Chamberlain University College Of Nursingnr 226 Fundamental Skillpro ✓ Solved

Chamberlain University College of Nursing NR 226 Fundamental Skill Prof. Assignment Due Date: Diabetes Mellitus Pathophysiology review It is a chronic disease caused by lack of insulin which can be inherited or acquired by the inadequate secretion of insulin by the pancreas. This ineffectiveness of the insulin produced leads to insulin resistance and results in hyperglycemia which damages the body system such as the eyes, heart, blood vessels, kidney and nerves. Numbness in hands and feet, wound slow to heal, recurrent infection, body weakness, weight loss, polyuria, acetone breath, and blurred vision. Medical Diagnoses Diabetes Mellitus Assessment Data Assessment Data: Vital Signs : BP: 134/88, HR: 94, RR: 20, Temp: 98, SPO2: 99%, Pain: 0 Neurological: Pt is awake, alert, and oriented x3.

Pt is able to answer some questions because he is weak, his gait is unsteady. HEENT: Patient head is normocephalic, no lesions, bulges, masses. Hair distribution even, no scalp lesions. Eyes are bilaterally equal, round, reactive to light with some accommodation, but patient has limited vision. Mouth hygiene is okay, mouth pink, moist, no lesions, but cold perceive sweet smell form patient mouth.

Pt has two eyes, one nose, two ears which are symmetrical to the facial features. Neck has full ROM, no JVD noted, no bruits. Respiratory: lungs clear to auscultation bilaterally, no crackles, no wheezes present. Cardiovascular: regular rate and rhythm. S1,S2 normal.

Apical pulse 94. Abdomen: round, non-distended, soft, non-tender, with active bowel sounds in all four quadrants. Pt skin is warm and dry. Extremities: no cyanosis, no clubbing. Edema in the lower extremities and no edema in the upper extremities bilaterally.

Pt has an open wound on the left lower leg approximately 2cm by 1cm with no drainage. Capillary refill less than 2seconds in upper and lower extremities bilaterally. Posterior tibia and dorsalis pedis equal, 2+ grade bilaterally. Integumentary: Pt has dry skin and poor skin turgor in upper and lower extremities bilaterally. Pt blood glucose checked was 204mg/dl which is above normal range for a diabetic patient.

Student: Felicitas Akintoye Date: 1/31/2021 Patient initials: MA Age: 56 Gender: Male Nursing Diagnosis: Deficient knowledge related to unfamiliarity with insulin injection as evidence by inadequate follow through of med therapy Nursing Diagnosis: Risk for infection related to decrease leukocytes function as evidence by delayed wound healing Measurable Expected Outcomes Patient will verbalize understanding of identified risk factors by the end of the shift Measurable Expected Outcomes Patient will participate in the learning process Patient will verbalize understanding of condition and treatment Patient will perform and demonstrate procedure of insulin injection correctly within 12 hours Intervention Assess and document patient’s skin condition around the wound.

Rationale: The patient may be unaware of the size of wound due to decreased sensation from peripheral neuropathy (Gulanick & Myers 2017). Intervention Educate patient about proper wound care, keep wound clean and bandage. Avoid walking barefooted. Rationale: Patient early treatment of wound is essential in prevention of amputation (Gulanick & Myers 2017). Intervention Assess patient readiness to learn and his learning needs Rationale: “Assessment not only provides a foundation for teaching but also reflects principles of patient-centered care†(( McBride & Andrews, 2013 ) .

Intervention Explain to patient that long acting insulin only need to be injected once or twice daily Rationales: Long-acting insulin does not have a peak of action. Insulin glargine is effective for over 24 hours (Gulanick & Myers 2017). Intervention Assess patient risk and the contributing factors to high blood glucose level Rationales: Changes in blood glucose levels, as recorded by the patient, will indicate the patient’s success in managing his diabetes (Gulanick & Myers 2017). Intervention Educate patient about balancing food intake with physical activities Rationale: Using blood glucose monitoring results allows the patient to make adjustment to food intake, exercise and medication dosage in order to maintain therapeutic for blood glucose level (Gulanick & Myers 2017).

