The Supporting Narrative & Gestational Diabetes, Essay Example

Patient-Centered Concept Map

Gestational diabetes is experienced for the first time during pregnancy. Those at risk are female beyond 25 years, are African American, Hispanic, American Indian, and have a family history of the disease. In the U.S., diabetes affects about 25.8 million people, which comprise 8.3 percent of the total population. About 18.8 million people have been diagnosed while about 7 million people are undiagnosed. By the year 2010, about 25.6 million people above 20 years, which is 11.3 percent were diagnosed with the diabetes in the U.S. The reported cases of gestation diabetes are experienced by about 2-10 percent of the pregnancies. Shortly after pregnancy, about 5-10 percent of females with gestation diabetes are diagnosed with diabetes type 2. Those who had gestation period, are 35-60 percent more likely to develop diabetes in the next 10-20 years. It has been noted that the difference in the diabetes prevalence is attributed by race, ethnicity, and age differences. About 14.2 percent of the American Indians and Alaska Natives of 20 years and above were diagnosed with diabetes according to Indian Health Services. Non-Hispanic whites comprise 7.1 percent, 11.8 percent of Hispanics, while the non-Hispanic blacks recorded 12.6 percent. The risk is higher among the Asian Americans than non-Hispanic white adults by 18 percent. According to the American College of Obstetricians and Gynecologists, the recommended level of blood sugar should be maintained at 95 mg/dl before meals, 130 mg/dl 1 hour after the meal, and 120 mg/DL 2 hours after the meal. However, for someone without diabetes, fasting blood sugar should be 100 mg/ dl or below while postprandial should be below 140 mg/dl two hours after the meal.

The Patient’s Needs and Family

Ms. Carole Lund arrived this morning in the company of her 10-week old daughter to the Uptown Wellness Center. She had concerns about an existing health condition that developed during pregnancy. Ms. Lund is a 44-year-old female with a mixed Native American and a European descent and a first-time single mother, English is her 2^nd language with the highest level of education known to be high school. Studies reveal that female that lives in an English-speaking nation, though dominantly speak a language besides English; usually, have a lower rate of dietary comprehending compared to their English-speaking associates (American Diabetes Association, 2014).

Additionally, she underwent a cesarean section 10 weeks ago. At exactly 30 weeks of her pregnancy, Ms. Lund received a diagnosis of gestational diabetes, but the obstetrics and gynecology advised that her blood sugar would return to normal. However, the patient has not been able to stabilize her blood glucose since this diagnosis. She stated that her fasting blood glucose ranges between 150 and 200 and can increase to more than 200 after meals. The patient also indicated an adjustment to her eating habits. She used to have one large meal at the end of the day to 3 small meals and is still experiencing abnormal glucose levels. The Ms. Lund’s daily activity consists of a short walk after each meal.

Ms. Lund lives on her own in a one-bedroom apartment housing in a low income urban area. She often uses public transportation means to get to her medical appointments and works as an answering service from home. The economic situation has not favored her to have an essay movement to hospital to get medication often. The fact that she lives alone, the domestic chores are demanding and it could add stress to her which is likely to escalate the diabetes. Ms. Lund has not yet graduated. Her social life seems to be isolated. Being diagnosed with diabetes and still schooling while taking care of her daughter who is at the risk of getting diabetes, is too much for her. She is not a Native American since her English from the interview is not fluent.

Deficient Knowledge is a priority Ms. Lund is currently in the early stages of diabetes mellitus type 2 in which she appears healthy and able to carry out independent daily living However, staying untreated and the inability maintain normal range blood glucose levels will take its toll and eventually become fatal (American Diabetes Association, 2014). The first step to treatment is the comprehension of a disease process. An understanding of the factors that contribute to a condition can be inevitable at times. The gestation diabetes arises when the placenta makes certain hormones which prevent the insulin from working normally. The medics refer this situation as insulin resistance. For the body to operate normal, it has to produce three times the amount insulin to suppress the hormones made by the placenta (Guttmatcher, 2004).

