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During my internship days at a well-known hospital at Melbourne, I was given the charge of a diabetic care unit where I had to come across a number of patients who were dealing with either high or low Blood glucose level issues. However, it should be added here that I had to focus on dealing with each patient differently while measuring the blood glucose level. For example, for a pregnant woman, I was asked to take the blood samples to check the blood glucose level; on the other hand, I mostly used the electronic blood glucose meters. In Australia, nearly 50% people with diabetes are aged 65 years or older (Dunning , 2016). In the middle of this, one day a patient of age above 65 years diagnosed with high blood glucose level was admitted to the hospital and I had to take care and measure the blood glucose level of that person. After admitting him, me with other nursing staff used the electronic blood glucose meters for immediate action and started insulin therapy. Our target glucose range was 140–180 mg/dL (7.8–10.0 mmol/L) (American Diabetes Association, 2019).
Quite often, such scenarios can be seen; in fact, a similar case happened with a pregnant woman before her delivery who was diagnosed with gestational diabetes. Her BGL was higher than 190 mg/dL (10.6 mmol/L) after the one-hour test. An insulin therapy was provided to the woman to stabilize the BGL before delivery.
During that situation, I was only thinking of making the blood glucose level of that patient stable to bring him back to normal life. Before the situation, I was thinking if I would be able to provide the proper insulin treatment and its aftermath. In 2017, nearly 11% of all deaths in Australia upheld diabetes as the principle reason (White et al. 2020); hence, I was worried. However, after seeing the patient stable, I was confident about myself. The other nursing staffs that were also there with me for help were mostly experienced; hence, they guided me pretty well in adopting the right ways to measure the BGL level. Later on, when the doctor arrived I assisted him in dealing with the patient. After hearing what the doctor said, I felt that I did the right thing by measuring the BGL of the old man with electronic blood glucose meters as it helped me to take immediate measures. In the case of the pregnant woman as well, I felt that dealing with her high blood glucose level using her blood sample was quite relevant.
Both the mentioned situations turned out to be extremely challenging for me. In the first case, I had to deal with an old age person and in the second case with a pregnant woman where they both had life risk. The good thing about the experience was that I have to learn the ways I can handle a situation and the bad thing was I lacked self-confidence. The way I and other nursing staff thought of dealing with the situation by providing proper insulin treatment right after measuring the BGL test with the help of electronic blood glucose meters in case of the old man helped him recover soon without any delay (Haines, 2019). I and other nursing staff contributed largely and positively to the situation by choosing the correct measurement steps and starting the treatment immediately.
According to Cheung et al. (2019), it has been found that Australian government has come up with the idea of conducting routine glucose assessment within the emergency department so that unrecognised diabetes can be detected. On the other hand, Kyi et al. (2019) identified that the National Safety and Quality Health Service (NSQHS) has introduced certain standards for Australian health care centres to report and benchmark related to the adverse results in diabetic care units. In fact, the hospitals have been enabled by networked glucose meter technology to keep track of Glucometric benchmarking. In the article by Farrer et al. (2019), the authors mentioned that the Australian Diabetes Educators Association (ADEA) has developed a set of guidelines for the diabetic care unit. It clearly states that outpatient diabetes schedules need to focus on reducing the risk of hypoglycaemia. Moreover, first-line treatment should highlight metformin whereas oral agents for hypoglycaemia need to be avoided (Herman, 2019). As a nursing intern under the diabetic unit, I need to take care of these guidelines in future days.
From this situation, I have learned that it is necessary to provide patients with first-line treatment having high blood glucose level. I need to develop my practical skill of measuring the BGL so that it can assist me in my future nursing days. However, in the case of that pregnant woman, I should have focused on using an electronic blood glucose meter before adopting the blood sample test. This would have helped in better and earlier treatment.
In future, I would focus on the guidelines by Australian Diabetes Educators Association (ADEA) for better treatment. I would focus on developing my practical skill by assisting other experienced nurses and look after the way they handle such situations. From next time, I would make sure to consult with the seniors and keep track of my work.
American Diabetes Association (2019). Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019. Retrieved on 04th October 2020 from https://care.diabetesjournals.org/content/42/Supplement_1/S173#:~:text=23%2C24).-,Insulin%20therapy%20should%20be%20initiated%20for%20treatment%20of%20persistent%20hyperglycemia,noncritically%20ill%20patients%20(2).
Cheung, N. W., Campbell, L. V., Fulcher, G. R., McElduff, P., Depczynski, B., Acharya, S., … Middleton, S. (2019). Routine glucose assessment in the emergency department for detecting unrecognised diabetes: a cluster randomised trial. Medical Journal of Australia. doi:10.5694/mja2.50394
Dunning, T. (2016). Assessing older people with diabetes in Australia. Diabetes Prim Care Aust, 1(4), 1-6. http://pcdsa.com.au/wp-content/uploads/2016/09/DPCA1-4_115-20_wm.pdf
Farrer, O., Yaxley, A., Walton, K., & Miller, M. (2019). A scoping review of best practice guidelines for the dietary management of diabetes in older adults in residential aged care. Primary Care Diabetes. doi:10.1016/j.pcd.2019.02.005
Haines, H.M. (2019). Prevalence and management of diabetes in residential aged care facilities in north-east Victoria, Australia. Retrieved on 04th October 2020 from https://www.racgp.org.au/download/Documents/AFP/2016/December/AFP-Dec-Research-Haines.pdf
Herman, A. O. (2019). Guidelines Issued on Managing Diabetes in Older Adults. Retrieved on 04th October 2020 from https://www.jwatch.org/fw115193/2019/03/25/guidelines-issued-managing-diabetes-older-adults
Kyi, M., Colman, P. G., Rowan, L. M., Marley, K. A., Wraight, P. R., & Fourlanos, S. (2019). Glucometric benchmarking in an Australian hospital enabled by networked glucose meter technology. Medical Journal of Australia. doi:10.5694/mja2.50247
White, H., Tendal, B., Elliott, J., Turner, T., Andrikopoulos, S., & Zoungas, S. (2020). Breathing life into Australian diabetes clinical guidelines. The Medical Journal of Australia, 212(6), 250-251. https://www.mja.com.au/system/files/issues/212_06/mja250509.pdf
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