Table of Contents

1)    Introduction: 1

2)    Pathophysiology: 1

3)    Nursing intervention and evaluation: 2

The rationale of the nursing interventions: 2

Impact on SIM character: 2

Sources of evidence: 3

4)    Ethical and legal professional issues: 3

5)    Conclusion: 3

References: 4

1)Introduction:

            The chosen SIM character to analyze the pathophysiological condition is suffering from diabetes type 2 named Inez. The medical report will be including a detailed perspective of the pathophysiological symptoms and signs. Different evidence based practices are also analyzed as per the condition of the patient. Despite this, various nursing interventions will be discussed as per the administration and support of the patients. (Kharroubi & Darwish, 2015). The interventions associates with the administration of Inez will be having different approaches such as medication and diet. Each nursing intervention will be according to the condition of the patient, along with its importance and rationale. It will be providing a detailed overview of the situation and the different responses submitted to the patient. Keeping in mind the code of ethics of NMC different legal and ethical practices will be a part of the report. This section will be including three sub sections that are legal, professional, and ethical. Professional issues and the importance of the factors will also be discussed. (Kharroubi & Darwish, 2015)

2)Pathophysiology:

            The female character of the SIM Inez has Type 2 diabetes, as well as from hypertension. She has had diabetes from the last five years, and according to her, medication is not an efficient treatment. She thinks medications to be as a slow poison. Inez has been diagnosed with diabetes due to pathophysiology, along with different signs and symptoms. Inez is 74 years old, and she lives with her husband. She has a boy and a girl, her family, is small but beautiful. She also has grandchildren, but sometimes she forgets about the name of her grandchildren. It is her demographic and social information.

Moving towards the pathophysiology and the signs and conditions of the Inez, many factors contribute to cause type 2 diabetes. (Carpenter et al., 2018). The primary reason for diabetes in Inez is the lack of physical activity. Inez is older and does not have any physical activity, while her husband continuously asks her to start sewing. Lack of physical activity in her body is the cause of leads to cause diabetes. Another factor associated with diabetes is Inez’s age, as with the increase in age, there are more chances of diabetes. Another cause of Type 2 diabetes is the resistance to the insulin cells into the body. (Hoffman, 2015).  It a body is resistant to insulin; it cannot lead to the metabolic process to breakdown glucose. This resistance increased the chances of an enhanced level of glucagon.  The beta cells present into the body do not produce enough insulin, which leads to cause the heightened level of insulin. (NICE guideline, 2015)

Although many approaches are present to improve the functioning of amino acids and fatty acids to deal with the regular operation of beta cells, but still to make the body came back to daily functioning, proper interventions are required while the process is still slow. All these factors caused this type of diabetes in Inez. Inez is further analyzed by having a look at the signs and symptoms that is the pathophysiology. The continuous appearance of the signs and symptoms that Inez is still suffering from the disease is the reason that she is relying on medications to the slow poison. The symptoms of type 2 diabetes include frequent urination, increased level of thirst, and also patient most of the time feels hungry. (Carpenter et al., 2018)

            Other contributing factors that were involved in the signs of type 2 diabetes is the feeling of getting tired along with the blurred vision than usual. (Hoffman, 2015).  The visit of Inez to the hospital was an indication that she might have faced some sort of injury in the past. The patients who suffer from diabetic type 2 show slow healing of wounds. The reason is that an increased level of sugar in the body results in the damage to nerves and blood vessels. This damage to nerves makes the healing process slower than usual. Also, there are higher chances of infection if the wound is not treated correctly. Another sign that indicates type 2 diabetes is the increased level of tingling, and numbness into the hand and feet. This sign occurs due to neuropathy and severe complication if the patient is not treated correctly. The patients who suffered from this disease have patches to dark skin on their body, and this condition is acanthosis nigricans. Diabetes can also lead to severe conditions that can even result in deadly situations. The factors include heart disease, stroke, damage to the nerves, kidney problems, blurred vision, and different sexual problems. (Booth & Johnson, 2019)

