurse. As one part of a local strategic response to this issue, Na’ema has been asked to come up with some interventions that could help improve health and well-being outcomes for young people with a diagnosis of diabetes. Na’ema is aware that improved diabetes control in young people can reduce the incidence of microvascular complications and delay their progression. She also understands that a diagnosis can affect a young person's mental health, emotional well-being, and even attendance at school and engagement in extra-curricular and social activities.    

3. What is the level of intervention possible in this case?  

4. Based on the above scenario, Prioritize two appropriate interventions Na’ema will be able to implement at the primary level.     

Answer 1

INTRODUCTION

Type -1 diabetes mellitus is also known as JUVENILE DIABETES MELLITUS.According to recent research ,type -1 diabetes continue to increase across the world and increasing the morbidity (disease rate) and mortality rate(death rate).Diabetes mellitus a chronic metabolic disorder caused by the deficiency or absence of glucose.Diabetes is divided into the following;

WHO CLASSIFICATION(2000)

-Type 1--Diabetes

-Type -2 Diabetes

-Other specific types-it includes gestational diabetes   

MEANING

-It is formely known as INSULIN DEPENDENT DIABETES MEIIITUS and JUVENILE DIABETES MELLITUS

-It is a chronic auto immune conditions that occurs when the beta cells of the pancreas cannot produce enough insulin

-Is a medical conditions that body does not make enough insulin

QUESTION-1

LEVEL OF INTERVENTIONS

-The levels interventions should have short term and long term goals,so goals are listed below

GOALS OR OBJECTIVES OF THE INTERVENTIONS

-To maintain the normal level of glucos

-To prevent the complications like Diabetic keto acidosis

-To permit normal growth and development

--To administer insulin as per physicians order

-To mainatin diet therapy

-To assess the early features of the complications

PRINCIPLES OF IINTERVENTIONS

-correction of shock

-correction of dehydrations

-correction of hyperglycemia

-correction of deficits in dehydrations

-correction of metabolic acidosis

-treatment of infections

-treatment of complications

LEVELS OF INTERVENTIONS AS FOLLOWS

1-INSULIN THERAPY

-Insulin is a hormone that help for the transportation of glucose from the blodd stream to the  cells or tissues

-Insulin therapy is divided into four according to their type of actions

1-RAPID ACTING INSULIN

2-SHORT ACTING INSULIN

3-INTERMEDIATE INSULIN

4-LONG ACTING INSULIN

2-BASIC AND ADVANCED DIABETES EDUCATION

1-about importance of insulin therapy

2-recognition of hypoglycemia and DKA(diabetic keto acidosis)

3-about meal plan

4-about aerobic and resistance exercise

5-about glucose monotoring techniques

6-about the importance of follow up care

3-NUTRITIONAL MANAGEMENT OR DIET THERAPY

1-prefer for regular meals ..but it should be 3 meals and 2 snacks

2-low salt and low fat diet

3-low cholesterol and high fibre rich diet

4-division of daily diet includes;

-20% at break fast

-20% at lunch

-30% at dinner

-10% at mid mornng ,mid afternoon and evening snacks

5-carbohydrate ratio have to maintain

4- PHYSICAL ACTIVITY

-prefer medium ranged physical activities help to control blood glucose level

-improve blood circulation

-prevent obesity and increase mental health

5-SCREENING

-screening test used to assess the following levels

-height

-weight

-thyroid hormone levels

-screening for foot care

-screening for dental and eye examination

-screening for complications like retinopathy,neuropathy,

-screening for blood pressure and serum creatinine levels

6-MANAGEMENT OF DIABETIC KETO-ACIDOSIS

-DKA is most important complications

-is defined as hyperglycemia in the presence of metabolic acidosis and ketonemia(the presence of ketones in the blood streams)

-profound insulin deficiency charactrized by hypotension,tachycardia,impaired skin  turgor,dehydration etc

7-PREVENTION AND EARLY DETECTION OF COMPLICATIONS

-early detection of complications is the most important interventions for type-1 DM

-the major complications are listed below

-retinopathy

-neuropathy

-nephropathy

-macrovascular diseases

-diabetic keto acidosis

-thyroid diseases

-celiac diseases

-cerebral odema

8-FOLLOW UP CARE

-help to prevent complications

-can manage glucose levels

-can reduce the specic clinical features like polyuria'polydypsia,polyphagia and weight loss

-assess for foot care

9-FLUID AND ELECTROLYTES

-maintain hydration status

-maintain electrolytes levels by administer sodium chloride,potassium,phosphate,and bicarbonates

QUESTION-2

-According to prioroty two interventions at the primary levels are

1-NUTRITIONAL MANAGEMENT-to prevent diabetic keto acidosis

2-SCREENIN TESTS-to assess the current health status

CONCLISION

The goals of treating diabetes mellitus in children are to maintain metabolic status,hydration status and electrolyte levels.Inorder to prevent complications have to give poroper nursing as well as medical care

" HEALTH IS NOT VALUED TILL SICKNESS COMES"