401209 Health Variations-Nursing Responsibilities

2. The defected reabsorption of glucose from the proximal renal tubule leads to the pattern of glycosuria (i.e. glucose in the urine) in the diabetes type I patient (Triplitt, 2012). The state of hyperglycemia in diabetes I patient effectively elevates the glycemic burden that reciprocally impacts the potential of glucose transporter proteins in the patient’s proximal convoluted tubules (Triplitt, 2012). Resultantly, the glucose begins appearing in the patient’s urine. The increased reabsorption of glucose under the influence of chronic hyperglycemia leads to the development of renal microvascular manifestations that further elevate the concentration of glucose in patient’s urine (Triplitt, 2012).
3. The pattern of bed wetting in children might indicate the development of systemic manifestations emanating under the influence of diabetes type I (Bottomley, 2011). Type I diabetes mellitus disrupts the bladder reflexes that resultantly elevates the bladder capacity, thereby leading to the pattern of urinary retention. The bladder becomes overactive that results in the development of increased urination and urgency (Golbidi & Laher, 2010). Diabetes type I patients experience detrusor hyperreflexia that results in the development of polyuria as well as urinary incontinence. In the presented clinical scenario, increased bed wetting by the patient attributes to the pattern of bladder hyperactivity under the influence of diabetes type I (Golbidi & Laher, 2010).
4. Hyperglycemia under the influence of diabetes type I result in the development of polydipsia (i.e. elevated thirst) (ADA, 2010). The pattern of increased thirst in diabetes type I results from the defective renal reabsorption mechanism and reduction in the intracellular volume. The dysregulation of the plasma osmolality under the influence of diabetes mellitus type I results in the inhibition of vasopressin secretion and increased urination. Resultantly, the patient’s hypothalamus senses the changes in the plasma osmotic pressure and leads the feeling of thirst (Arai, Stotts, & Puntillo, 2013).
5. The pattern of insulin dysregulation in diabetes mellitus type I impacts the appetite mechanism controlled by hypothalamus (Young-Hyman & Davis, 2010). The deactivation of the beta cells of pancreas results in decreased insulin secretion that reciprocally disrupts the functionality of postrema region of the brainstem of the patient. Resultantly, metabolic and hormonal signals related to the food intake are activated (Young-Hyman & Davis, 2010). The consistent imbalance in the concentration of glucagon, leptin, insulin and amylin elevate patient’s appetite and satiety. Furthermore, the increased administration of insulin in diabetes I results in the state of hypoglycemia that might also elevate the appetite of the treated patient (Young-Hyman & Davis, 2010).
6. The elevated concentration of ketones in diabetes type I reveals the diminished production of insulin in the diabetic patient (NCGC, 2015). Resultantly, the patient experiences the conditions of hyperglycemia and lipolysis. The sustained elevation in the concentration of ketones in the blood of the diabetic patient predisposes her towards the development of diabetic ketoacidosis. The elevation in patient’s ketones leads to the deposition of elevated fatty acid levels that further leads to the development of insulin resistance in the diabetic patient. The increase in ketone concentration might also lead to the development of ketonemia. Increased ketone concentrations reciprocally elevate the risk of diabetic type I patient in terms of acquiring the disease conditions attributing to gastroparesis, electrolyte imbalance, cerebral edema and respiratory distress syndrome.
7. Weight loss in diabetic type I patients occurs under the influence of hyperglycemia (ADA, 2010). The disruption of the metabolic control of the diabetic type I patient leads to the development of insulin neuritis and associated weight loss (Aslam, Byrne, & Rajbhandari, 2014). The condition like diabetic neuropathic cachexia further aggravates the pattern of weight loss in the diabetic type I patients (Aslam, Byrne, & Rajbhandari, 2014). Inappropriate or lack of insulin administration might also lead to the development of weight loss in the diabetic patient (Lawrence, et al., 2008).

