UNIT
\nCODE HLTENN025 UNIT TITLE Implement and monitor care for a person with diabetes
\nQualification Code HLT54115 Qualification Title Diploma of Nursing
\nTask Number
\n&
\nName 1. Case study with Short answer questions.
\nStudent ID Number 5886478 Student Name Samjhana magar
\nStudent Declaration
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\n\u2022 I have been made aware of my rights and responsibilities as a student and have read the student handbook.
\n\u2022 This assessment is my original work and no part of it has been copied from any other source except where due acknowledgement is made.
\n\u2022 No part of this assessment has been written for me by any other person, except where such collaboration has been authorised by the assessor concerned.
\n\u2022 I have not previously submitted this work for this or any other program\/unit.
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\n\u2022 I give permission for this work to be reproduced, communicated, compared and archived for the purpose of detecting plagiarism.
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\n\u2022 Note: the UOW College will hold a copy of this completed form and relevant completed task for 6 months.
\n\u2022 I declare that I agree to the above statements
\nSigned samjhana Date<\/p>\n
Assessor to complete:
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\n? Not Yet Satisfactory ? Satisfactory
\n? Not Yet Satisfactory
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\n2nd Submission
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\nResult Code What this result means
\nSatisfactory S You have completed the individual task to a satisfactory standard
\nNot Yet Satisfactory NYS You have not completed the individual task to a satisfactory standard, in this case please discuss your options with your Trainer\/Assessor, you may be able to resubmit if this was your first attempt at the task.
\nCompetent C You have successfully completed all assessment tasks satisfactorily and are now competent in this Unit of Competency
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\nASSESSMENT OVERVIEW
\nTask Due Date Steps required for completion \u2013 Learner to check each requirement
\n1. Case Study and Short Answer Questions One week after delivery of refresher unit, on Sunday 2400.*Trainer to confirm exact date ? Learner will be emailed this assessment booklet. It must be downloaded, completed and emailed back to the trainer in word document form *Trainer to confirm submission method, alternative is for download and upload through Axcelerate.
\n? Learner must respond to ALL questions in the case study
\n? All answers must utilize in text citations and a reference list
\nIf you disagree with the task result, you have the right to appeal the decision. Please refer to the student grievance policy found on the UOW College website.<\/p>\n
HLTENN025 \u2013 Implement and monitor care for a person with diabetes
\nTASK 1 \u2013 Case study and Short Answer Questions
\nDue Date: Sunday 2400, One (1) weeks after completion of unit.
\nWord Count: Answers can be brief but must included all required information. Unless specified answers should be composed in full sentences with a logical progression of ideas.
\nSubmission Method: Student Assessment booked
\nReferences: Harvard format, including in text citation and reference list.
\nInstructions:
\nYour answers do not need to be over lengthy, but do need to provide sufficient information and detail to demonstrate that your knowledge and ability is consistent with the following criteria:
\n\u2022 theoretical and practical knowledge and skills for specialised and\/or skilled work and\/or further learning
\n\u2022 broad factual, technical and some theoretical knowledge of a specific area or a broad field of work and learning
\n\u2022 broad range of cognitive, technical and communication skills to select and apply a range of methods, tools, materials and information to complete routine and non-routine activities
\n\u2022 knowledge and skills to demonstrate autonomy, judgement and limited responsibility in known or changing contexts and within established parameters
\nYour answers should reflect your learning in class and utilise the resources recommended by your trainer.
\nYou may be required to provide examples, strategies, methods or give your opinion which may come from your nursing work, nursing training or other professional experiences.
\nYou should be providing sufficient detail to demonstrate your underpinning knowledge, understanding, and also provide any additional information or knowledge which supports your recommendations.
\n.
\nBob is a retired 69-year-old man with a 5-year history of type 2 diabetes. Although he was diagnosed in 1997, he had symptoms indicating hyperglycemia for 2 years before diagnosis. He had fasting blood glucose records indicating values of 6.1 \u2013 7.8mmol\/L, which were described to him as indicative of \u201cborderline diabetes.\u201d He also remembered past episodes of nocturia associated with large pasta meals and Italian pastries. At the time of initial diagnosis, he was advised to lose weight (\u201cat least 10 kg\u201d), but no further action was taken.
\nReferred by his general practitioner to the diabetes specialty clinic, Bob presents with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on glyburide Metformin, 500 mg\/dayevery morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon.
