Chronic Illness and Disability - Nursing Assessment Answer

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• Subject Name : Nursing

Diabetes Illness and Disability Nursing Assessment Answer

1. Individual sufferings with type 1 diabetes face issue with glucose metabolism due to the destruction of the insulin-producing pancreatic beta-cell that disturb the blood glucose level. The absence of the insulin decreases the proper breakdown of the glucose and thus it directly increases the concentration of the glucose in the blood. Some of the symptoms that are a direct indicator for the type 1 diabetes include increased thirst, weight loss excessive appetite and enhancedurination (Kahanovitz et al., 2017). The role of the insulin starts after the digestion of the food when glucose molecules enter the bloodstream and raise the blood glucose level. Different hormones play a role in stimulating the release of insulin for beta cells to decrease the amount of glucose in the blood. One of the important metabolic hormones that play a central role is incretins it stimulates the beta cells. Insulin binds to the cell surface receptors that are present on the skeletal muscle, liver and adipose tissue. These signals are important to make the glucose transporters available over the cell membrane. These transporters help the cell to transport the glucose from the blood into the cells to decrease the blood glucose level (Tokarz et al., 2018). 

Insulin therapy is considered to be the best intervention for type2 diabetes as it helps to maintain the blood glucose level in the blood but it also helps to reduce the chances of complication that can occur due to increased blood glucose level. The mainstream treatment of type1 diabetes is considered to be insulin as it is involved in the glycemic control that is necessary for diabetes management (DiMeglio et al., 2018). The case study discusses the 15-year-old boy had complaint of excessive thirst and increased diet that after an examination revealed to be the patient for type 1 diabetes. His blood glucose level and blood ketone level require immediate attention thus he is prescribed with insulin for balancing the blood glucose level.

2. NovoRapid is considered to be fast-acting insulin that helps to improve the blood glucose level by improving glycemic control. The basic functioning of the NovoRapid is to increase the storage and decrease the breakdown of the glucose by increasing the peripheral glucose uptake. The administration of the NovoRapid is considered to be the 5-10 minutes before the meal.  There are some side effects thus need continuous monitoring of the dose to identify any side effect that needs to be rectified (Rubin et al., 2020). 

The NovoRapid is absorbed more rapidly when compared to conventional insulin and the onset occur after the 10-20 minutes of the subcutaneous injection. It has a low binding with the plasma protein that is about 0-9% thus it is eliminated rapidly having a half-life of about 81 minutes.   The subcutaneous route of administration is preferred while administration of the NovoRapid and thus nurses are expected to continuously monitor the patient blood glucose level. The amount of the NovoRapid should be accurately estimated as per the patient condition to reduce the chances of overdose or underdose that can further add complication. Overdose of insulin directly leads to the condition of hypoglycaemia as cell intake too much of glucose that can directly increase the complication of the individual. Under dose of insulin can lead to hyperglycaemia where the supplies of the glucose exceed the demand thus increase blood glucose level(Hermansen et al., 2016).  The Novorapid was prescribed to Zach Forbes due to his blood glucose level and there is a need to maintain the blood glucose level. 

3. The patient administered with NovoRapid requires continuous monitoring as the dose play an important role when it comes to glycaemic control. The testing of blood glucose level before and after the administrations of the insulin helps to track the concentration of the glucose and evaluate the effect over the patient (Heise et al., 2015). The faster onset of the NovoRapid is the reason that increases the need to continuously keep a track of the patient blood glucose level as the required dose of the insulin should be fulfilled and overdose an increase complication. The action of the NovoRapid is considered to lower down the blood glucose level after 10-15 minutes of administration or maximum up to one hour and this lead to fluctuation in the blood glucose level. The rise or downfall is common after the administration of the NovoRapid and monitoring the blood glucose can help to identify how the patient body is responding with comparison to the medication (Heise et al., 2017). The diabetes care he is recommended to can help him to have a track of the fluctuation in the blood glucose level that is necessary to understand the impact of the medicine over the Zach Forbes.

4. Diabetes is one of the non-communicable disorders that not only impact the mental and psychological aspect of the patient. The deteriorated physical health decreases the active life pattern and makes it more sedentary that increase the chances of further complication. The psychological effect that generally arises due to the type 1 diabetes reduce the wish to live an active life and some of the issues include depression, stress, low self-esteem, anxiety and overthinking. The lifelong impact of type 1 diabetes over the individual and his/ family is also one of the reasons behind the increased stress (Kakkar&Puri, 2016). The emotional distress that directly decreases the mental wellbeing of the individual includesa different aspect. Some the aspect that is related to decrease mental health includes emotional crisis, diabetes distress, phobia to medication and psychiatric disorder. The social support is one of the necessary aspects that can help the patient to feel good and positive as these aspects can directly hamper the physical wellbeing of the individual (Kalra et al., 2018). 

Zach can face emotional or physical issues due to diabetes and it can directly impact his academic performance as he is in 10th. The love of Zach for sports will also be influenced by the decreased strength that will directly affect him due to peer pressure and low self-esteem. The part-time job he used to do in McDonald's may also get hampered that is one of his methods to earn his own money. The medication and decreased physical health will directly impact his daily activity as now he has to be more careful concerning diet or medication.  The boy needs good emotional support after the discharge so that he can understand and mold his daily routine to maintain his health status while performing all the necessary activities. 

References

DiMeglio, L. A., Evans-Molina, C., &Oram, R. A. (2018).Type 1 diabetes. Lancet (London, England), 391(10138), 2449–2462. https://doi.org/10.1016/S0140-6736(18)31320-5
Heise, T., Hövelmann, U., Brøndsted, L., Adrian, C. L., Nosek, L.,&Haahr, H. (2015). Faster-acting insulin aspart: earlier onset of appearance and greater early pharmacokinetic and pharmacodynamics effects than insulin aspart. Diabetes, obesity & metabolism, 17(7), 682–688.https://doi.org/10.1111/dom.12468
Heise, T., Stender-Petersen, K., Hövelmann, U., Jacobsen, J. B., Nosek, L., Zijlstra, E., &Haahr, H. (2017).Pharmacokinetic and pharmacodynamics properties of faster-acting insulin aspart versus insulin aspart across a clinically relevant dose range in subjects with type 1 diabetes mellitus. Clinical Pharmacokinetics, 56(6), 649–660. https://doi.org/10.1007/s40262-016-0473-5
Hermansen, K., Bohl, M.,&Schioldan, A. G. (2016).Insulin Aspart in the management of diabetes mellitus: 15 years of clinical experience. Drugs, 76(1), 41–74. https://doi.org/10.1007/s40265-015-0500-0
Kahanovitz, L., Sluss, P. M., & Russell, S. J. (2017). Type 1 Diabetes - A Clinical Perspective. Point of Care, 16(1), 37–40. https://doi.org/10.1097/POC.0000000000000125
Kakkar, J.,&Puri, S. (2016). Psychosocial implications of type 1 diabetes mellitus among children in India: an emerging challenge for the social work profession. Open Journal of Psychiatry & Allied Sciences, 7(2), 103-110. 10.5958/2394-2061.2016.00016.1. 
Kalra, S., Jena, B. N., &Yeravdekar, R. (2018).Emotional and psychological needs of people with diabetes.Indian Journal of Endocrinology and Metabolism, 22(5), 696–704. https://doi.org/10.4103/ijem.IJEM_579_17
Rubin, R., Khanna, N. R.,& McIver, L. A.(2020). Aspart Insulin. Treasure Island, United Kingdom: StatPearls Publishing.