Posted at 12.05.2018
The following paper will think about an experience as a trainee assistant practitioner which involved the attention and support of a patient with type 1 diabetes. Because of this reflection I'll use Charge as a pseudonym name for my patient as The Medical and Midwifery Council (2010) areas that. "The common laws of confidentiality displays that people have the right to anticipate that information given to a nurse or midwife is only used with the objective for which it was given and can not be disclosed without agreement. This includes situations where information is disclosed right to the nurse or midwife and also to information that the nurse or midwife obtains from others". For this project Gibb's Reflective Pattern (1988) will be utilised as Personally i think more comfortable with this model. Gibbs (1998) identifies the experience as an occurrence which involves discovering good and bad feelings, however Johns (1995) shows that the fundamental reason for reflective practice is to enable the specialist to interpret an event in order to discover from it.
Type 1 diabetes is a lifelong condition in which the body cannot control the quantity of blood sugar in the blood vessels. It is because your body cannot produce the natural hormone insulin. Diabetes is a common, lifelong condition so that Zimmet et al (2001) identify that in developed countries one person in thirty may be damaged and it is likely that by 2025 you will see 3 hundred million people who have diabetes worldwide, this is principally the result of more sedentary life styles and increased weight problems. In 2006 Diabetes UK projected that there were more than two million people with diagnosed diabetes and up to one million who are still undiagnosed (Diabetes UK 2006). A alternative approach to this long-term condition is essential as it can come with so many issues. Complications may happen from limited management and treatment of the condition, which can adversely have an impact on the quality of life and have financial implications for patients and the Country wide Health Service (DH2001). There are two types of diabetes. In type 1 diabetes there is no creation of insulin by the beta () cells of the pancreas. In type 2 diabetes, which makes up about over 80 per cent of all cases of diabetes, insulin is made by the skin cells and it is released into the blood vessels, but it consequently fails to respond properly at the websites of sugar uptake, which are skeletal muscle, liver and adipose structure (Donnelley and Garber 1999, Reginato and Lazar 1999).
As a trainee helper practitioner I had been asked by the region sister to go to Bill to do a bloodstream test which had been requested by the general practitioner as Expenses is housebound and struggling to attend a blood clinic. The blood test was to check on his full blood vessels count and HbA1c which was not done for almost a year. Expenses is seventy four years of age, lives alone and has resided with diabetes for many years. Bills wife passed on this past year and has one boy who lives many a long way away so sees him hardly any; he does however have a neighbour who pops directly into check on him now and again. Expenses administers his own insulin in the mornings and checks his blood sugar levels daily before presenting his insulin.
My first impressions of Charge were that he looked frail and quite pale but having not fulfilled him before this might have been the norm for him. Whilst taking the blood sample I started chatting to Costs and he started to tell me that he had several episodes of feeling unwell lately and on that morning hours he had felt particularly unwell. I asked him to explain why he thought unwell and what symptoms he was experiencing. He explained the symptoms included shaking in his hands, feeling lightheaded and a fuzzy headaches. As the trainee assistant practitioner I noticed it necessary to explore what was wrong with Monthly bill even further. To begin with I began taking some basic specialized medical observations, his blood circulation pressure was 140/90, pulse 80 and regular that have been both within normal boundaries. He came out pale and clammy therefore i checked his blood sugar level which was 3. 2mmols; Costs was suffering from hypoglycaemia. Blood sugar levels are normally looked after within relatively small boundaries at about 5-7mmol/l (Williams and Pickup 2004).
My immediate matter was to ensure Bills blood sugar levels did not drop any more and the top priority was to take short term action and increase his blood glucose to prevent it becoming any worse. Costs had no blood sugar tablets or glucogen so along with his consent I viewed in his refrigerator and cupboards to find something that could increase his bloodstream sugars quickly. All of that was at his fridge was a carton of dairy a few slices of bread and some jam, I immediately gave him a glass or two of dairy and made a jam sandwich. I thought it was my responsibility to remain with Charge until his blood sugar returned to suitable levels and he had recovered from this episode of hypoglycaemia. I got Bills blood glucose levels every 10 minutes until it went back to a safe and satisfactory level. Bills blood sugar levels was now 5. 2mmols and he was feeling brighter I checked to see if he ever recorded his blood sugar levels or held a record of supervision of his insulin but there is nothing at all. I asked him about his diet he said he hadn't been feeling up to eating much, I asked who do his shopping which he enlightened me his neighbour gets his dairy and bread and a few other little parts when he needed them. I was aware that having less food in the house was most likely the cause of Costs experiencing hypoglycaemic disorders.
Hypoglycaemia occurs when the blood glucose level falls below 4mmol/L and it is a common side effect of insulin remedy. Factors behind hypoglycaemia include skipped or late foods, not wanting to eat enough, taking too much insulin, exercise and high alcohol. Country wide Health Services Alternatives (2009) state that hypoglycaemia should be treated with fast-acting carbohydrate, for example, 3-6 glucose tablets, 150ml fizzy drink or 50-100ml Lucozade, and adopted up with a longer-acting carbohydrate, for example, biscuits or a sandwich. Glucose gels, for example, GlucoGel are useful to raise blood glucose levels and blood sugar should be documented five to ten minutes after treatment.
