Acute Care Nursing

2. Findings on The Patient’s Acute Condition

Hypertension and type 2 diabetes are interlinked with each other and they are both the causes of metabolic syndrome which at times involve obesity as well as cardiovascular disease. Both hypertension and type 2 diabetes shared some of the risky factors and this is the reason, they also lead to the worsening of the patient’s condition (Vintila, 2018). It has been found from the patient in the case study that the person was suffering from severe right-sided weakness in both of his arm and leg. His heart rate was also not in a god condition that is 90/min along with BP 170/100. The respiratory rate is 18/min and the temperature is 36.7 degree C. At the time of identifying high blood pressure and type 2 diabetes, it have often been found that the patient is suffering from no symptoms as being highlighted by The American Heart Association (HA). Again , the after certain diagnosis in the context of type 2 diabetes, it have been found that the high sugar symptoms involve excessive thirst , fatigue, increasing amount of urination during night etc (Aleman, 2018).

For the patients like Dale, it have had been found often that diabetic patients might suffer from more infections which might involve urinary tract infections , upper respiratory tract infections and thrush.

The assessment findings from the epidemiologic studies highlight that the co-existence between hypertension and type 2 diabetes pointed to common genetic as well as an environmental factor. In the context of pathophysiology of type 2 diabetes and hypertension the insulin resistance increased inflammation of the tissue, and increased rate of the sympathetic nervous system are some of the complex perspectives of hypertension and type 2 diabetes (Mallory, 2018).

Activation of the renin-angiotensin-aldosterone system, or (RAAS) increases the number of aldosterone secretions from the adrenal gland and this results into the retention of the salts and the expansion of the volume along with continuous hypertension. Again, aldosterone also increases hypertension through the enhancement of SNS activity by decreasing parasympathetic activity and hence the reduction of baroreceptor sensitivity (Joann, 2018). Other effects involves secretion of the increased amount of extracellular matrix deposition by the side of glomerular cells leads to type 2 diabetes and hypertension.

3. Formulation of Nursing Interventions by Using Certain Nursing Literatures to Support Care Decisions

For the patients with type 2 diabetes-like Dale as per the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, it has been recommended that the blood pressure should be normalized at <130/80mmHg so that death, as well as disability linked to high BP, can be easily avoided. In this context, the nursing intervention will occur in such a manner so that the patients like Dale can go through certain changes of life like improved diet, managing weight along with certain important medication like the consumption of antihypertensive medication comprised of less sodium, less calorie (800-1,500 kcal/day) with high fiber diet coupled with 30-45 minutes’ walk (Vintila, 2018).

Through this, the lipid profiles within a patient and the insulin resistance can be controlled properly. One of the recent meta-analysis has stated that the antihypertensive therapy has reduced the mortality rates along with myocardial infarction . This medication helps patients like Dale in reduction of the risk of strokes. Again the implementation of the nursing interventions will be done in such a way where the patents will be assisted in consuming less of caffeine in tea , coffee and also less consumption of chocolates (Mallory, 2018). In the context of the collaborative approach, the nurse should behave friendly with the patient like Dale to make lifestyle changes. Side by side, the patient should also hear the recommendations from the nurse on community resources like health centres programs, check-ups which helps in controlling hypertension. The nursing interventions should also involve observation on postural BP through which the position changes will gradually be encouraged.

Side by side measuring the daily weights of the patients should also be noted continuously. Aggressive fluid replacement is required so that the current deficit and the ongoing losses can be easily detected. In addition to this, the patients like Dale should be avoided in prolonged sitting along with crossed legs for long or standing. Again, an adequate amount of hydration is needed for the patients which are not only important for the physical development but are also helpful for the changes in the psychological state of the patent like Dale. Again consensus development also turns out to be necessary and scientific for the development of new knowledge for the patients where there exists the best use of the information’s be scientific or collective clinical circumstances. Another important medication that is essential for this kind of treatment is the consumption of angiotensin-converting enzyme inhibitors for the patients having the atherosclerotic disease (Musayev, 2018).

RAAS blockers are considered as one of the first line choices to treat the patients with type 2 diabetes. It involves the consumption of antihypertensive treatment which helps in the reduction of normoalbumuniric patients with diabetes. It needs to be implemented that there should be mandatory monitoring of renal function and electrolyte which reduces the chances of patients from facing heart attacks. Finally, the treatment known as radiofrequency ablation of renal nerves helps in deactivating sympathetic nerve supply through a vascular catheter. In this context, the nurse should be efficient enough in making the choices efficiently and acting on it in an effective way which will involve vicarious learning and modeling along with verbal persuasion like getting proper encouragement and support from the others (Musayev, 2018). The nurse should train her patient in such a manner so that in her absence, the patient like Dale proved to be efficient enough in using community –based automated devices to monitor his pressure.