            Glucose plays an essential role in the maintenance of the bodys regular functioning. First of all, glucose maintains the energy level inside the body. Glucose plays a critical role in the operation of red blood cells. Liver, on the other hand, is the storage house of glucose. This glucose, as a result, is utilized by the muscles and the neurons. Glucose present in liver maintains the consistency level of the glucose in the cells. The brain is another organ that requires glucose the most. Glucose plays an essential role in multiple functions, like thinking, learning, and remembering. Deficiency in glucose not only leads to the abnormal brain functioning, but it also reduces the brains capability to perform several functions. (Penn et al., 2020)

Moreover, glucose serves as the fuel of the body and fluctuations in this level leads to cause serious complications such as diabetes mellitus type 2. In diabetes mellitus type 2 problem with insulin occur in Inez that leads to the variations in the level of glucose. Pancreas is the gland which functions in the production of insulin, but in diabetes two, the capacity of pancreas to make insulin reduces, and it leads to the disease known as insulin. Insulin assists in allowing glucose to enter in the cells. Two conditions might occur in this disease that includes the case in which the body fails to make insulin, or the insulin might not work. By this abnormal functioning, Inez’s body does not make enough glucose, and the glucose does not tend to enter in cells. The conditions might make the glucose low or high, causing diabetes mellitus type 2, and it leads to the failure of the insulin production. Pancreas detects a higher level of glucose in the cells and continue making insulin that might also cause serious complications. (Carpenter et al., 2018).  The symptoms of diabetes type 2 Mellitus includes the increased level of thirst, enhanced frequency of urination, increase in the hunger level, weight loss and fatigue, slow healing process and enhanced incidence of infections. The appearance of the symptoms is due to the cause that the body becomes insulin resistant. Blurred visions and tingling in the hands is another primary symptom of diabetes mellitus type 2. (NICE guideline, 2015)

            Multiple risk factors are present in diabetes mellitus type 2, which leads to the complications and outbreak of the disease. The risk factors include weight, and if a person is overweight, the risk factors increases the most. Inactivity and the family history are also involved in the risk factors of diabetes mellitus type 2. Race, age, and gestational diabetes are also present in the list.  (NICE, 2018)

3)Nursing intervention and evaluation:

            For providing Inez with proper care and assistance, different nursing interventions will be playing an essential role which is defined as the process for providing treatment to the patient to improve the healthy behaviour. For this purpose, detailed information and the reason of disease must find out. It includes aetiology and the pathophysiology of type 2 diabetes. Also, the aetiology of type 2 diabetes is the contributing factor in causing the disease. One condition that might also be the reason for the disease is the increased level of glucose into the liver. The patient has the age of more than 45 in which there are more chances to suffer from the disease. (Hoffman, 2015). All the above described conditions are the reason for causing diabetes in the older woman. Increased levels of glucagon and insulin resistance and the age factor is the most contributing ones in creating the disease and its progression to a more extended period. Keeping this into mind, the possible nursing interventions are described below:

            Several nursing interventions will be considered while treating the patient suffering from diabetes mellitus type 2. Those interventions include training the patient to monitor the levels of glucose at home by the self. Also, I will let him know the factors that will be reviewing about the instability in the level of glucose. Also, Inez will be educated about the medications and their working methodology to treating him effectively. Another intervention will be the introduction of the diet plan and the revision of the type of insulin and the injection sites. All the interventions will work effectively, and as a nurse, it is the responsibility to treat Inez during the application of these interventions. The responses will maintain the body weight and metabolism of Inez. Following the diet will also work efficiently in the maintenance of the body weight. (Penn et al., 2020)

