Introduction
Diabetes mellitus (DM) is a complex metabolic disorder characterised by glucose elevation (hyperglycaemia). The prevalence of this condition has exponentially increased across the globe (Whicher et al., 2020). Specifically, as of 2019, the number of adults living with DM was 463 million (9.3%) of the global population (Banday et al., 2020). It is estimated that if the same trend continues by 2030, there will be 578 million people struggling with the condition (Banday et al., 2020; Zghebi et al., 2017). People develop type 2 diabetes due to abnormalities in insulin secretion or insulin dysfunction leading to hyperglycaemia and other organ complications (Belleza, 2020). There are genetic elements that predispose people to developing the disease when people advance in age and have a sedentary lifestyle (Goff, 2019). The prognosis and presentation of DM vary significantly and may interfere with the normal functioning of body organs. The patients should adhere to strict management recommendations for medications, diet, exercise, and self-care to ensure glycaemic control and enhance their quality of life.
Assessment
It is good practice for patients to undergo regular clinical check-ups, which aids in long-term planning. A patient may come to the hospital for other reasons, but after hospitalization, the physician notices some symptoms that resemble those of DM 2 (Lawson et al, 2018). The signs include excess urine production, lethargy, excessive thirst, and fatigue (Dunning, 2019). Noteworthy, the first step in diagnosis is establishing the patient’s fasting blood glucose. Other important tests are microalbuminuria test and lipid profile for the laboratory examination (Belleza, 2020). For positive result, the nurse should measure their blood pressure levels both while standing and sitting to check for orthostatic changes. Moreover, clinicians should be informed that DM2 is a risk factor to periodontist, and inspect the mouth of all patients (Nguyen et al., 2017). The visual acuity and body mass index of the patients should be assessed to get a comprehensive report on their health and the extent of damage brought about by the diabetes.
Diabetes type 2 has a variety of courses based on the level of insulin malfunctioning. Normally, insulin secretion occurs in the pancreatic beta-cell, which is an anabolic hormone (Belleza, 2020). The hormone is essential for the metabolism, transportation of glucose, and maintaining the same level of sugar in the body. However, for some people, the pancreatic beta cells are destroyed due to genetic predisposition (Nikita et al., 2019). The implication is that glucose cannot be stored in the liver and it is not reabsorbed by the kidney after achieving its threshold leading to glycosuria. In type two DM, the main problem is impaired secretion of insulin and insulin resistance making it ineffective in regulating the release of glucose and leading to hyperglycaemic and hyperosmolar nonketotic syndrome (Belleza, 2020). Gestational diabetes occurs in pregnant women where they experience intolerance at the onset of a pregnancy.
The assessment continues even after the initial prognosis and starting of treatment. In subsequent clinical visits, it is vital to check whether there is any development of neuropathy, cardiac arrest, or foot ulcers (Dunning, 2019). Moreover, it is essential to review if the patient understands how to monitor their blood sugar levels even when they are not using drugs (Parsons et al., 2017). Notably, in the initial stages following a diagnosis most people often have denial which prevent them from adhering to the treatment recommendations. Therefore, assessing if the client is following the pharmacological regimen and making life changes is vital. Knowing some cultural barriers and linking the patient to socio-psychological support is vital in helping cope.
Planning
The DM is a chronic disease, implying that after the initial diagnosis, the patient has to make several adjustments. It is the official role of nurses to make plans that will improve the prognosis of the patient. Nonetheless, during the planning process, a multidisciplinary team of dieticians and nutritionists, nurses, gym instructors, and nurses all have an opinion of how the patient can positively progress (Dunning, 2019). When there is proper professional coordination, the input from all the people is included. Furthermore, the input of the patient, such as their free time, can be included in the patient’s report. Thus, the best care plan for persons with DM should be evidence of collaboration and shared decision-making experience.
The plan should be individualised based on the type of DM, the patients’ schedules, and prognosis. The nurses should psycho-educate patients to take an active role in lowering the glycaemic index through lifestyle changes (Akhter et al., 2017; Coates et al., 2018). Still, they can effectively manage the symptoms for a better outcome. It is also essential to check if there are any possible barriers such as lack of knowledge, resources, time, and poor collaboration that may impend the treatment efforts (Banday et al. 2020; Leal et al., 2020). Understanding the possible drawbacks help to ensure that the nurses are well prepared to deal with unprecedented challenges. The nurses can then come up with strategies such as training or the use of evidence-based research strategies to achieve the desired outcomes.
Furthermore, it is vital to recognise that the treatment for hospitalised patients who have diabetes continues even after their discharge. Firstly, the focus should be on the immediate symptom alleviation and then management of the blood sugar to improve prognosis efforts (Banday et al. 2020). For instance, if the patient comes with a problem or an injury that refuses to heal and is causing pain, the nurses should care for the wound and ensure that the patient is okay. The pharmacological planning is essential in the initial phases of treatment. The medics should have knowledge of drug interactions, allergies, and severe side effects, making the medics plan the correct treatment regimen for the patient. If the patient has other close relatives with the disease, they can assess similarities in the presentation to aid in making plans.