4. Choice of Two Constructs from Pearson Centred Practice Framework and Considering how This Construct Enhances Person-Centered Care Delivery

Pearson Centred Practice Framework had been developed from McCormack’s conceptual framework which primarily focuses on the caring attitudes by the nurses for their patients. The framework states that principles on human science are ultimately the main building block of the framework which is consistent and also focuses on what it means like human freedom, choices and responsibilities, aesthetics and intuitions etc. In this context , the attributes of the staff that is the nurse needs to be considered first which is one of the primary component of the framework (Lana, 2019).

The framework depends on humanistic caring where there exist moral component practices which gets translated through relationships and are built upon interpersonal processes (Aleman, 2018). The two constructs which will get highlighted in the framework in the context of person centred care delivery are:

  • Knowing self: As professionals like nurse in this context, makes adequate sense of her knowing and also became person-centred practitioner though self-awareness, engagement and reflections. As a person centred framework, this particular framework enhances care for the patients after the development of the emotional relationship with the patient like Dale that is the mental engagement with the patient. In this context, the nurse as a professional should develop certain self-defining characteristics along with enhancement of self-awareness based on which she can add some colors to the patient’s life and can be able to provide adequate commitment to her job while serving the patient. Here beliefs and values of the nurse needs to be interconnected with each other for daily operations and practice through which workplace culture can be well uplifted also and along with that the concern and care for the patient should also be sustained for longer periods (Tanya, 2020). This way , shared mission and vision and ideas can be well managed between the patient and the nurse.
  • Shared decision making: In this aspect , the nurse as a professional practitioner after considering the patient’s needs and their personal preferences like Dale need to talk with him and should ensure that he will take the medications timely. In this shared decision making concept , the term deliberation is defined as one of the important process through which the implications can be well accessed by considering range of possible futures involving both practical as well as emotional aspect. Hence shared decision making is basically stated as one of the interdependent as well as interpersonal process where both the healthcare providers as well as the patients related and collaborated with each other so that they can influence each other’s decision making (Musayev, 2018). This helps in enhancement of mutual trust and language cordonance in between the patient and the healthcare provider (nurse). The benefits of shared decision making is that both individuals receives as well as delivers care and this way understands that how it is important for the individuals. This way both the patient and the nurse feels supported and always remains informed. The health as well as social care professionals tailors the care or the treatment so that the individual needs can be met effectively (Bmcpublichealth, 2019).

5. Explanation of The Care that Will Be Provided to The Case Study Patient

It can be evaluated by stating that firstly early detection by the nurse as well as the clinical staffs should be done to reduce the future risk and to start early medications. Then the screening needs to be performed for the patients where glucose testing turns out to be important. FPG is also one of the preferred test in order to screen and diagnose diabetes in both the adults and the young people. A focus should be made on the components of comprehensive care in order to ensure the optimal management of patient with diabetes. This way the intercurrent illness can be easily eradicated like blood in urine or blood ketones (Aleman, 2018). The aggressive glycaemic management with the intake of insulin will ultimately help in reduction of the morbidity among the patients.

References for Acute Care Nursing

Aleman, O. O. F., 2018. Early clinical manifestation of type 5 cardio-renal syndrome in patients with type 2 diabetes and hypertension. Journal of Hypertension: Open Access, Volume 07, pp. 15-25.

Bmcpublichealth, 2019. Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review. [Online] Available at: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7842-6 [Accessed 2020].

Joann, J., 2018. Type 2 Diabetes and High Blood Pressure: What’s the Connection?. [Online] Available at: https://www.healthline.com/health/type-2-diabetes/hypertension [Accessed 2020].

Lana, B., 2019. The link between diabetes and hypertension. [Online] Available at: https://www.medicalnewstoday.com/articles/317220 [Accessed 2020].

Mallory, D., 2018. An Update on Hypertension in Children With Type 1 Diabetes. Canadian Journal of Diabetes, 42(2), pp. 199-204.

Musayev, 2018. ISSUE ON ANGIOTENSIN RECEPTOR BLOCKER VALSARTAN AS APPLIED TO ARTERIAL HYPERTENSION PATIENTS WITH TYPE II DIABETES. Journal of Hypertension, 36(2), pp. 279-280.

NurseKey , 2019. The Person-centred Practice Framework. [Online] Available at: https://nursekey.com/the-person-centred-practice-framework/ [Accessed 2020].

Tanya, M., 2020. An Exploration of Person-Centredness in Practice. [Online] Available at: http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No2-May-2011/Person-Centredness-in-Practice.html [Accessed 2020].

Vintila, 2018. DIABETES AND DYSLIPIDEMIA CONTROL IN A POPULATION OF HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS. Journal of Hypertension, Volume 36, p. 138.

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