NUR113 Nursing Concepts

Introduction

Chronic illnesses are a threat to the wellbeing of individuals. It is essential for nurses and other health practitioners to manage chronic diseases such as type two diabetes to prevent more deaths.  Nurses play an indispensable role in providing care for adult patients with diabetes type 2. Chronic diseases have been identified as the leading cause of death in the world. Type 2 diabetes causes both long terms and short-term effects. Early treatment and management will promote the well-being of the community. Chronic conditions are related to economic costs encompassing social and community values hence lasting effects reduction in quality of life and lost opportunities. Person-centered care is essential since it helps the individuals to manage themselves in regards to the diseases to improve the quality of life. It is important to note that person-centered care provides a human face to the continuum of care including disease prevention, treatment, care, and support services in regards to the needs and voices of individuals. From a nursing perspective, there is a focus on the patient in a compassionate way (Gluyas, n.d ). Recommendations need to be put in place to enhance nursing practice through patient care.

Type 2 diabetes is a growing health issue yet it is a condition that is managed in primary care by practice nurses. More resources are required to carry out the nursing responsibility for individuals with type 2 diabetes. Nurses must encourage them to take their medications so that the blood glucose level can be controlled.  Adults with diabetes type 2 require critical care to ensure their safety. Nurses ensure that the needs of the patient by listening and creating a dialogue with a view of establishing a relationship in which the person is the principal partner (Tourigny, 2016). This enhances the service efficiency and the effectiveness of the results.  

Pathophysiology of type 2 diabetes

Diabetes is a life-long sickness that affects the way the body handles glucose. It is characterized by a chronic hyperglycemic condition that results from insulin’s insufficient actions.  The primary pathophysiological characteristics of type 2 diabetes are impaired insulin and increased insulin resistance. The reduced insulin secretion is a decrease in glucose responsiveness that is observed before the onset of the disease clinically (Sankar, Veeramani, Balasubramanian, Sivakumar & Kumar, 2017). The impaired insulin secretion is developmental, and its progress encompasses glucose toxicity and lipo-toxicity. If untreated, they cause a reduction in pancreatic B over time. The progression of the impairment of pancreatic B cell function increasingly affects the long-term control of blood glucose. Sufferers at the early stages after the sickness onset clearly shows an increase in postprandial blood glucose as an outcome of increased insulin resistance and decreased initial phase secretion, the progression of the deterioration of pancreatic B cell function subsequently causes permanent elevation of blood glucose (Ferrannini& DeFronzo, 2015).

Insulin resistance is a condition where the insulin in the body does not exert adequate action proportional to its blood concentration. The impairment of insulin action in vital target organs like liver and muscles is a common pathophysiological characteristic of type 2 diabetes. Insulin resistance is developed and expands before disease onset. The research into molecular mechanism for insulin action has clarified how the strength of the insulin is associated with generic elements and environmental elements. Genetic factors that are known include not only insulin receptor, and insulin receptor substrate (IRS)-1 gene polymorphism that affects the insulin signals directly but also polymorphisms of thrifty genes like the uncoupling protein (UCP) gene related to obesity and promotes insulin resistance. Gluocolipo-toxicity and inflammatory mediators are also essential as the mechanisms for impaired insulin secretion and insulin signal impairment ( Yki-Järvinen et al., 2014).

 There is immediate attention that has put the focus on the involvement of adipocyte bioactive substances in insulin resistance. While leptin, resistin and free fatty acids act to add strength, adiponectin enhances resistance. Clinical tests to evaluate the insulin extent resistance encompasses homeostasis model assessment for the resistance of insulin (HOMA-IR), insulin sensitivity test (loading test), steady-state plasma glucose(SSPG), minimal model analysis and insulin clamp technique.

How signs and symptoms affect adults

Adults living with type 2 diabetes are more vulnerable to different types of both long and short-term complications that may lead to premature deaths.  Many people who have diabetes type 2 are mostly obese or overweight with central visceral adiposity. Thus the adipose tissue plays a critical role in the pathogenesis of diabetes mellitus. Many complications are caused by type 2 diabetes encompasses retinopathy (Type 2 Diabetes Mellitus Guide: Causes, Symptoms and Treatment Options. (n.d). This means that people with diabetes mellitus have eye abnormalities in the eyes associated with diabetes development.  Individuals who had no eye issues previously associated with the disease can develop eye problems over more time and time. Therefore it is vital for individuals to control sugars and blood pressure and cholesterol to prevent the development of eye infection (Harding, Shaw, Peeters, Cartensen, & Magliano, 2015).

Another complication is the damage to the kidney. There is an increased risk of kidney disease which means that the longer the individual has diabetes, the more the risk increases. This kind of complication has carried the critical threat of illnesses like heart conditions and kidney failure and urinary tract infections. There can be increased urination, and the drinking of the fluids can be absent or mild (Endocrinology, 2014).   