Different types of medication have proved effective for managing diabetes, but they may have undesirable side effects or interact with other drugs. The Biguanides, such as Metformin, are often the first among the doctors’ suggestions (Liao, 2017). They function by cutting the blood sugar and enhancing the utilization of insulin but may interact with Amiloride, Cephalexin, Digoxin, and Procainamide. The second drug regimen is the sulfonylureas classification which clash with more than 100 drugs, including antifungals and antibiotics (Liao, 2017). On the positive side, Metformin has the advantage of reducing glycaemic index and weight (Wilding et al., 2018). There must be a plan to use an alternative class of DM drug when the person is in the hospital. Alternatively, the patient can use non-insulin management strategies through lifestyle change (Owens, 2017). All the plans and the decisions must be documented to make the implementation seamless.
Implementation
The primary objective of implementing the diabetes management plan is to normalise the insulin activities and adapt an intensive treatment while educating the patient on cautions and management of symptoms. Nursing management priorities include restoring electrolytes, reversing metabolic abnormalities, identifying the underlying causes, and preventing complications (Belleza, 2020). The patient must adopt specific lifestyle changes to enhance the quality of life, minimise hospitalization, and improve functioning (Banday et al. 2020). The patient and their non-professional caregivers should be empowered with information on the pathophysiology of DM so that they are intrinsically motivated to manage their symptoms.
Following the drug prescription, dietary changes are essential in helping the patients to manage their blood sugar. Meal planning such as a diet low in carbohydrate is vital in helping patients reach normal levels of BMI (Wang et al., 2018; Dunning, 2019; McArdle, et al., 2017). A diet full of protein is important to increase the feeling of fullness and repair cells (Li et al., 2022). The patient should consume small portions of food regularly instead of eating large portions of meals in a single sitting to enhance glycaemic control. Nursing care should emphasise a patient-centred approach whereby the specific features of the patient, such as sex, age, type of DM, and level of activities, are considered in the meal planning.
Implementing an exercise regime helps the body be more sensitive to insulin, making diabetes more manageable. It is also worth noting that uncontrolled diabetes is a risk factor for other chronic diseases such as cardiovascular diseases and nerve damage (Dunning, 2019; Matthews et al., 2020). However, when a person exercises, they get a variety of benefits, including weight loss and management, controlled blood pressure, better sleep, improved mood, and reduced bad cholesterol. Thanks to digitalization there it is possible to continually get in touch with the patient using electronic media (Pal et al., 2018; Murray et al., 2018). A gym instructor or physical therapist can help the patient decide the best time of engagement in physical activity, type of exercise, and duration. If the healthcare organization has aerobic classes, plans can be made for all patients to join.
Clients should ensure that they have food that help them to cut down the fats. Eating a healthy diet with whole grains, green leafy vegetables, fruits, and nuts help to manage weight and control glycaemic index (Dyson et al., 2020). Family and friends should help support the patients by reminding them of their planned schedule and joining in some of the activities.
Evaluation
An evaluation should follow the implementation of a nursing care schedule to ensure that the treatment program goals are achieved and the patient has a positive prognosis. One way of evaluating is through the measurement of glucose levels. As the patient follows the medications, exercise, and diet routine, they should be able to maintain their blood glucose levels below 7mmol/L/ 140 mg/dL, which is considered normal (Dunning, 2019). Patients with high blood sugar levels may indicate that the plan is not working or they are not faithful in following the program. Providing psychological support is important to avoid stress at this point. The expected outcome is that the clients who are overweight or obese begin to lose weight and then maintain within the normal range. Failure to maintain a healthy body mass index is an indication of failure and a need to restrategise.
The measurements of the overall quality of life can help the care team evaluate progress. Focus should be on variables such as presentation of opportunistic symptoms, number and period of hospitalization, response to drug therapy, and overall patient health. Four main signs may signal that the DM is getting worse, including an extreme feeling of thirst, frequent urination, inexplicable weight loss, and recurrent infections (Dunning, 2019). Patients who present with these symptoms need special attention to prevent them from developing neuropathy; the nurse should ask for other common symptoms, including tingling or numbness in the feet and hands, blurred vision, high blood pressure, fatigue, and increased appetite (Pumerantz et al., 2017). These can be red flags during the evaluation process that shows the treatment program has failed and need some readjustments.
Qualitative questions through direct feedback by patients or their unprofessional caregivers can give elaborate explanations as to the effectiveness of the plan. For example, the nurse can ask about the consistency in taking medication and whether there are any side effects. Moreover, they can make inquiries about the patient’s adherence to diet and exercise routine. The advantage of qualitative evaluation is that it allows the professionals to determine the treatment’s barriers. For example, poor glycaemic control may be due to denial and the use of other traditional drugs. As the client explains, the healthcare professionals identify areas of education and restrategise the treatment plan.
Conclusion
Diabetes is a chronic disease that causes significant strain on the quality of life due to its pathophysiology. However, the patients can have a healthy life with the proper nursing care from the multidisciplinary team. Type 2 require pharmacological, nutritional, exercise, and psychological care. Assessing the patient for their background, allergies, and symptoms is the first and most crucial step in designing an individualized treatment. From the assessment, the multidisciplinary team should collectively decide on the most appropriate drug, diet, and exercise to ensure glycaemic control. Moreover, the family and friends should offer moral support to the patient. Once the plan is implemented, it is vital to evaluate if it suits the patient. The best nursing care plan alleviates the symptoms, reduces chances of hospitalization, and enhances overall wellness.
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