 The selected interventions in the case of Inez are specified medication and diet as per her condition. Her diet plan includes the diet that will be helping her in maintaining her weight. Obesity is a significant cause of diabetes. So to support her sugar level, Inez is recommended to have the diet having low levels of carbohydrates, as well as food having low fat. Low calories food intake will help her in the maintenance of the sugar level. Balance in the energy level can also be accomplished if she enhances her physical activity. The food having starch is not preferred in her diet. Her diet as a whole must be having fruits, vegetables, grain, legumes, and skimmed milk has low fat. Also, maintenance of carbohydrate in her food is the foremost thing for her healthy lifestyle. It will be keeping a balance between diabetes and carbohydrates. For the medication intervention, Inez has been medicated with two medicines Atenolol and Gliclazide. These medicines will be helping her in fast recovery and to maintain her sugar and blood pressure level. Other effective medications for diabetes type 2 might be Insulin, DPP 4 inhibitors, Meglitinides, a Sulfonylureas. (NICE guideline, 2015)

The rationale of the nursing interventions:

Every nursing intervention described above is selected due to their importance in evidence based practices. First of all, the reason for checking hyperglycemia is that it blocks the usual amounts of insulin and glucagon into the body. For the maintenance of the glucose level into the body, the sugar level must be checked before and after having meals. Glycosylated haemoglobin must also be analyzed into the body as this is also effective in measuring the blood glucose level. The temperature and physical condition and changes in the patient are addressed to address the situation of neuropathy occurring in the patient. Enhanced physical activity maintains the blood glucose level that is why it is included in the nursing interventions. Every selected intervention and person centred approach is based on the set of rationales and evidence based practices. (Bell, 2010). Diet and medication intervention will be promoting a healthy lifestyle. Both of these interventions will keep a balance in Inez’s sugar level. However, Inez must be checking her sugar level before and after her meals.

The rationale of choosing the above interventions is to maintain the health of Inez while enhancing the knowledge about the disease and the relevant factors which will be serving to stabilize his condition. Diabetes can cause severe complications in the patients. So these interventions will assist Inez to treat the issue efficiently.

Impact on SIM character:

The above described interventions will be impacting positively to deal with the condition of Inez as the patients believe that medications are not the solutions to her problem. So these person based approaches and nursing approaches will be preventive measures to enhance the normal functioning of the patient. Delivering the above interventions will help in maintaining the sugar level of the patient, and it will also help keep the average level of insulin into the body. (Khatri, 2019). The diet and medication will be helping her in faster recovery. Also, this will be assisting Inez to maintain a healthy lifestyle. The medicines and the diet plan will help her in dealing with health decline. Also, it will be helping her out in keeping her healthy lifestyle. (Carpenter et al., 2018).

Pathophysiology Type 2 diabetes links with the resistance in the production of insulin The pancreatic beta cells present inside the body tend to decrease with age, and this disease occurs in progression. Various environmental and genetic factors can also cause infections. Sometime vascular complications might also be involved due to the degeneration of the blood vessels into the body. But the decreased capability of the beta cells is the reason for causing diabetes type 2. The diseases do not have a single domain, but rather than that, it is associated with multiple areas that might be due to genetic and environmental reasons. Age and genetics are the most contributing factors that need to be addressed here in the discussion of the case. Having a look at the pathophysiology and eh above described elements, the delivery of the nursing interventions will be supporting care, support, and primary health care functions. (Bell, 2010)

Sources of evidence:

All the resources of evidence to find out the relevant details about the condition of the Inez’s are peer reviewed up to date journals. The research is adequately conducted to address all the points required for performing the analysis properly. (NICE guideline, 2015). Different nursing journals and medical interventions are utilized in the study. The sources are reputable and include various research journals, medical journals, scholarly articles, and nursing journals. Different approaches and tools like CASP tools are used considered to selected the evidence based sources and to evaluate the work properly. According to the selected pieces of evidence applying the nursing interventions on the patient will help in the speedy recovery of Inez and the healthy behaviour of the patient. Also, the evidence is of great importance as it highlights all the primary needs of the patients accurately. (NMC, 2019)

4)Ethical and legal professional issues:

