Type I Diabetes

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Type I Diabetes Mellitus

Type I Diabetes Mellitus simply state is having too much glucose in the blood. Unfortunately, it is not such a simple disease. Type I diabetes is the most dangerous to have and it used to mean an early death to those diagnosed with it. It is usually in the emergency room that these patients are diagnosed. They come in very sick, unaware of the severity or nature of their illness. The pancreas, the organ that produces insulin, produces no insulin at all. They seem to think that the bodys immune system attacks and destroys the part of the pancrease that produces insulin (William L. Isley, 2005). This lack of insulin prevents the transportation of glucose to cells, which deprives them of the energy needed for the body to function.

Basic Conditioning Factors

Mrs. S, a 57 year old woman was admitted with a blood sugar of 348 mg/mL today and is also complaining of tingling in her toes. Upon further assessment, the area at the tip of her left great toe shows signs of skin breakdown. She was recently diagnosed with type 1 diabetes. She has not seen her endocrinologist as recommended but she has gone to one diabetes education class. She has a medical history of depression and hypertension (HTN). Her vital signs are as follows: blood pressure -132/76; temperature 98.9 Fahrenheit; pulse 98; respirations 24; weight 196 pounds. Her labs, A1C is at 8.1% and her BUN and creatinine are within normal limits. She currently takes lisinopril (Prinivil) 25 mg, three times a day; Lantus insulin 10 units every morning; Lispro insulin 1 unit per 15 grams of carbohydrates consumed; Lexapro 10 mg daily and vitamin D 2000mg daily.

Expected Signs and Symptoms of Primary or Admission Medical Diagnosis

Common signs and symptoms of diabetes type 1 include the three Ps, Polydypsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive hunger) (Williams/Hopper, 2015). Another side effect is diabetic ketoacidosis (DKA). This is frequently the illness, which brings the patient in for treatment, which results in a diagnosis of type 1diabetes. Diabetic ketoacidosis is a serious condition. It is like a domino effect. The cells starve because the lack of insulin to bring glucose to the cells. Next the body starts breaking down fat to fuel the cells and as a result an acid like substance called ketones(Williams/Hopper, 2015) are released into the blood stream. Once this occurs, the ketones continue to build up causing DKA.

Some other symptoms include Kussmauls respirations, breath that may smell of fruit or alcohol, abdominal pain, vomiting and dehydration(Williams/Hopper, 2015). According to Williams and Hopper, if DKA is left untreated tachycardia, hypotension, shock, loss of consciousness occur and finally death. There are several causes of diabetic ketoacidosis, overeating, too much stress, a sudden illness or lack of prescribed insulin or medication(Williams/Hopper, 2015).

Nursing Diagnosis

Mrs. S shows ineffective self-health management that is related to complexity of therapeutic regimen; deficient knowledge; perceived seriousness as evidenced by serum glucose of 348 mg/mL and impaired skin integrity on left great toe.

Plan of Care

Nurse will help the client to self-manage her own health through teaching about strategies for changing eating habits; establish a collaborative partnership with the client for purposes of meeting health-related goals; help client to enhance confidence in her ability to manage the illness; involve family members in knowledge development, planning and shared decision-making. Patient will upon discharge describe daily food and fluid intake that meets therapeutic goals. She will also verbalize ability to manage therapeutic regimens and collaborate with health care providers and education classes to decide and implement such therapeutic regime that is fitting with goals and personal lifestyle.

Medications

Lantus (glargine) is classified as an anti-diabetic and is a long-acting insulin. It is used with both type 1 and type 2 diabetics to manage hyperglycemia. It stimulates glucose uptake in the muscles and fat and inhibits hepatic glucose production (April Hazard Vallerand, Cynthia A. Sanoski, Judith Hopfer Deglan, 2017).

Lispro (Humalog) is also classified as an anti-diabetic, is a rapid acting insulin and is used to control hyperglycemia in both type 1 and type 2 diabetics. Its action on the body increases glucose uptake in muscle and fat and impedes glucose production in the liver. Blood sugar testing should be done before administration and the patient should have a meal readily available as well as willing to eat (April Hazard Vallerand, Cynthia A. Sanoski, Judith Hopfer Deglan, 2017).

Prinivil (lisinopril) is classified as an angiotensin converting enzyme inhibitor (ACE inhibitor) anti-hypertensive by producing vasodilatation. It is prescribed to lower blood pressure and decreases risk of death from a cardiovascular causes. Side effects and adverse reactions can include cough, hypotension, taste disturbances, dizziness fatigue, headache, chest pain edema, tachycardia, diarrhea, nausea and vomiting, to the more severe angioedema and agranulocytosis (April Hazard Vallerand, Cynthia A. Sanoski, Judith Hopfer Deglan, 2017). Lexapro (escitalopram) is classified as antidepressant and is a selective serotonin reuptake inhibitor, (SSRI).

It works by preventing the reuptake of serotonin in the central nervous system (April Hazard Vallerand, Cynthia A. Sanoski, Judith Hopfer Deglan, 2017). Some of the more common side effects are insomnia, diarrhea, nausea, drowsiness, abdominal pain, and decreased libido. The more severe include suicidal thoughts, serotonin syndrome and neuroleptic malignant syndrome. Vitamin D fat-soluble and is classified as a vitamin and/or supplement. It is taken daily to prevent and treat vitamin deficiencies and to supplement patients with certain metabolic disorders.  

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