After ensuring that Bill's hypoglycaemic strike had subsided and he was feeling better I made him a cup of tea and remaining him another sandwich that he may have at lunchtime. My first thoughts were of matter for Bills safeness in the future so that a trainee associate practitioner I knew that it was my responsibility to see my coach immediately to go over the situation. I had been satisfied which i had taken the time to learn what was incorrect with Bill which he had recovered from his hypoglycaemic episode which I might not exactly have taken period to do in my own previous role. From years of employed in the community medical setting experience I got totally aware that other mutli-displinary companies might need to be involved in the good care of Bill. I went back to the office and fed back again to my mentor and later that day we came back to Invoice and a full assessment was carried out, it emerged to light that Invoice had been battling for some time with his diabetes, personal care and shopping and housework. It was decided by my coach that for the interim period until good care and support for Charge could be implemented that the district nursing team would administer his insulin that way his blood glucose levels could be regularly noted and ensure that he has eaten something. He was also referred to the community diabetic nurse for an assessment of his insulin plan.
Dietary management of type 1 and type 2 diabetes Nutritional therapy is an essential part of effective management of diabetes and has a vital role in assisting people who have diabetes to accomplish and maintain best glycaemia control (Delahunt 1998, UKPDS 1990). I seen the general practitioner surgery and obtained some patient home elevators diabetes health care and diet and required them to Invoice, with the guidance of my mentor I sat with him and read through them. Once a health care package was in place the carers would be prepared of what foods Bill should and really should not have plus they would assistance with meal prep. The English Diabetic Association (1999) suggest that ideally nutritionary information should be shipped with a diabetes specialist dietician, yet, in the truth of Charge awaiting an appointment to see the dietician could have considered time and the info was needed on a far more immediate basis.
McGough (2003) claim that set up patient education performs an important role in allowing people with diabetes to manage their diabetes over a day-to-day basis and a greater emphasis should be on the benefits associated with regular physical activity and weight reduction. More overall flexibility in the percentage of monounsaturated fat and carbohydrate in dietary intake and sucrose should no longer be limited to a specific amount. For Monthly bill primarily it was essential that he was given regular foods and snack foods at least 3 x daily to prevent any further hypoglycaemic episodes. An urgent referral was sent to people of the multi-disciplinary team and a gathering was arranged the next day with a sociable services. Recommendations were also delivered to the city diabetic nurse, dietician and feet health services. On assessment with my mentor she discovered that Bill had not been washing properly and had not cut his toenails for quite a while, Bill was also experiencing pain in his legs and feet. Costs was apt to be experiencing diabetic peripheral neuropathy, and I completed a pain diagnosis chart with him. Hill (2009) recognizes that unpleasant neuropathy affects your feet, typically causing burning or stabbing pain, which is particularly apparent during the night. This was a reflection of what Monthly bill referred to his pain as and we reassured him that his pain control would be discussed with his doctor as at the moment Bill had taken no analgesia in any way and there was none inside your home. The general practitioner recommended paracetamol 1000mg four times daily at first as he thought that the pain may improve once more control have been gained again with his diabetic control. I went back to assess Charges pain control several times after commencing paracetamol and it acquired advanced, he was still experiencing small discomfort but believed that he'd like to keep on this routine as he didn't want anything stronger currently. It was arranged with Bill that would be analyzed again the next week.
A joint visit was done with the diabetic nurse, my mentor and myself and it was discovered that Bills approach of providing his own insulin was poor scheduled to poor dexterity in his hands and he was unable to turn his insulin pen properly or read the digits on the pen evidently. It was unclear how much time Bill have been trying to control in this way but Bill would certainly need permanent care along with his insulin from the region medical team. The diabetic nurse identified that Bills eyesight was particularly poor which he previously not possessed his eyes inspected for quite some time. Diabetic retinopathy is a significant cause of blindness and many patients don't have any observeable symptoms of the destruction occurring in the retina before complications have become advanced. NICE (2008) recommend total annual screening for all those patients with diabetes and a record of the retina is made by digital imaging for season on year assessment to identify the development and development of retinopathy. The overall practitioner was up to date that Bill hadn't had his eyes examined and he decided that he'd refer him for retinopathy screening.
As a trainee associate practitioner I've learnt valuable knowledge in the management and good care of patients with diabetes, from Expenses requiring a daily habit blood vessels test he has turned into a complex patient with multiple problems related to his diabetes. Due to the word constraints of the article all areas of complications relating to diabetes cannot be protected but through researching and reading around the topic I know of other difficulties such as nephropathy, cardiovascular, cerebrovascular and peripheral vascular disease. I've persisted as an assistant trainee practitioner to visit Bill and screen his progress with my mentor. His blood glucose levels have improved upon and are looked after managed between 6-9mmols. Charge has needed some internal support as he can be used to experiencing few people and suddenly his life has improved and he has several customers of the multidisciplinary team browsing and critiquing him regularly. Overall Personally i think a sense of satisfaction that from a tedious blood test and utilising a more advanced role all this relating to Costs has been determined and his health insurance and care are much more improved.