\nBob also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia (elevated LDL cholesterol, low HDL cholesterol, and elevated triglycerides). He has tolerated this medication and adheres to the daily schedule. During the past 6 months, he has also taken a \u201cpancreas elixir\u201d in an attempt to improve his diabetes control. He stopped these supplements when he did not see any positive results.
\nHe does not test his blood glucose levels at home and expresses doubt that this procedure would help him improve his diabetes control. \u201cWhat would knowing the numbers do for me?,\u201d he asks. \u201cThe doctor already knows the sugars are high.\u201d
\nBob states that he has \u201cnever been sick a day in my life.\u201d He recently sold his business and has become very active in a variety of volunteer organizations. He lives with his wife of 48 years and has two married children. Although both his mother and father had type 2 diabetes, Bob has limited knowledge regarding diabetes self-care management and states that he does not understand why he has diabetes since he never eats sugar. In the past, his wife has encouraged him to treat his diabetes with herbal remedies and weight-loss supplements, and she frequently scans the Internet for the latest diabetes remedies.
\nDuring the past year, Bob has gained 30kg. Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 3kg. He has never seen a dietitian and has not been instructed in self-monitoring of blood glucose (SMBG).
\nBob\u2019s diet history reveals excessive carbohydrate intake in the form of bread and pasta. His normal dinners consist of 2 cups of cooked pasta with homemade sauce and three to four slices of Italian bread. During the day, he often has \u201ca slice or two\u201d of bread with butter or olive oil. He also eats eight to ten pieces of fresh fruit per day at meals and as snacks. He prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by pasta. His wife has offered to make him plain grilled meats, but he finds them \u201ctasteless.\u201d He drinks 8 oz. of red wine with dinner each evening. He stopped smoking more than 10 years ago, he reports, \u201cwhen the cost of cigarettes topped a buck-fifty.\u201d
\nThe medical documents that Bob brings to this appointment indicate that his hemoglobin A1c(A1C) has never been 8%. His blood pressure has been measured at 150\/70, 148\/92, and 166\/88 mmHg on separate occasions during the past year at his general practice clinic. Although he was told that his blood pressure was \u201cup a little,\u201d he was not aware of the need to keep his blood pressure =130\/80 mmHg for both cardiovascular and renal health.<\/p>\n
Bob has never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunisations are up to date, and, in general, he has been remarkably healthy for many years.
\nPhysical Exam
\nA physical examination reveals the following:
\n\u2022 Weight: 130kg height: 170cm body mass index (BMI): 32.6 kg\/m2
\n\u2022
\n\u2022 Blood pressure: Sitting, right arm 154\/96 mmHg;
\n\u2022 Pulse: 88 bpm; respirations 20 per minute
\n\u2022 Eyes: corrective lenses, pupils equal and reactive to light
\n\u2022 Heart: Rate and rhythm regular, no murmurs or gallops
\n\u2022 Vascular assessment: femoral, popliteal, and dorsalis pedis pulses 2+ bilaterally
\n\u2022 Neurological assessment: diminished vibratory sense to the forefoot, absent ankle reflexes, monofilament (5.07 Semmes-Weinstein) felt only above the ankle
\nLaboratory Results
\nResults of laboratory tests (drawn 5 days before the office visit) are as follows:
\n\u2022 Glucose (fasting): 8.9 mmol\/L
\n\u2022 Creatinine: 1.0 mg\/dl (normal range: 0.5\u20131.4 mg\/dl)
\n\u2022 Blood urea nitrogen: 18 mg\/dl (normal range: 7\u201330 mg\/dl)
\n\u2022 Sodium: 141 mg\/dl (normal range: 135\u2013146 mg\/dl)
\n\u2022 Potassium: 4.3 mg\/dl (normal range: 3.5\u20135.3 mg\/dl)
\n\u2022 Lipid panel
\n\u2022 Total cholesterol: 5.3 mmol\/L
\n\u2022 LDL cholesterol (calculated): 1.8 mmol\/L
\n\u2022 HDL cholesterol: 1.5mmol\/L<\/p>\n
\u2022 HbA1C: 8.1% (normal: 4\u20136%)
\n\u2022 Urine microalbumin: 45 mg (normal: 30 mg)
\nSection 1. Identify diabetes care services in the Australian health care environment
\n1.1. Describe and briefly discuss three (3) diabetes care services available in New South Wales. Your answer must include information on funding of the service.
\n1. NDDS
\n2.Diabetes NSW AND ACT Australia
\n3.