            The ethical, legal, and professional issues that occur while evaluating the condition of Inez were the presence of a limited history of the patient. The medical history of Inez does not have an apparent reason that caused the outbreak of diabetes. The legal issue that occurred in assessing the condition of the patient is to work with informed consent, and the patient is not even interested in taking assistance from proper treatment. Also, she is not involved in nursing. Negligence of Inez also comes out to be a limitation in providing therapy to the patient. Conflicts in the workplace while treating the patient was also the limitation in the assessment of the patient. (Khatri, 2019)

            The cost effective measures and the primary prevention strategies are the reason to cause ethical and legal issues. Different legal policies of the country related to the medical platform play the principal role in creating the legal matters. Bureaucratic controls and corruption in the medical departments serve as a barrier in providing Ibez with effective and on time treatment. (NICE guideline, 2015). NMC code of conduct is there to make improvements in the nursing interventions and to deal with the legal, ethical, and professional issues. The application system of behaviour deals with the legal problems of the workplace, and this code helps in the better treatment of the patient. NMC provides solutions to several legal issues by introducing different legislative practices setting different arguments and principles.  Implementing the code of ethics and clinical skills in the system helps in providing the patient with proper support and care. The main legal issue is that there was no consent taken by the patient, and this is not acceptable as per the code of ethics of NMC. (NMC, 2019). Code of ethics involved in treating Inez is maintaining the dignity of the patient, taking consent from the patient, and providing him with the right to know about everything related to the disease. Also, confidentiality will be maintained.

            Inline care to the patients is of great importance as it involves all the primary health care and different evidence based practices into the system.  Inline care is an essential part of the healthcare department that assists in dealing with the legal, professional, and ethical issues that came across in providing the patients with treatment. It helps in the application of evidence based practices. Also, it helps in enhancing the quality of life of the patient. (Booth & Johnson, 2019)

5)Conclusion:

            The above discussion revolves around a case study and different evidence based practices required for providing Inez with treatment. Different approaches and nursing interventions, along with the rationale, provides a straightway path to treat the patient effectively. Analysis of Inez shows different key points that help out in the implementation of primary health approach and nursing interventions. (Medical News Today, 2017)

References:

Kharroubi, A. T. and Darwish, H. M. (2015) Diabetes mellitus: The epidemic of the century, World journal of diabetes. Baishideng Publishing Group, Inc. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4478580/ (Accessed: July 14, 2020).

Carpenter, R., DiChiacchio, T. and Barker, K. (2018) Interventions for self management of type 2 diabetes: An integrative review, International journal of nursing sciences. Chinese Nursing Association. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6608673/ (Accessed: July 14, 2020).

Booth, S. and Johnson, M. J. (2019) Improving the quality of life of people with advanced respiratory disease and severe breathlessness, European Respiratory Society. European Respiratory Society. Available at: https://breathe.ersjournals.com/content/15/3/198 (Accessed: July 14, 2020).

NMC (2019) Our legal framework, The Nursing and Midwifery Council. Available at: https://www.nmc.org.uk/about us/governance/our legal framework/ (Accessed: July 14, 2020).

Hoffman, R. P. (2015) Controlling Diabetes, Journal of Ethics | American Medical Association. American Medical Association. Available at: https://journalofethics.ama assn.org/article/controlling diabetes/2005 11 (Accessed: July 14, 2020).

Bell, D. S. H. (2010) Ethics in Diabetic Clinical Trials, Diabetes Care. American Diabetes Association. Available at: https://care.diabetesjournals.org/content/24/3/606 (Accessed: July 14, 2020).

Vera, M. (2020) Diabetes Mellitus Nursing Care Plans: 13 Nursing Diagnosis, Nurseslabs. Available at: https://nurseslabs.com/diabetes mellitus nursing care plans/ (Accessed: July 14, 2020).

Khatri, M. (2019) Type 2 Diabetes: Symptoms, Causes, Diagnosis, and Treatment, WebMD. WebMD. Available at: https://www.webmd.com/diabetes/type 2 diabetes (Accessed: July 14, 2020).

