Question

case study
Julie is 45 year old mother and lives on a cropping farm, run as a family business, with her husband and his brother. Julie has three children same, aged 14; Katie, aged 12 and James aged 8.The two older children attend boarding school and return home for holidays. James is at home and attends the local primary school 50 km away.
Both Julie's boys have type 1 diabetes that she manages.
Julie has lived with her diabetes for 37 years and has many comorbidities due her both her diabetes and celiac disease. which she developed as a teenager. Julie has stage 3 chronic kidney disease, poor eyesight and osteoporosis. She is currently tryinģ to give up smoking after having smoked since of 16.
Julie currently sees her endocrinologist in large metropolitan hospital every three-month at outpatient clinic. It take her five hours to drive by car to the appointment in the city a journey that she takes with her husband. Her nephrologist is based at the regional hospital about 2 hours drive from home.Julie engages with a diabetes educator via phone and face to face monthly . The local hospital is 50 km away and is small, rural hospital. with a locum doctor and regular nursing staff, who cover the acute inpatient ward, and community registered nurse. She attends a community chronic diseases self management program at the local church hall run by the community registered nurse once a week in town and does her weekly groceries. Julie has expressed to the diabetes educator that she need more assistance with managing her own condition. She is concerned that her son who have type 1 diabetes, may end up with the same comorbidities as her because she has an autoimmune chronic condition

Question
identify 5 evidence based nursing intervention that are appropriate to implement in planning the patient's nursing care and provide a clear rationale for each intervention

Answer 1

The five evidence based nursing interventions are:-

1) Intervention

Assess for signs of hyperglycemia for the type 1 diabetes patient.

Implementation

Assessed for signs of hyperglycemia for the type 1 diabetes patient.

Rationale

Hyperglycemia results when there is an inadequate amount of insulin to glucose .excess glucose in the blood creates an osmotic effect that , results in increased thirst ,hunger , and increase urination.

2) Intervention

Assess blood glucose levels before meals and at bedtime to the patient.

Implementation

Assessed blood glucose levels before meals and at bedtime to the patient.

Rationale

Blood glucose should be between 140 to 180 mg/dl .non intensive care patients should be maintained at premeal levels <140mg/dl.

3) intervention

Administer basal and prandial insulin to the patient.

Implementation

Administered basal and prandial insulin to the patient

Rationale

It adherence to the therapeutic regimen promotes tissue perfusion. It keeps glucose in the normal range slows the progression of microvascular disease.

4) intervention

Monitor urine albumin to serum creatinine for renal failure .

Implementation

Monitored urine albumin to serum creatinine for renal failure.

Rationale

Renal failure causes >1.5 mg /dl .microalbuminuria is the first sign of diabetic nephropathy.

5) Intervention

Assess the pattern of physical activity to the patient.

Implementation

Assessed the pattern of physical activity to the patient.

Rationale

Physical activity helps lower blood glucose levels.Regular exercise is a core part of diabetes management and reduces risk for cardiovascular complications .