There is also poor circulation of blood and nerve damage. This is caused by the damaged nerves and hardened arteries that leads to reduced sensation and poor blood circulation in the feet. This may lead to increased infection and the risk of ulcers which heal inappropriately and in turn raises the risk of amputation significantly.  The damage to the nerves can also lead to digestive issues like vomiting, nausea, and diarrhea. Diabetic neuropathy mostly damages the nerves in legs and feet.  The neuropathy can range from pain and numbness depending on the affected nerves. To some people, a person with diabetes can be painful and disabling. A person can have more than one type of neuropathy. The first one is peripheral neuropathy that affects the legs and feet first followed by the hands and the arms. Its signs and symptoms include numbness, burning sensation, increased sensitivity to touch and severe foot issues (Kahn, Cooper & Del Prato, 2014). The second type of neuropathy is autonomic neuropathy that affects the heart, bladder, intestine, stomach, sex organs and eye nerves. It causes hypoglycemia unawareness which means lack of awareness that sugar blood levels are low, bladder issues, constipation, slow stomach emptying, painful swallowing, increased heart rate at rest and matters controlling blood temperature. The third type of neuropathy is radiculoplexus neuropathy that affects the nerves in the thighs, buttocks, legs, and hips.  The symptoms are severe pain in a bone or thigh or buttock that happens in a day or more, Weak and shrunk thigh muscles, difficulty getting up from a sitting position, abdominal swelling and loss of weight.

The last one is mononeuropathy commonly on old adults which refers to damage to a particular nerve in the face, middle of the body or leg. The symptoms always go away without treatment over a few months.  It causes nerve problems in the eyes and in the face that leads to double vision, difficulty focusing, aching behind one eye and paralysis on one side of the face (   Nauck, & Meier, 2016).

The role of the nurse in delivering interprofessional personal centered care

Individuals with chronic conditions like diabetes type 2 must not manage their health in isolation. Nurses must always help the victims to engage in decision making where possible actively. These conditions have a scope of impacts on social, economic and emotional effects. Effectively engaging the individuals in the management of type 2 diabetes empowers them to enhance their knowledge in regards to their condition. It also helps them to involve the caregivers and their families in planning care appropriately. (Acheson, 2012).  Decisions and behaviors are needed to enhance health and wellbeing on a daily basis by individuals themselves. Nurses help individuals to make informed choices and build confidence and understanding that enables action to maximize their results in regards to their health and maintain optimal quality of life at any stage of their illness.

Moreover, nurses ensure that individuals with complex care are supported to navigate and access coordinated care in multiple health contexts and services. They also help in discharging and referring pathways that are in existence between healthcare services. Additionally, they offer a support system and communication about advance care plans, especially during care transitions.

Inaccessible health care services can have adverse effects on the continuity of care.  There can be limited access to health care caused by physical and economic barriers as well as cultural elements like lack of knowledge regarding diabetes type 2. Nurses ensure the patients to have an adequate distribution of services and workforce that will enable them to receive appropriate treatment (Grassi, 2015).  Digital technology can also have a positive effect in promoting the quality of life. Nurses help in using technological tools that create opportunities that improve health regarding type 2 diabetes. These encompass the use of non-face to face where they clinically operate using a phone to give advice, video referencing or other digital health platforms. If they are used appropriately, it can enhance communication between the patient and the nurse and collaboration across health settings and services. This ensures that the patients have equitable access to quality healthcare (Perkin, 2011).

Nurses share information regarding type 2 diabetes which helps in continuous quality improvement procedures individually and ensures that the patients are monitored and evaluated about the health performance. This enhances the patient’s safety because the information shared and creates an intense focus that will ensure better health outcomes. A universal health record is also used by the nurses to share various issues in regards to diabetes type 2.

Recommendations

Nurses should realize that diabetes self-care relies on a sufferer’s beliefs in regards to health or the perceptions of the illness, self-efficacy, wishes, and preferences, coping proactively, support from the family, financial resources and daily events. They should work as a team to ensure that they consider all these points to ensure that there are proper diabetes management and decision making. This will enable them to improve the effectiveness of the care provided. Working as a team will allow them to help as many patients as they can to manage the disease accordingly.

Nurses should also offer therapeutic education to patients in regards to chronic illnesses such as diabetes. Therapeutic training helps the patients to manage themselves appropriately in regards to diabetes mellitus. Patients with these diseases can participate in self-management actively (  Semenkovich, Brown, Svrakic & Lustman, 2015). Therapeutic education encompasses a set of educational activities that are vital for the management of chronic illnesses. Through this, the patients can learn more about the dangers of chronic diseases. They should also promote and evaluation of a healthy lifestyle that focuses on prevention and early treatment of overweight and obesity in adults.