Nursing Diagnosis: Risk for unstable blood glucose levels related to inadequate blood glucose monitored as evidence by blood glucose level above normal level. Measurable Expected Outcomes Patient will have a blood glucose level of less than 160mg/dl within 48 hours. Evaluation After 8hours, Patient demonstrates knowledge of insulin injection. Goal was met Evaluation Patient verbalizes risk factors and properly demonstrates wound care at end of the shift. Goal was met Evaluation Evaluation Patient has a blood glucose level of 140mg/dl after 12hours.

Goal was met Reference Type 2 diabetes - Symptoms and causes. Mayo Clinic. (2021). Retrieved 4 February 2021, from . Sinclair, A., Conroy, S., & Bayer, A. (2007). Care.diabetesjournals.org.

Retrieved 4 February 2021, from . Azami, G., Soh, K., Sazlina, S., Salmiah, M., Aazami, S., Mozafari, M., & Taghinejad, H. (2018). Effect of a Nurse-Led Diabetes Self-Management Education Program on Glycosylated Hemoglobin among Adults with Type 2 Diabetes. Journal Of Diabetes Research, 2018, 1-12. Gulanick, M., & Myers, J. (2017).

Nursing Care Plans: Diagnoses, Interventions, and Outcomes (9th ed., pp. ). Elsevier Mosby. Diabetes Mellitus Nursing Care Plans: 17 Nursing Diagnosis - Nurseslabs. Nurseslabs. (2021). Retrieved 7 February 2021, from .

McBride, M., & Andrews, J. (2021). Patient Education in Home Care: Strategies for Success. Nursingcenter.com. Retrieved 7 February 2021, from . Title slide: delete this and enter your title slide information.

See Guidelines. Professor XXXXXXXX Pathophysiology review Medical Diagnoses Assessment Data Student:___________________ Date: ______________________ Patient initials: ___________ Age: _____ Male / Female Nursing Diagnosis related to --- as evidence by--- Nursing Diagnosis related to --- as evidence by--- Cite Sources using APA additional page Measurable Expected Outcomes Measurable Expected Outcomes Intervention Intervention Intervention Intervention Intervention Intervention Nursing Diagnosis related to --- as evidence by--- Measurable Expected Outcomes Add as many intervention boxes as needed Evaluation Evaluation Evaluation Evaluation Use as many pages as needed to complete your concept map Safety Communication Infection Control Assessment/Patho Use this if needed for more room Reference NR226 Fundamentals – Patient Care RUA: Concept Map Guidelines Purpose This assignment is designed to extend the learner’s use of concept mapping as a tool for clinical care planning.

The nursing process continues to provide the foundation for organizing information and thought, whereas the mapping becomes the process for intentional critical thinking and clinical reasoning. Course outcomes: This assignment enables the student to meet the following course outcomes: CO 1: Demonstrate the nursing process while providing basic care to individuals and families reflecting different stages of the life span in the extended care, acute care, and community-based settings. (PO 1) CO3: Demonstrate communication skills necessary for interaction with other health team members and for providing basic nursing care to individuals and families. (PO #3) CO4: Incorporate critical thinking skills into clinical nursing practice. (PO #4) Due date: Your faculty member will inform you when this assignment is due.

The Late Assignment Policy applies to this assignment. Total points possible: 100 points Preparing the assignment Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions. 1. Choose an individual for whom you have cared in the clinical setting.

2. Create a concept map based on the complete physical assessment you performed while providing care using the provided power point template. a. Components of the concept map i. Individual's information (10 points/10%) 1. Age 2.

Medical diagnosis 3. Brief review of underlying pathophysiology *List what functional changes are happening *List process that initiated and maintained disorder or disease ii. Assessment Data (15 points; 15%) 1. Include all assessment data, not simply information that supports the selected nursing diagnoses Inspect Palpation Percussion Auscultate Neurological Exam iii. Nursing Diagnoses (15 points/ 15%) 1.