\n1.2 Describe and briefly discuss three (3) members of the interdisciplinary team who provide specialist or complementary care to the person with diabetes (ie. In addition to medical and nursing staff). Your answer must include a description of the role of organization or provider.
\n1.deitician or nurse \/ pharmacist\/ podiatrist
\n2.diabetic educator
\n3.doctor
\n1.3 Describe and briefly discuss two (2) agencies or community organisations where you could refer Bob. Discuss how he could benefit from that referral.
\n1.comunity health center .
\n2.diabetic clinic.
\nSection 2. Assess the needs of person with diabetes
\n2.1 Briefly explain the pathophysiology of diabetes. Your answer must include the key difference between Type 1 and Type 2 diabetes mellitus.
\n2.2 Based on the case study complete a holistic nursing assessment of Bob. Your answer needs to review his history, current results and observations and treatment regime. List and briefly describe six (6) issues that will need to be addressed when planning care for Bob.
\n1.diet plan
\n2.medication review
\n3.education
\n4.nutritional assessment for diet plan
\n5.neuro vascular care for foot
\n6.physio assessment advising for regular check up 6
\n2.3 Discuss Bob\u2019s current understanding of his condition, self-management strategies and medications. Your answer must include the strategies and assessments you would use to determine Bob\u2019s level of knowledge.
\n– open eneded question: background adls,
\nstrategies
\n–
\nCommunication,
\nvisual assessment.
\na-h assessment blood pressure
\nneurological assessment
\nmanagement
\nexcersie, diet
\nMediation review. Not taking his medication, metformin and lipto
\n2.5 1. How would you assess Bob\u2019s wife\u2019s understanding of diabetes? 2. How does her level of understanding impact Bob\u2019s diabetes management? 3. How could you involve her in the care planning for Bob?
\n1. Knowledge and understanding
\n2. she is the carer of the bob,
\n3. we can ask open ended question to her wife abd assess her she got the understanding
\nContribure in regrads to nutritional , medication on time.
\nSection 3. Perform complex nursing intervention to Help a person to achieve and maintain optimal diabetes health
\n3.1 1 a. List in order of priority Bob\u2019s three (3) most important nursing care needs and then discuss why you prioritised these issues in this order.
\nHtn affect cardiac and renal
\nFoot care -reflexion, injuries,
\nHealth ducation for diabetes , diet, self management<\/p>\n
1.monitir bld sugar
\n2.guve toeat
\n3. remonitored after 30 ,min and record
\nRationale for Prioritisation:
\nAt 3pm Bob is returning from the toilet. You note he is unsteady on his feet. He looks pale and sweaty and complains of having a headache and feeling dizzy. He tells you he is trying a new diet where you fast intermittently and he hasn\u2019t in fact eaten anything since 6pm the previous day. You take his blood glucose level and it is 3.4mmolL His urinalysis shows SG 1035, +++glucose, +ketones.
\n3.1.1.b How does this new information impact how you would prioritise Bob\u2019s nursing care?
\nHydration therapy
\nFluid, obesravation related to bgl
\nEncourage diet
\n2.4 Explain in relation to your knowledge to diabetes, the likely cause of Bob\u2019s signs and symptoms.
\nStarvation = dehydration= glucose krtonr hypo
\nThirst,
\n3.4 Describe your clinical actions in response to Bob\u2019s signs and symptoms.
\nI will do monitor blood sugars and give him something to eat likelollies to raise his blood sugars, fluid hydration
\n3.5 1. Evaluate and interpret Bob\u2019s blood and urine test results. Briefly discuss the findings.
\n2. Using the ISBAR model communicate findings to the interdisciplinary health care team.
\nI –
\nS –
\nB –
\nA –
\nR –
\n3.6 Your interventions are effective. Describe how you would continue to liase with the registered nurse while providing ongoing support for Bob.
\nSection 4. Evaluate the care plan for a person with diabetes, and support a person\u2019s self-management.
\n3.2 Using the template below develop a care plan for the management of Bob\u2019s diabetes for the next six months. Your answer must include four (4) Nursing diagnoses and both short term and long term goals for Bob. It also must include interventions that support self management of diabetes.
\nNursing Diagnosis Goals Interventions
\n1.nutrition deficiency
\n2.education on diabetes
\n3.foot care
\n4.
\n3.3. Discuss how would you assess Bob and his wife\u2019s understanding of his new care plan, particularly relating to his new self-management strategies?
