UNDERSTANDING  COMPLEX CARE NEEDS 

 

COMPLEX ENDOCRINE CONDITIONS LIVING WITH DM      10/05/2024.

 

The lesson started with an introduction of the module learning outcomes, followed by the learning outcomes, the aims and objectives of the module. An introduction of the topic was also done. The gastrointestinal tract (GIT).

• The GIT is basically one long muscular tube from mouth to anus.
• The digestive system breaks down food and drink through the process of digestion into nutrients, specifically carbohydrates, proteins and fats.
• These nutrients are absorbed  into the bloodstream and transported to cells throughout the body.
• Once in the cells they provide fuel for cell function and the building blocks required for cell growth and repair.

The digestive system starts from the mouth through the following parts:

• Oropharynx
• Stomach
• Small intestine (duodenum, jejunum and the ileum)
• Large intestine (caecum, colon ascending, transverse, descending, sigmoid)
• Rectum & the 
• Anus 

The walls of the GIT is made up the following:

• The mucosa (innermost layer)
• Sub-mucosa (outside the mucosa)
• Serosa (outermost layer)

The process of digestion is as follows: 

• An enzymatic process which converts complex foodstuffs into smaller absorbable units.
• The primary process used is hydrolysis (breakdown by addition of water)
• Some components such as water, mineral salts, vitamins and glucose are already in a suitable form for absorption.

There are basically three forms of food molecules, and they are as follows:

• Carbohydrates. (simple sugar and starch)
• Proteins ( dietary protein is required to supply the amino acids for formation of body protein, any surplus is used as a source of heat and energy).
• fats.( the main useful components of ingested fats are the triglycerides or triacylglycerols, because fats are not soluble in water, digestion of fats is complicated, detergents produced in the liver – the bile salts – emulsify the fat and render it susceptible to the action of lipases secreted by the pancreas which hydrolyse it to form monoglycerides and free fatty acids.

 

We looked at Diabetes Management (DM), ia a condition in which the body does not produce enough insulin, and / or the body does not properly respond to insulin. Insulin is a hormone produced in the pancreas. Insulin enables cell to absorb glucose in order to turn it into energy.

The role of insulin required for transport of glucose into : muscle, adipose, liver. The absence of insulin can lead to: glucose accumulates in the blood use amino acids for gluconeogenesis, converts fatty acids into ketone bodies ;like acetone, acetoacetate, beta hydroxybutyrate.

The following are the complications of DM:

• Hypoglycaemia
• Hyperglycaemia
• Ketosis
• Acidosis
• DKA (hyper + ketosis + acidosis)
• HHS

DKA is a state of absolute or relative insulin deficiency aggravated by ensuring hyperglycaemia, dehydration, and acidosis-producing derangements in intermediary metabolism, including production of serum acetone.

 

Hyperosmolar hyperglycemic state (HHS) is an acute metabolic complication of DM characterised by impaired mental status and elevated plasma osmolality in a patient with hyperglycemia. 

• Occurs predominantly in type 2 DM ( a few reports of cases in type 1 Dm)
• The presenting symptom for 30-40% of type 2 DM
• Not commonly associated with ketonuria and acidosis.

DM is classified based on the severity of the acidosis.

• Mild:  PH less than 7.3 and /or HCO3<15 mmol/L
• Moderate : PH less than 7.2 and /or HCO3<10 mmol/L
• Severe : PH <7.1 and/ or HCO3<10 mmol/L

The following are people at risk of diabetes:

• Age <12
• Those with low socioeconomic status.
• People with poor access to medical care.
• Stress (increased ketotic metabolism).
• Glucocorticoids, atypical antipsychotics, diazoxide, and some immunosuppressive drugs.

A question: why ketone? This is because:

• No carbohydrate intake  (fasting, gastroenteritis, Atkins diet, neonate fed -fat milk)
• Prolonged exercise, pregnancy.
• Lack of insulin activity (onset of DM, interruption of insulin delivery in patients with established DM).
• Increased in insulin resistance (infection, surgery, stress, illness)

The following are the signs and symptoms of hyperglycemia, ketosis and acidosis:

• Deep rapid breathing.
• Fruity breath odour.
• Dry mouth.
• Nausea and vomiting.
• Lethargy.
• Drowsiness.
• Thirst
• Tachycardia/shortness of breath
• hypotension/dehydration

In preventing DM, consider the following:

• Diabetic education.
• BM monitoring.
• Easily digestible liquid diet when sick.
• Supplement short acting insulin.
• Reducing , rather than eliminating, insulin when patients are not eating.
• Guidelines for when patients should seek medical attention.
• Case monitoring of high risk patients.
• Special education on patients on pump Mx

 

 

                                              KSB ADDRESSED.

                                               KNOWLEDGE

 

 

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice .

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice. 

K8: Understand how discriminatory behaviour is exhibited. 

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people. 

K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes. 

K11: Understand the factors that may lead to inequalities in health outcomes. 

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and well-being. 

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes. 

K14: Understand the importance of health screening. 

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care. 

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care. 

K17: Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care .

K18: Understand and apply the principles and processes for making reasonable adjustments .

K19: Know how and when to escalate to the appropriate professional for expert help and advice. 

K20: Know how people’s needs for safety, dignity, privacy, comfort and sleep can be met.

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care. 

K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health. 

K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity. 

K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain. 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life. 

K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld. 

K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies. 

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications and adverse reactions. 

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.

K36: Understand the roles of the different providers of health and care.

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

K38: Understand the complexities of providing mental, cognitive, behavioural and physical care needs across a wide range of integrated care settings. 

K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives .

K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services. 

K41: Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it. 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills.

 

                                             SKILLS 

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements.

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people. 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing.

S25: Meet people’s needs for safety, dignity, privacy, comfort and sleep.

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health. 

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity. 

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain. 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed.

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members.

                                    BEHAVIOURS

 

B1: Treat people with dignity, respecting an individual’s diversity, beliefs, culture, needs, values, privacy and preferences.

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice. 

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness.