Pathophysiology Teaching Plan to Enhance Self-Care Patient confidence in managing their care is fundamental in successes of the patient’s care. The ability to cope with not only the diagnoses of diabetes but also be able to manage the life adjustments which requires daily attention is a challenge which needs assistance from health care providers. Diabetes Diabetes has two types, Type 1 which had been known as Juvenile diabetes, and type 2 which is adult onset. In type 2 diabetes the body either fails to produce an adequate amount of insulin from the pancreas or stops producing insulin.
This revents the body from processing and lowering glucose in the blood, which is shown by elevated glucose levels in lab work and being expelled in the urine. The glycogen stores become markedly reduced and there is less glucose available for release when it may be needed. This teaching is going to discuss the plan to teach a patient how to manage self-care regarding their Type 2 Diabetes diagnosis. As noted by Funnell et al. , (2009) “Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and is necessary in order to improve patient outcomes.
First knowing what the ymptoms are of Diabetes are important and include increased thirst, frequent urination, extreme hunger, unexplained weight loss, presence of ketones, and/or sugar in the urine, fatigue, changes in vision, slow healing sores, and frequent infections (“Diabetes Complications – Mayo Clinic”, 2017). The pancreas is responsible for releasing insulin into the bloodstream. The insulin then enables the sugar to enter cells, which decreases the blood sugar level in the blood. Glucose plays an important role in the body and comes from two sources: food and the liver.
The liver will store the sugar and can also make glucose for elease when glucose fall too low in the bloodstream. In a person who had Type 2 Diabetes, the body is not able to do this, and glucose levels rise. There is still much to understand about why who gets Type 2 Diabetes. Weight can play a factor in development of Type 2 diabetes, inactivity, family history, race, age, if the female had previously developed gestational diabetes, if the female has polycystic ovary syndrome, high pressure, and abnormal cholesterol and triglyceride levels (“Diabetes Complications – Mayo Clinic”, 2017).
Most of these risk factors are preventable or able to be minimized, some enetic factors, like race or family history, are not. This is where prevention teaching for patients who enter care with risk factors is very important. If a patient is able to be educated and exposed to how to minimize their risk factors to possibly prevent the development of type 2 diabetes is life changing. When the development of type 2 diabetes intervention early is critical, to help the patient develop healthy habits which can manage and minimize any complications.
The lines of treatment of type 2 diabetes begins at diet and life style changes if it is caught early. Dietary improvements and increase n physical activity can help decrease the A1C (a blood test used to track glucose levels over the past 3 prior months) and improve other lab values as well. Intervention at this level with the patient includes education as to what foods are high in carbohydrates, which include breads, some vegetables, and fruits, healthy portions and how physical activity can help decrease glucose levels (McCance, 2014).
The next line of treatment would be that of oral hypoglycemic drugs in addition to life style changes noted before. With close monitoring of blood sugar levels, control of glycemic levels is very possible. If not, the next level of treatment is that of injectable insulin. Self-Care Theory The self-care theory used will be that of Orem’s Self-care deficit theory (2011) Teaching for the patient will include many objectives including the patient’s current condition, the needs of the patient, communication level and effective method for this patient, and evaluations of patients understanding and acceptance.
The choice of this theory is that as it allows the provider to review the patient’s defects, so the information can be taught to empower the patient to their highest ability of self- care. Supportive Data The Self-teaching plan is used to address the educational needs of a type 2 diabetic patient in the outpatient setting to promote self-care and management of the disease for an improved quality of life. Desired Patient Outcomes and Objectives The patient will be able to verbalize and demonstrate understanding of the self-care plan and measurements to reach well-being and higher quality of life with control of their diabetes.
The Patient will be able to verbalize healthy food choices, including identifying what carbohydrates are and how to read food labels. The patient will be able to demonstrate nderstanding of their current plan of care by informing nurse how to read their medication labels, including drug name, dose and direction, verbalize their last A1c, how to check their blood sugar with their personal meter and safety discard of sharps. The patient will be able to verbalize a plan of action regarding increasing daily physical activity, including safety actions like keeping snacks on hand for episodes of low blood sugar.
These address Bloom’s revised Taxonomy of learning, as they are all individualized, patient centered, measurable and address the cognitive, affective, and psychomotor domains. Assessment Assessment of the patient’s knowledge of diabetes, including their current health status. Collecting this will show area’s which intervention and education is needed. Assessment of the patient’s preferred method of communication, learning, and educational style need.
This will assist the educator in discussing the information in a manner which the patient will be able to accept, understand and retain critical information regarding their health and their actions. Providing a safe, non-judgmental environment for this is important, as if the patient feels like the ducator is “belittling or thinks the patient is ‘dumb” they will close off to any interaction and accept or trust. Assessment of the patient’s acceptance of the disease, and their support system. If the patient is not accepting that they have Diabetes, they are not ready to learn how to manage it.
They patient may need assistance in progressing thought the phases of acceptance. Assess the patient’s ability to self-monitor, administer, and preform self-care activites. This is important as if the patient is not able to safety administer their medications, or do self-foot exams, then they have areas of risk which may equire additional education, or changes in plan of care. Interventions Educating the patient on what type 2 diabetes is, including the pathophysiology of the disease at an appropriate educational level (Davis, 2009). This would start with asking the patient what they know about diabetes.
The review of symptoms of high blood sugar (hyperglycemia) and low blood sugar(hypoglycemia) will be important, with the patient being able to recall which symptoms go to each condition, what they can do to correct the situation and when to seek medical assistance. This not only mpowers the patient with the ability to monitor themselves, but gives them control in understanding their condition. Surveillance of glucose levels at home and how often they should be seen by their provider. Surveillance of their feet for any injury or change in sensation.
Monitoring of their skin for any non-healing wounds, injections, or changes in sensation. For female patients, the monitoring of vaginal health, including encouragement of well-woman exams as directed by provider, monitoring of yeast infections and bladder infections. The patient’s verbalization of why these actions are important for easuring their understanding and comprehension of information discussed. As noted in Orem’s theory of self-care (2011), the activities carried out by the patient to maintain their own health is therapeutic and measurable.
Evaluation of patient’s self-care of their diabetes will be measured with review of their glucometer readings, if compliant with monitoring of blood sugar and of taking medications, dietary log, physical activity log, if the patient has been in as walk-in patient for infections or diabetic related issues, and clinical findings of their lab values and exam of feet, hands, eyes and dental. The basic conditioning factors of the patient would be collected during the appointment, which includes age, gender, patterns of living, family, health care system and social (“Dorothea Orem Theory- Nursing Theory”, 2011).
These factors may reveal barriers to health care access, medication, or support system, if the patient is noted to be non-compliant. If the patient is the primary care giver for an aged parent, and house money gives to the care of that family member, it may shine light on why the patient is not taking medications as ordered, as they are not able to afford it. This can help provider as it allows an opportunity for the provider to refer the patient to a social worker, who might be able to locate additional services to help with the care of the elder family member.
Being able to understand a patient’s reasoning behind a choice in their care may allow other options in treatment. Healthy people 2020 integration into the patient teaching is very useful, as it will not only help the patient relate to others in the nation with comparison of weight, fruit and vegetable intake, and physical current levels and goals (Healthy People 2020, 2017). In the self-care plan, the Healthy People 2020 goals of Physical activity, increased fruit and vegetable intake and health weight, are all intergratable and helpful interventions for the patient.
As noted in the Health People 2020 (2017) publications, nutrition and weight status is important as it is decreased American’s risk of Type 2 diabetes. Evaluation of Teaching The information which is taught to the patient would be done in a clinical setting, void of unnecessary voice and distraction. The patient will be able to have support system with them, like their spouse. Information with is reviewed via handouts and sample cookbook related to diabetics, are all for the patient to keep.
The session for a diabetic teaching is 30 minutes, which does include 5 minutes’ discussion on ways to increase phys on ways to increase physical activity, 10 minutes for discussion on medication, self-care examinations, home monitoring of blood sugar, logging of diet and physical activities, signs and symptoms to watch out for and safety steps, like wearing shoes, keeping floors clean, keeping an emergency kit of their medication, battery for meter, snacks for low blood sugar and list of medications and last labs. minutes for the provider to exam and discuss information.
5 minutes for evaluations and questions. In most cases, time can go over, or less time in one area to provide more time in another as it is needed for the patient’s situation. Objectives are partially met for most situations. Objectives which are not met, the intervention/plan is re-evaluated for goal to be met at next appointment. In the nursing teaching, in a condition accepting patient, the goals listed are met.
For the future, the nurse can continue to provide education as to medication, side effects, and general patient care and support, but as noted by the National Standards for Diabetes Self-Management Educations, “DSME will be provided by one or more instructors. The instructors will have recent educational and experiential preparation in education and diabetes management or will be a certified diabetes educator. ” (2010). This will provide a richer, higher level of diabetic centered patient centered education for the patient. Having a nurse educator whom is also a certified diabetes educator can be a great assist for facilities.
Evaluations of Evidence Based Resources The handouts for the patient’s session would be locally provided by the Diabetes Program, which is a grant run program which provides diabetic support, prevention and education to the local population of the Three Affiliated Tribes. The Evidence Based Resource of Healthy People 2020, Funnell et al. National Standards for Diabetes Self-Management Education (2009), The Mayo Clinic (2017) and the Nursing Theory (2017) all provide a well explained description of how important it is to have a patient centered plan of care for the patient for the maximized potential for patient successes.
With keeping the guidance of the course books in mind, structuring an educational plan for the patient, to empower the patient, is not only good practice, but provides the patient the needed tools to live. Without a wellstructured plan of care, and self-management teaching, the patient is set up to fail in managing their health (Bradshaw, & Hultquist, n. d. ). Reflection Reflection of the teaching plan would show that of being able to have more time with the patient, as to further explore life style changes and modifications to maximize successes in their management of health.
Being able to understand the barriers which are not only in place for nurses to be able to teach and guide patients when they need it, but for the patient as well. Time barriers for both the patient and the nurse, as there is only 30 minutes scheduled for the patient, which is decreased if they must go to lab, or are running late. Work load of the nurse, as she might not be able to fully devote that patient’s time to the patient, as there is other patients to hurry and get roomed.
Greater than that, can be the health care assess barriers, as patients might have long waits before an appointment for the provider is available. As a masters prepared nurse, being able to look into the larger picture when it comes to issues which prevent a patient from receiving the highest level of teaching, is an areas which can be explored more. Perhaps with decreasing these barriers, it will allow the patient and nurse to have a more effective teaching experience.