Medical News (2020) Type 2 Diabetes Mellitus, Practice Essentials, Background, Pathophysiology. Available at: https://emedicine.medscape.com/article/117853 overview (Accessed: July 14, 2020).

Medical News Today (2017) 9 early warning signs and symptoms of type 2 diabetes, Medical News Today. MediLexicon International. Available at: https://www.medicalnewstoday.com/articles/323185 (Accessed: July 14, 2020).

Kahn, S. E., Cooper, M. E. and Del Prato, S. (2014) Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future, Lancet (London, England). U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226760/ (Accessed: July 14, 2020).

Yki Järvinen, H. (2019) Pathophysiology of type 2 diabetes mellitus, Oxford Medicine Online. Oxford University Press. Available at: https://oxfordmedicine.com/view/10.1093/med/9780199235292.001.1/med 9780199235292 chapter 130302 (Accessed: July 14, 2020).

Mayo Clinic (2019) Dementia, Mayo Clinic. Mayo Foundation for Medical Education and Research. Available at: https://www.mayoclinic.org/diseases conditions/dementia/symptoms causes/syc 20352013 (Accessed: July 14, 2020).

Yous, M. L. (2017) Nurses Experiences in Caring for Older Adults With Responsive Behaviors of Dementia in Acute Care Marie Lee Yous, Jenny Ploeg, Sharon Kaasalainen, Lori Schindel Martin, 2019, SAGE Journals. Available at: https://journals.sagepub.com/doi/full/10.1177/2377960819834127 (Accessed: July 14, 2020).

NMC (2019) International Journal of Nursing Studies, International Journal of Nursing Studies | Dementia: nursing interventions and health systems for high quality care | ScienceDirect.com. Available at: https://www.sciencedirect.com/journal/international journal of nursing studies/vol/96/suppl/C (Accessed: July 14, 2020).

Huang, Stolniceanu, Thang, Johnson and Duzenli (2019) Login, Nuclear Medicine Communications. Available at: https://journals.lww.com/nuclearmedicinecomm/pages/default.aspx (Accessed: July 14, 2020).

Glasper, A., Search for more papers by this author, P, E., A, G., S, H., L, S. and V, T. (2015) Can the new NMC Code improve standards of care delivery?, British Journal of Nursing. Available at: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2015.24.4.238?journalCode=bjon (Accessed: July 14, 2020).

McKibbon, K. A. (2011) Evidence based practise, Bulletin of the Medical Library Association. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC226388/ (Accessed: July 14, 2020).

Parrish, D. K. (2017) Evidence Based Practice: A Common Definition Matters, Taylor & Francis. Available at: https://www.tandfonline.com/doi/full/10.1080/10437797.2018.1498691 (Accessed: July 14, 2020).

NICE (2018) CKS is only available in the UK, NICE. Available at: https://www.nice.org.uk/cks uk only (Accessed: September 19, 2020).

NICE guideline (2015) Overview: Type 2 diabetes in adults: management: Guidance. Available at: https://www.nice.org.uk/guidance/ng28 (Accessed: September 18, 2020).

H. Chuang, B. G. Verheggen, M. Charokopou, D. Gibson, S. Grandy & B. Kartman (2016) Cost effectiveness analysis of exenatide once weekly versus dulaglutide, liraglutide, and lixisenatide for the treatment of type 2 diabetes mellitus: an analysis from the UK NHS perspective, Journal of Medical Economics, 19:12, 1127 1134, DOI: 10.1080/13696998.2016.1203329

Penn, L., Rodrigues, A., Haste, A., Marques, M., Budig, K., Sainsbury, K., Bell, R., Araújo Soares, V., White,                    M., Summerbell, C., Goyder, E., Brennan, A., Adamson, A. and Sniehotta, F., 2020. NHS Diabetes Prevention Programme In England: Formative Evaluation Of The Programme In Early Phase Implementation.