Nursing Responsibilities Related to Aspart Administration by FlexPen

1. Prior to Administration

Nurse professional needs to evaluate and monitor patient’s blood glucose level and meal delivery pattern prior to the administration of insulin (Freeland, Penprase, & Anthony, 2011). The nurse professional should ascertain the pre-filled status of FlexPen prior the administration of Aspart to the concerned patient. Insulin should be stored below 30 C (Tandon, et al., 2015). Insulin should never be withdrawn from the FlexPen with the utilization of the syringe in the context of reducing its scope of contamination. The withdrawal should only be done by the needle provided with the pre-loaded Flex-Pen device (HSE, 2013). The nurse should keep the blood glucose measuring equipment ready with her for its immediate utilization after the insulin administration. The nurse should ascertain to wear gloves before initiating the insulin administration to the treated patient. The nurse professional should ascertain the removal of barriers to insulin administration while educating and counselling the patient in relation to the requirement of diabetic management through FlexPen intervention (Levich, 2011). The nurse professional should effectively reduce the fear and anxiety related to the insulin utilization in the treated patient. This will considerably reduce the scope of treatment denial by the concerned patient. The nurse professional should also explain the rapid action of the FlexPen intervention and encourage the patient to eat immediately after the administration of Aspart protocol.

2. During Administration

The nurse professional must appropriately mix and roll the insulin suspension in the FlexPen device to avoid the administration of sub-therapeutic dosages (Grissinger, 2011). The nurse must carefully administer the insulin injection while avoiding the occurrence of needle stick injury. The nurse should efficiently align the injection angle for the safe administration of insulin to the eligible patient (Grissinger, 2011). The nurse professional should inject Aspart in a manner to avoid any probability of insulin leakage at the site of injection. The injection needle must remain inserted for a duration of six seconds for reducing the scope of development of the wet spot on the patient’s skin (Grissinger, 2011). The nurse professional should make sure to perform priming of the FlexPen and undertake an appropriate dose selection through the process of dialling (Pearson, 2010). The required insulin dose should be injected while depressing the injection button. The needle should be carefully removed from the pen after dosage administration.

3. After Administration

The nurse professional should evaluate patient’s blood glucose level after insulin administration. This should be performed in the context of identifying and tracking and the episodes of hypoglycaemia that might emanate because of inappropriate insulin dosage preparation (Ramadan, Khreis, & Kabbara, 2015). The nurse must carefully observe the occurrence of symptoms including sweating and palpitation after FlexPen insulin administration. She should also evaluate the occurrence of neurological manifestations and mood fluctuations in the patient following the insulin injection (Kedia, 2011). Accordingly, the patient might be instructed for meals consumption in the context of controlling the hypoglycemic episode. The symptoms including nausea and headache (if experienced after insulin administration) require immediate communication to the treating physician in the context of reducing the scope of clinical complications (Kedia, 2011).

1. Emotional Impact:

The diagnosis of diabetes I in Briana’s case created many difficulties with the child as well her parents. Their daily life was disrupted and they were forced to deviate from their daily routine. Diabetes type I affected Briana’s education as well as quality of life. The pattern of self-regulation of Briana and her family was considerably impacted under the influence of diabetes type I. Briana remained dependent on her medication administration and dietary regimen on her family members as well as the care taking staff at her school. These restrictions also impacted her play activities and downgraded the level of confidence. Evidence-based research literature confirms the negative influence of diabetes mellitus type I on the cognitive capacity and emotional consistency of individuals (Chew, Shariff-Ghazali, & Fernandez, 2014). Resultantly, Briana remains predisposed towards the development of personality disorder and associated clinical manifestations.

2. Physical Impact:

The development of diabetes type I in Briana reduced the frequency of her physical activity under the influence of exercise restrictions and the absence of self-regulation. She failed to undertake play activities for longer duration because of disrupted glycemic control (Colberg, Laan, Dassau, & Kerr, 2015).

Nursing Care for Briana:

Nursing intervention for Briana would focus on the establishment of self-management capacity through the administration of psychosocial interventions (Harvey, 2015). This will resultantly reduce the psychological stress of Tom that raised because of the care taking requirements of Briana. The nurse professional requires to counsel the family members of Briana (including Tom) with the objective of configuring their trust and confidence on the recommended treatment interventions. This will effectively elevate the compliance of the patient on the treatment regimen and reduce the mental burden of her father. Nursing strategies would further focus on the configuration of social support structure for the patient while partnering with her parents. Continued psychosocial support necessarily warranted for patient’s father in the context of proactively overcoming the scope of occurrence of familial conflicts that might arise because of the diabetic burden of the patient. The patient, as well as her father need to receive effective nursing interventions for improving their coping skills and psychological capacity in the context of overcoming the disrupted pattern of life emanated because of patient’s diabetic manifestations (Miller & DiMatteo, 2013).

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