\nOpen- ended question
\n6 Months later Bob returns to the clinical and you are asked to review his diabetes management. He has lost 7kg. His BP is 120\/80, PR 70, RR 18. He demonstrates independently taking his blood sugar level and his random BSL is 6.7mmol\/L. You review his BSL readings and find that he has had readings of 3-4 2 or times a week. He has been compliant with his medication telling you he takes it first thing of a morning, before his morning walk and before breakfast so that he never forgets. Bob tells you his wife is still very support and no longer makes him take the supplements. He does state that she insists he eats 3 pieces of fruit every day to support his vitamin intake.
\nBob asks you if you know of any good support groups for people with diabetes and somewhere so he can -go exercise with people my own age-
\n4.1 Review Bob’s care plan. Suggest a modification according to the person s progress toward planned outcomes in and who you would consultation and collaboration with from the interdisciplinary health care team.
\nConsult local gp in regards to medication for further education to medication
\nRefer back to dietician to review their plans for the updates
\nSend to diabetic educator f he wills for review or follow up of the plans.
\n4.2 Compare your nursing interventions and their outcomes against evidence-based best practice in diabetes nursing care. Briefly discuss any commonalities or differences.
\nSeek Careplan
\n4.3 Identify and discuss two (2) opportunities for Bob and his wife and provide information on available community resources and how to access them.
\n1.local pharacist
\n2.community nurses\/ community health care center
\n4.4 From the information in the case study discuss whether you feel Bob’s understanding of his condition, medications, regimes and self – management has improved. Your answer must include the strategies can you utilise to check his understanding.
\n– re-evaluating ,
\nBob has zero knowledge first
\nNursing care plan
\nCheck his weight
\nPerform assessment.
\nBgl
\n4.5 Discuss how would you help and support Bob in providing correct information to his wife.
\n4.6 Write a brief progress note relating to Bob’s uptake by the person of specific health promotion initiatives to support hi self-management. Your answer must include: Weight\/BMI, exercise, diet, self- monitoring, compliance with treatment regime.
\nBob is demonstrating his weight and maintaining and looks healthy
\nKnows how to check BSL and checking 3 times a day
\nTaking medicine at the correct time
\nWorking on regular exercises
\nWife knows how to cook the diabetic food and they are happy with each others.
\nSuggested Resources
\nhttps:\/\/www.bupa.com.au\/health-and-wellness\/health-information\/az-health-information\/cholesterol-and-your-health
\nhttps:\/\/www.nps.org.au\/australian-prescriber\/articles\/safe-prescribing-of-metformin-in-diabetes
\nhttps:\/\/www.diabetesaustralia.com.au\/type-1-diabetes
\nhttps:\/\/www.diabetesaustralia.com.au\/type-2-diabetes
\nhttps:\/\/static.diabetesaustralia.com.au\/s\/fileassets\/diabetes-australia\/f4346fcb-511d-4500-9cd1-8a13068d5260.pdf
\nBrown, D., Edwards, H. 2014 Lewis\u2019s medical-surgical nursing: assessment and management of clinical problems, Chapter 48: Nursing Management of Diabetes, Elseveir, Chatswood.
\nhttps:\/\/www.dhhs.tas.gov.au\/publichealth\/health_literacy\/health_literacy_toolkit\/checking_understanding<\/p>\n
.
\nStudent Assessment
\n(complete one only at the end of each unit of competency)
\nUNIT
\nCODE UNIT TITLE
\nQualification
\nCode Qualification
\nTitle
\nStudent ID Number Student Name
\nTraining Content
\nWhat did you like best about the training, and why?
\nWhat did you like least about the training, and why?
\nIf your attitudes have changed through undertaking this training, please indicate what has changed, and what part of the training influenced this change.
\nAre there any changes you would suggest to improve the training program? If so, what would they be?
\nDid the trainer establish and maintain a supportive learning environment?<\/p>\n
Please tick as appropriate (1 \u2013 Poor ? 5 \u2013 outstanding)
\nRATING 1 2 3 4
\nWas this session relevant to you in your work? (if applicable)
\nWas the trainer prepared and organised?
\nHow do you rate the quality of the resources used?
\nHow do you rate the usefulness of workbook activities?
\nHow do you rate the effectiveness of practical exercises?
\nI authorise the use of the above comments in marketing material and publications.
\nYes ? No ?
\nStudent Signature Date<\/p>\n","protected":false},"excerpt":{"rendered":"
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