STU Managing Individuals With Persistent Diabetes Discussion Replies
150 words each with peer review article (with a DOI):
Alexandra
This week of clinical was good, and I feel that I was able to learn some valuable skills to help me in my own practice one day. I have noticed that a lot of the patients who come to the office are mostly follow-ups, blood reviews, or medication refills. I try to take initiative when there is a physical or a sick patient so that I am sure to work on my skills while I am there. I feel that I have gotten better at predicting patient outcomes and determining the plan of care before I speak to my preceptor. It feels good to become more comfortable and efficient in my practice.
One patient in particular was memorable to me this week. She presented for a follow-up appointment after being hospitalized. She mentioned that she was hospitalized due to an event that occurred where she could not breathe or catch her breath. She stated that she went to bed fine and she woke up the next morning feeling like she was gasping for air. She stated that she could not even gather enough air to speak her name to the 911 operator. She was transported to a local hospital and treated for hypoxia. She stated that she was on a C-pap machine for 3 days and was released with medication and a recommendation to follow up with pulmonology. The patient presented in the office with her symptoms resolved but she was very nervous that it was going to happen again. She stated that she is a heavy smoker and she is worried she might be having these problems because of that. She related that this event occurred on the one-year anniversary of her daughter’s passing and that she is taking it as a sign to quit smoking. Her physical exam was unremarkable and lung sounds were clear.
The plan of care for this patient would be to put her in contact with a pulmonologist who could aid her in diagnoses and treatment. For this patient, it is also imperative that she quit smoking as any further exacerbation could be detrimental to her health. I would provide her with smoking cessation tools and prescribe medication to aid her in this process. Furthermore, continuing the medication prescribed by the hospital is important until she can follow up with a pulmonologist. At the hospital, she was prescribed an antibiotic and an inhalant.
One possible differential diagnosis for this patient includes chronic obstructive pulmonary disease (COPD). COPD is one of the most prevalent diseases among smokers, commonly seen in older adult females (Wheaton, et al., 2019). Given these statistics, this patient has multiple risk factors that would correspond with this diagnosis. COPD is often characterized by persistent respiratory symptoms and airway restriction (Alobaidi, et al., 2020). Another possible diagnosis is chronic bronchitis. Chronic bronchitis is a sub-diagnosis of COPD that a patient can experience when they have an exacerbation. This is often characterized by persistent airway inflammation, which can include a productive cough and chest pain (Kim & Criner, 2013). Lastly, a panic attack related to post-traumatic stress disorder is a possible diagnosis for this patient. Given that the patient mentioned that this event occurred on her daughter’s passing anniversary it is possible that she could have experienced a panic attack that resulted in her not being able to breathe.
The health promotion intervention for this patient would be to educate her on the possible diagnoses of COPD. Given that this is her first time having an exacerbation she may not know exactly what the disease means. Also, aiding the patient in cessation of smoking and education as to why cessation of smoking is necessary will be incorporated into the health promotion. Lastly, offering the patient support and helping her find possible support groups for parents who have lost children may be beneficial for her grieving process and help to avoid any panic attacks associated with her loss.
Aiding a patient in discovering and managing a new disease and diagnosis is something that I will carry into my practice as a Nurse Practitioner. I will carry forward the ability to diagnose, treat, and refer patients to the correct specialty.
Hany
Introduction
The clinical experience I had this week was fulfilling and demanding as I continued to treat patients with chronic diabetes. The emphasis was on evaluating, identifying, and organizing a patient’s care for diabetes and its consequences. The difficulties and achievements encountered during the clinical experience, a thorough patient assessment, potential differential diagnoses, interventions for health promotion, and the relevance of the most recent peer-reviewed research guidelines in enhancing the care of diabetic patients will all be covered in this essay.
Challenges and Successes
This week presented a range of difficulties and achievements in the care of people with long-term diabetes. A patient who failed to control their blood glucose levels even though they took their medication as prescribed posed a significant challenge. This demonstrated how difficult it is to control diabetes and how individualized care regimens are necessary. Seeing improvements in a patient’s wound healing as a result of diligent adherence to their care plan and medication regimen was the week’s highlight. This emphasized how crucial patient education and self-care are to the treatment of diabetes.
Patient Assessment
This week’s featured patient was a male, 58-year-old with a lengthy history of type 2 diabetes. The following signs and symptoms (S&S) were present in him:
The patient complained of excessive thirst and urination, or polyuria and polydipsia.
Unintentional weight loss: Over the previous few months, he had shed ten pounds.
Fatigue: The patient reported feeling quite weak and fatigued.
Inadequate management of blood glucose: His HbA1c value of 10.2% suggests inadequate glycemic control.
Neuropathy: He complained of numbness and tingling in his feet.
Non-healing foot ulcer: There were indications of infection on the patient’s diabetic foot ulcer.
Examination
Examining the patient revealed that his vital signs were stable, but that he had a non-healing ulcer on the plantar aspect of his right foot, along with purulent discharge, erythema, and warmth (Alshammari et al., 2021). Although he could feel his peripheral pulses, his lower extremities had diminished sensation, which may indicate neuropathy. The patient’s lab findings showed raised white blood cell count and elevated fasting blood glucose levels, both of which were compatible with infection.
Plan of Care
The management of hyperglycemia involves closely monitoring blood glucose levels and starting insulin therapy. According to the American Diabetes Association’s (ADA) standards, glycemic control should be approached individually.
Wound care includes unloading the afflicted foot, topical medicines, and daily dressing changes. The patient’s wound care plan complies with the guidelines for controlling diabetic foot ulcers provided by the International Working Group on the Diabetic Foot (IWGDF).
Infection Control: In order to treat the infection, antibiotics were prescribed based on the results of the culture and sensitivity tests (Alshammari et al., 2021). This is in keeping with the guidelines for diabetic foot infections provided by the Infectious Diseases Society of America (IDSA).
Differential Diagnoses
1.Diabetic Foot Ulcer: The most likely diagnosis, based on the patient’s clinical presentation and diabetes history, is diabetic foot ulcer (Holton et al., 2022). Such ulcers are more likely to occur in patients with neuropathy and poorly managed blood glucose.
2.Cellulitis: One typical consequence of diabetic foot ulcers is cellulitis, which is made more likely by the erythema, warmth, and purulent discharge surrounding the ulcer.
3.Osteomyelitis: This condition should be taken into consideration when non-healing foot ulcers occur, particularly if the infection is persistent. To rule out bone involvement, you might need to get an MRI or X-ray.
Health Promotion Intervention
Diabetes self-management is the main goal of the patient’s health promotion program. This includes teaching the patient the value of appropriate foot care, blood glucose monitoring, medication compliance, and lifestyle adjustments. Telling him to join a support group for people with diabetes support group can also provide emotional support and further education.
Significance of Research Guidelines
Current peer-reviewed research criteria that guarantee evidence-based practice support the care strategy. A solid basis for managing diabetes and its complications is provided by the IWGDF Guidelines for diabetic foot ulcers and the ADA guidelines for glycemic management. We can give our patients the finest care possible and achieve better results by following these recommendations.
Conclusion
The clinical experience that we had this week managing individuals with persistent diabetes was both educational and difficult. Evidence-based practice was ensured by developing the patient’s assessment, care plan, and health promotion intervention based on the most recent research guidelines for diabetic foot ulcers. Differential diagnosis took into account a range of options and emphasized the significance of personalized care. An advanced practice nurse can learn a lot from this experience, which emphasizes the need of ongoing education and research-based care in the effective management of patients with chronic diabetes.
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.