Nurses should also encourage the patients to make healthy meals and engage themselves in physical activities to enhance their health. It is essential for the sufferers to watch what they eat and have access to healthy foods. Nurses must be able to assess the patients regularly to promote a healthy lifestyle. The amount of fats taken must be reduced to prevent obesity and weight gain.  Physical activity is essential to prevent diabetes mellitus. An active lifestyle that involves the physical activity of at least one hour a day and vigorous exercise that is needed to decrease the risk of developing type 2 diabetes. Physical health is essential since it promotes the well-being of an individual. Besides, it prevents chronic diseases like diabetes (Colberg et al., 2016).

Furthermore, early identification of subjects at risk of developing type 2 diabetes is needed.  The must be legislative action to promote a healthy lifestyle for all patients and individuals. The government must ensure that the social, health, nutritional economic and welfare arenas should move forward on an integrated approach to the prevention of the disease. This will help in creating awareness about diabetes type two hence promoting a healthy lifestyle.

In conclusion,   patient care makes sure that the patient is in the centre of health provision and nurses play a critical role in preventing diabetes mellitus since chronic illnesses have been known to be number one cause of death globally. The nurses provide compassionate care to the patients. Proper recommendations must be put in place to prevent further damage caused by type 2 diabetes. Therapeutic education helps the patients to understand more information about chronic diseases such as type 2 diabetes.

References

Acheson, K. J. (2012). Diabetes Pathophysiology. Nutritional and Therapeutic Interventions for Diabetes and Metabolic Syndrome,89-101. doi:10.1016/b978-0-12-385083-6.00007-3

Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., … & Tate, D. F. (2016). Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care, 39(11), 2065-2079.

Endocrinology, T. L. (2014). Kidney failure: Are we failing? The Lancet Diabetes & Endocrinology,2(5), 349. doi:10.1016/s2213-8587(14)70107-x

Ferrannini, E., & DeFronzo, R. A. (2015). Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes. European heart journal, 36(34), 2288-2296.

Gluyas, H. (n.d.). Patient-centred care: Improving healthcare outcomes. Retrieved from https://journals.rcni.com/nursing-standard/patientcentred-care-improving-healthcare-outcomes-ns.30.4.50.e10186

Grassi, L. (2015). Communicating anticancer treatment cessation and transition to palliative care: The need for a comprehensive and culturally relevant, person-centered approach. Cancer,121(23), 4104-4107. doi:10.1002/cncr.29638

Harding, J. L., Shaw, J. E., Peeters, A., Cartensen, B., & Magliano, D. J. (2015). Cancer risk among people with type 1 and type 2 diabetes: disentangling true associations, detection bias, and reverse causation. Diabetes care, 38(2), 264-270.

Hemmingsen, B., Gimenez?Perez, G., Mauricio, D., i Figuls, M. R., Metzendorf, M. I., & Richter, B. (2017). Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, (12).

Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet, 383(9922), 1068-1083.

Nauck, M. A., & Meier, J. J. (2016). The incretin effect in healthy individuals and those with type 2 diabetes: physiology, pathophysiology, and response to therapeutic interventions. The Lancet Diabetes & Endocrinology, 4(6), 525-536.

Perkin, K. (2011). Nurse practitioners and interprofessional collaboration. Journal of Interprofessional Care,25(4), 243-244. doi:10.3109/13561820.2011.586244

Sankar, R., Veeramani, S. R., Balasubramanian, S., Sivakumar, G. S., & Kumar, S. S. (2017). Prevalence and Predictors of Renal Artery Stenosis in Patients with Type 2 Diabetes and Coronary Artery Disease Undergoing Coronary Angiography. INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY, 5(1), 113-115.

Semenkovich, K., Brown, M. E., Svrakic, D. M., & Lustman, P. J. (2015). Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs, 75(6), 577-587.

Tourigny, L. (2016). Nursing and Patient Care. Journal of Nursing & Patient Care,01(01). doi:10.4172/2573-4571.1000e101

Type 2 Diabetes Mellitus Guide: Causes, Symptoms and Treatment Options. (n.d.). Retrieved from https://www.drugs.com/health-guide/type-2-diabetes-mellitus.html

Yki-Järvinen, H., Bergenstal, R., Ziemen, M., Wardecki, M., Muehlen-Bartmer, I., Boelle, E., & Riddle, M. C. (2014). New insulin glargine 300 units/mL versus glargine 100 units/mL in people with type 2 diabetes using oral agents and basal insulin: glucose control and hypoglycemia in a 6-month randomized controlled trial (EDITION 2). Diabetes Care, DC_140990.