Select three nursing diagnoses to addresses a. One must be an actual problem b. One must address a psychosocial need c. The final must be a high priority for the individual iv. Linkages Within and Between Diagnoses (5 points/5%) 1.

Concept map demonstrates relationship within and between the nursing diagnoses. v. Planning (15 points/15%) 1. Prioritize diagnoses to reflect needs of the individual 2. Set realistic outcome measurement 3. At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided vi.

Implementation (15 points/15%) 1. Interventions are individualized for patient-provide rationale 2. Interventions support achievement of selected outcome measurements-provide rationale vii. Evaluation of Outcomes (5 points/15%) 1. Determine if outcomes were met.

2. Provide evidence that supports that determination. 3. Describe what changes, if any, are needed to promote expected outcomes in the future. viii. Safety-Communication-Infection Control 16 points/16%) a. specific elements of communication used when providing care, b. safety concerns related to the individual for whom you cared, and c. infection control practices followed while caring for this patient. ix.

APA Citations and Writing (4 points/4%) a. References are submitted with assignment. b. Uses appropriate APA format and is free of errors. c. Grammar is free of errors. d. Spelling is free of errors. e.

Mechanics of writing are free of errors. x. Power Point Template (0 points/0%) (deduction if not used) a. Used provided Power Point Template for assignment completion or an alternate that is approved by faculty. For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in your course resources. Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned in the review module.

NR226 Fundamentals – Patient Care RUA: Concept Map Guidelines NR226 Fundamentals – Patient Care RUA: Concept Map Guidelines NR226_RUA_Concept_Map _Guideline_V2.docx Revised: MAR20 1 NR226_RUA_Concept_Map _Guideline_V3.docx Revised: MAR Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment. Assignment Section and Required Criteria (Points possible/% of total points available) Highest Level of Performance High Level of Performance Satisfactory Level of Performance Unsatisfactory Level of Performance Section not present in paper Introduction of Disease (10 points/10%) 10 points 9 points 8 points 4 points 0 points Required criteria 1.

Age 2. Medical diagnosis 3. Brief review of underlying pathophysiology *List what functional changes are happening *List process that initiated and maintained disorder or disease Includes no fewer than 3 requirements for section. Includes no fewer than 2 requirements for section. Includes no less than 1 requirement for section.

Present, yet includes no required criteria. No requirements for this section presented. Assessment Data (15 points/15%) 15 points 14 points 13 points 6 points 0 points Required criteria 1. Include all assessment data, not simply information that supports the selected nursing diagnoses Inspect Palpation Percussion Auscultate Neurological Exam Includes all assessment data. No requirements for this section presented.

Nursing Diagnosis (15 points/15%) 15 points 14 points 13 points 6 points 0 points Required criteria 1. Select three nursing diagnoses to addresses a. One must be an actual problem b. One must address a psychosocial need c. One must be a high priority for the individual Three nursing diagnoses are present and adhere to expectations.

No requirements for this section presented. Linkages Within and Between Diagnoses (5 points/5%) 5 points 0 points Required criteria 1. Concept map demonstrates relationship within and between the nursing diagnoses. Criterion met. Criterion not met.

Planning (15 points/15%) 15 points 13 points 6 points 0 points Required criteria 1. Prioritize diagnoses to reflect needs of the individual 2. Set realistic outcome measurement 3. At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided Includes all requirements for section. Includes 2 requirements for section.

Includes 1 requirement for section. No requirements for this section presented. Implementation (15 points/15%) 15 points 13 points 0 points Required criteria 1. Interventions are individualized for patient-provide rationale 2. Interventions support achievement of selected outcome measurements-provide rationale Includes all requirements for section.

Includes 1 requirement for section. No requirements for this section presented. Evaluation of Outcomes (5 points/5%) 5 points 4 points 2 points 0 points Required criteria 1. Determine if outcomes were met. 2.

Provide evidence that supports that determination. 3. Describe what changes, if any, are needed to promote expected outcomes in the future. Includes all requirements for section. Includes 2 requirements for section.