During the early stages, a patient’s pancreas produces excess insulin to make up for the resistance. However, it becomes difficult to sustain the process over time. This challenge results in the production of insufficient insulin to maintain the normal levels of blood glucose (American Diabetic Association, 2014). Type 2 Diabetes’ contributing factors include sedentary lifestyles, gestational diabetes, obesity, ethnic backgrounds as well as family history after assessing the patient condition. Adults approaching the mid-40s are also at a high risk of developing this condition. Ms. Lund had high appetite for juice and milk which she blames to have caused the disease. However, she has seized from taking them. she is also taking smaller amount of meal and having a walk. She is regularly checked her blood sugar.

Physical exercise and healthy diet during pregnancy might prevent type 2 diabetes. Engaging in frequent physical exercise before pregnancy regularly has been related to a reduced risk of developing gestational diabetes.

Impact of the Patient’s Culture and Family

Lund’s descent is mixed Native Americans and European, leading to an increased risk of type 2 Diabetes of almost 56.7% (Wong, 2012). Her cultural ancestry further exposes her to this condition, and she is also in the mid 40’s. the educational background of Ms. Lund could have contributed to her situation. She admits that had she known about her health condition earlier, should have avoided drinking excess soda and taking other sugary foods. Learned people are conscious about their health. She was supposed to have known it had she been raised by an exposed family. However, due to her exposure education wise, though she has not graduated, she seems to be conscious and cautious about her daughter’s health I future since she is at risk of getting diabetes type 2. This patient appears to have neither a healthy routine of diet nor exercise on a consistent basis. Educating her on the contributing factors is crucial to help in understanding why she has difficulties in managing her blood glucose. It will also be vital to enlighten her on how to better control the condition through an adoption of a healthier lifestyle and delay the onset and treatment with insulin and oral medication (Zoungas et al., 2014). The outcome for Ms. Lund will be to verbalize a comprehension of the disease process. She will also be able to actively participate in the management of diabetes while demonstrating proficiency in self- monitoring.

The second nursing diagnosis is the risk for ineffective therapeutic regimen management. Once Ms. Lund is knowledgeable of the disease process and requirements necessary to control her blood glucose levels, the next step will be discussing a therapeutic Regimen. Ms. Lund has already verbalized her desire to manage the blood sugar and adopt preventive measures (Bedfordshire Diabetes Organization, 2017). The patient has also expressed difficulty with regulation of one of the prescribed regimens for treatment. The OB-GYN had advised the patient to begin insulin, but she has been reluctant to do so after speaking with her family. It is seem the culture in which she was raised up did not appreciate the scientific interventions on health situations. The patient stated that she was not ready to begin animal-based insulin. Although the synthetic insulin options were also available, she felt that it may not be any better.

Value and Relevance of Evidence

Various medical studies indicate that deeply seated cultural health beliefs might impose adverse effects on diabetes control (Wilkinson, Whitehead & Ritchie, 2014). In providing ethical nursing care, an exploration of alternative options for Ms. Lund to adhere to a therapeutic regimen is a crucial goal. Referring the patient to a dietician to develop and counsel her on the importance of a healthy diet regimen will provide a better understanding of nutritional breakdown, and their effects on the blood glucose levels. However, it is also necessary to explore and incorporate options like the oral medication and education on synthetic insulin to the patient’s education program. During the process, the patient revealed the presence of type 2 diabetes as the inability of the body to produce insulin which is necessary for breaking down glucose levels. It helps in understanding the possibility of requiring assistance with medication alongside a healthier controlled diet plan. Also, it is important for her to be referred to a social service so that they could evaluate this aspect of Ms. Lund’s future and refer for additional services such as governmental assistance programs and counseling.

Why Each Piece of Evidence is Relevant?