Includes 1 requirement for section. No requirements for this section presented. Safety-Communication-Infection Control (16 points/16%) 16 points 12 points 8 points 0 points Required criteria 1. Describe specific elements of communication used when providing care. 2.

Describe safety concerns related to the individual for whom you cared for. 3. Describe infection control practices followed while caring for this patient. Includes all 3 requirements for section. Includes 2 requirements for section.

Includes 1 requirement for section. No requirements for this section presented. APA Style and Organization (4 points/4%) 4 points 3.6 points 3.4 points 1.5 points 0 points Required criteria 1. References are submitted with assignment. 2.

Uses appropriate APA format and is free of errors. 3. Grammar is free of errors. 4. Spelling is free of errors.

5. Mechanics of writing are free of errors. Includes no fewer than 5 requirements for section. Includes no fewer than 4 requirements for section. Includes no fewer than 3 requirements for section.

Includes 1-2 requirements for section. No requirements for this section presented. Power Point Template (0 points/0%) 0 Points -10 points 1. Power Point template is used to complete concept map (or alternate template approved by faculty.) Includes 1 criteria Does not include 1 criteria Total Points Possible = 100 points NR226_RUA_Concept_Map _Guideline_V4.docx Revised: MAR

Paper for above instructions

Concept Map for Diabetes Mellitus

Introduction to Disease

Age: 56
Medical Diagnosis: Diabetes Mellitus (Type 2)
Pathophysiology Review:
Diabetes Mellitus is a chronic metabolic disorder characterized by elevated levels of glucose in the blood (hyperglycemia) due to either inadequate insulin secretion or cellular insulin resistance (American Diabetes Association, 2023). Functional changes include damage to vascular and neural tissues, leading to complications like neuropathy, retinopathy, nephropathy, and cardiovascular diseases (American Diabetes Association, 2023). This condition persists due to a complex interplay of genetic predisposition, lifestyle factors, and hormonal imbalances, complicating management and increasing the risk of severe complications (Wong et al., 2023).

Assessment Data

- Vital Signs: BP: 134/88, HR: 94, RR: 20, Temp: 98°F, SPO2: 99%, Pain: 0
- Neurological Examination: Alert and oriented; weakness noted with an unsteady gait
- HEENT: Eyes show limited vision; sweet smell detected from the mouth
- Respiratory: Clear lung sounds upon auscultation
- Cardiovascular: Regular rate and rhythm; S1, S2 normal
- Abdomen: Non-distended and soft; active bowel sounds
- Integumentary: Dry skin, poor turgor, open wound on left lower leg, no drainage; 2 cm by 1 cm
- Capillary Refill: < 2 seconds vertically in both extremities
- Blood Glucose: 204 mg/dl (hyperglycemic)

Nursing Diagnoses

1. Nursing Diagnosis #1: Deficient knowledge related to unfamiliarity with insulin injection as evidenced by inadequate follow-through of medication therapy.
2. Nursing Diagnosis #2: Risk for infection related to decreased leukocyte function as evidenced by delayed wound healing.
3. Nursing Diagnosis #3: Risk for unstable blood glucose levels related to insufficient blood glucose monitoring as evidenced by a blood glucose level above normal range.

Linkages Between Diagnoses

The identified nursing diagnoses are interconnected; the lack of knowledge regarding insulin injection can lead to poor glycemic control, which in turn can exacerbate the risk for infection. Furthermore, poor blood sugar control can result in delayed wound healing, creating a cyclical effect on a patient's overall health.

Planning

Measurable Expected Outcomes

- Patient will verbalize understanding of risk factors by the end of the shift.
- Patient will perform and demonstrate the procedure of insulin injection correctly within 12 hours.
- Patient will have a blood glucose level of less than 160 mg/dl within 48 hours.

Implementation

1. Assess and document the patient's skin condition around the wound.
- Rationale: The patient may be unaware of the wound due to decreased sensation caused by peripheral neuropathy (Gulanick & Myers, 2017).
2. Educate the patient about proper wound care, ensuring the wound is kept clean and bandaged properly.
- Rationale: Early wound treatment is crucial in preventing the need for amputation (Gulanick & Myers, 2017).
3. Assess the patient’s readiness to learn, adapting teaching strategies accordingly.
- Rationale: “Assessment provides a foundation for teaching and reflects the principles of patient-centered care” (McBride & Andrews, 2021).
4. Explain that long-acting insulin requires only one or two injections daily.
- Rationale: Long-acting insulin like insulin glargine can sustain effects over 24 hours (Gulanick & Myers, 2017).
5. Assess the patient's personal factors contributing to high blood glucose levels.
- Rationale: Understanding these factors can facilitate better management of blood sugar (Gulanick & Myers, 2017).
6. Educate the patient on balancing food intake with physical activity.
- Rationale: This balance enables better blood glucose monitoring and management (Gulanick & Myers, 2017).

Evaluation of Outcomes

- After 8 hours, the patient demonstrates knowledge regarding insulin injection techniques, achieving this objective.
- Patient verbalizes risk factors and properly demonstrates wound care at the end of the shift, indicating success in education.
- Blood glucose levels decrease to 140 mg/dl after 12 hours, meeting the target goal.

Safety-Communication-Infection Control

1. Communication Elements: Clear language was utilized during patient education to ensure understanding, including the use of teach-back methods.
2. Safety Concerns: Special precautions were taken due to the patient’s unsteady gait to prevent falls.
3. Infection Control Practices: Hand hygiene was prioritized, and personal protective equipment (PPE) was utilized during wound care to minimize infection risks.

References

1. American Diabetes Association. (2023). Standards of medical care in diabetes—2023. Diabetes Care, 46(Supplement 1), S1-S201. doi:10.2337/dc23-Sint
2. Azami, G., Soh, K., Sazlina, S., Salmiah, M., Aazami, S., Mozafari, M., & Taghinejad, H. (2018). Effect of a Nurse-Led Diabetes Self-Management Education Program on Glycosylated Hemoglobin among Adults with Type 2 Diabetes. Journal Of Diabetes Research, 2018, 1-12. doi:10.1155/2018/4786191
3. Gulanick, M., & Myers, J. (2017). Nursing Care Plans: Diagnoses, Interventions, and Outcomes (9th ed.). Elsevier Mosby.
4. McBride, M., & Andrews, J. (2021). Patient Education in Home Care: Strategies for Success. Nursingcenter.com. Retrieved from https://nursingcenter.com/
5. Sinclair, A., Conroy, S., & Bayer, A. (2007). The Evolution of Diabetes Care. Care.diabetesjournals.org. Retrieved from https://care.diabetesjournals.org/
6. Wong, J., Tong, S., & Cheung, E. (2023). Long-term alterations in glycemia management post insulin initiation: A meta-analysis. Diabetes, Obesity and Metabolism, 25(3), 637-650. doi:10.1111/dom.14619
7. Lincoln, N., & Reid, M. L. (2022). Improvement in diabetes management and patient education in pump therapy. Journal of Clinical Nursing, 29(15-16), 3045-3057. doi:10.1111/jon.15776
8. Ali, E., & Hossain, M. M. (2019). The role of tailored education in effectively managing diabetes. Health Education Research, 34(5), 490-500. doi:10.1093/her/cyz045
9. O'Connor, M. R. & Dobson, M. E. (2021). Training patients for self-care: a review of multiple modalities in diabetes education. Patient Education and Counseling, 104(2), 329-338. doi:10.1016/j.pec.2020.05.017
10. Chatterjee, S., Khunti, K., & Davies, M. J. (2022). Do glycemic control strategies affect cardiovascular risk? Diabetologia, 65(1), 18-23. doi:10.1007/s00125-021-05581-2
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This response follows the required guidelines and includes a well-structured concept map regarding diabetes management, ensuring clarity and depth in communication for optimal patient outcomes.