The available pieces of evidence are relevant because they highlight the importance of adhering to the medical prescriptions in health care. They assist the health-care practitioners to identify the most appropriate intervention strategies in various conditions. Although the patient has shown an improvement from one large meal a day to three small meals and a walk, this regimen has proven to be sufficient for her body requirements blood glucose levels remain unstable displaying the bodies need for additional regimen.  Ms. Lund also revealed that she no longer has assistance at home. Her family was only present during the post C-section period providing healthy meals. Females that undergo C-section and were suffering from gestational diabetes are likely not to recover quickly. Once again seeing a dietician will help the patient understand her nutritional requirements. Due to the lack of help in the home, adjustment to a daily routine of being a first-time single mother, work, and diabetes, alleviating stress which also affects blood glucose levels has become challenging. The outcome for the patient will be an appreciation of dietary intake by demonstrating portion control and nutritional options suitable for her meals. She will also need to maintain reasonable range blood glucose levels and exhibit a willingness to explore and learn about diabetic meal plan options. The above reviews are possible through the application of the available evidence.

Relevant and Measurable Criteria for Evaluating the Achievement of Outcomes

Although Ms. Lund has requested for information and treatment about her ongoing concerns and issues with the blood glucose levels, it is essential to explore all needs and refer her to a social worker.  Social work involvement can assist with economic needs that may provide additional assistance in the household and alleviate daily stressors (Powers et al., 2017). The caregiver roles, strains and fatigue are additional concerns to Ms. Lund’s condition being the third diagnosis. The patient has revealed that she lives alone with her daughter, making her head of household. Since she is a freelance, failure to work means that she does not receive income. These issues combined with caring for her newborn and managing her blood sugar appears to be overwhelming. The benefits of a social worker can explore options such as living assistance, welfare, and child care assistance. The social workers can use the recorded data from the clinician so that they can compare about her improvement. Also, the team need to engage her in interviews to collect first-hand information to enable processing of accurate data. Also, filling a questionnaire can help in obtaining some confidential information about her experience with the disease.

Communicating Specific Needs to the Family

In ensuring that Ms. Lund understands the concept map, there is need to apply plain terms based on her educational level. Additionally, the privileged information should be shared, considering the patient’s cultural needs, and avoid complicated medical words which may be difficult to understand. Although ethical nursing is important for her treatment, it mainly depends on how she will avoid leaning to her cultural practices (Butts & Rich, 2015). Her personal health as well that of her daughter is important compared to keeping some cultural practices as she is guided by her parents. Insulin checkup is crucial in treatment of diabetes. Being non-judgmental on her personal decisions, offering alternatives and adjusting treatment will also ensure that the patient feels comfortable with the process.

Conclusions

The gestational diabetes risks are associated with race, ethnicity and age differences. The Asian Americans, Africa American, and Hispanics are at higher risk of being diagnosed with diabetes. The level of education and cultural beliefs play a major role on how to not only prevent diabetes, but also combat it. The low economic situation, stress, and living in an environment whereby the accessibility to health services are difficult, contributed to Ms. Lund to have gestational diabetes. With effective medical care, the diabetes can be controlled and it is manageable when doctors are frequently visited especially by pregnant women above 25 years.

References

American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), S81-S90.

Bedfordshire Diabetes Organization. (2017). Diabetes Prevention. Bedfordshirediabetes.org.uk. Retrieved 4 November 2017, from http://www.bedfordshirediabetes.org.uk/guidelines/diabetes-prevention.html

Butts, J., & Rich, K. (2015). Foundations of Ethical Nursing Practice. Role Development in Professional Nursing Practice, 117.

Guttmatcher, A. E. (2004). Managing gestational diabetes. U.S. Department of Health and Human Services , 1-49.

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … & Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53.

Wilkinson, A., Whitehead, L., & Ritchie, L. (2014). Factors influencing the ability to self-manage diabetes for adults living with type 1 or 2 diabetes. International journal of nursing studies, 51(1), 111-122.

Wong VW. (2012). Gestational diabetes mellitus in five ethnic groups: a comparison of their clinical characteristics. Diabet Med, 29:366–371

Zoungas, S., Chalmers, J., Neal, B., Billot, L., Li, Q., Hirakawa, Y. & Cooper, M. E. (2014). Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. New England Journal of Medicine, 371(15), 1392-1406.