Nursing process in diabetes mellitus: what is it for?

There is a huge number of very different diseases, in the treatment of which not only the work of the doctor, but also the nursing process, is of great importance. In diabetes, modern medical institutions place the main work, as well as control over the performance of various appointments on the part of the doctor on the shoulders of the junior medical staff. Therefore, such work should not be underestimated, because this category of employees in certain situations plays far from a secondary role.

Diabetes: Do we need control?

Nursing process in diabetes mellitus is carried out in accordance with current regulations. According to the accepted classification, there are two main types of this disease:

• Insulin-dependent;
• Non-insulin dependent.

Both can often be found in modern people, and the nursing process with diabetes can be required at almost any age. The causes of the development of the disease can be very diverse, but all of them, one way or another, have a direct connection with the process of producing the hormone insulin. It is not always necessary to talk about the shortage or absence of a given substance, since its volume can be normal or even exceed it, but the cells of the human internal tissues do not perceive the hormone, which leads to an increase in the total sugar level in the blood.

Nursing in diabetes mellitus is also complicated by the fact that the disease does not have any pronounced symptoms, therefore, for a long time it can remain completely unnoticed, causing significant harm to the body. This is why it is dangerous, because when a person learns about his diagnosis, some things can already be irreversible, and it's not uncommon for situations that the patient can hear this phrase for the first time after suffering a hyperglycemic coma. However, all this refers to the insulin-independent form of the disease, since the sister process in diabetes mellitus (DM-1) is somewhat easier due to rapid development and rapid diagnosis.

Stages of

There are three main stages of the development of this disease:

1. Prediabetes. In this case, the main risk groups are identified, that is, those people who have relatives with a similar diagnosis, patients suffering from overweight, people over 45 years of age or women who have given birth to dead children or infants weighing more than 4.5 kg.
2. Latent form. At this stage, the disease is absolutely imperceptible and most often in the morning sugar remains within normal limits. You can determine it by conducting a specialized test of the sensitivity of the organism to glucose.
3. Diabetes. The disease in no way "hides" and with due attention it can easily be diagnosed by various external signs. Nursing process in diabetes is often prescribed after the patient has a constant thirst, frequent urination, a sharp set or weight loss, the presence of sugar in the urine or skin itching.

After and during the diagnosis, as well as further clarifying the specific cause of this illness, a person may need not only the help of a qualified doctor, but also the support of nurses. At the same time, not everyone understands what includes a map of the nursing process in diabetes mellitus and what it is.

Main goals

First of all it is worth noting that the nursing process is a certain technology of patient care, which has a justification from a medical and scientific point of view. Its main goal is to maximize the quality of life of the patient, as well as to provide assistance in finding a solution to not only the existing problems, but also those that may appear in the future. Based on this, a map of the nursing process is drawn up in diabetes mellitus.

How are the works carried out?

The package of measures in itself includes the following:

• The first stage, from which the nursing process begins in diabetes mellitus, is the examination, when it is provided assistance in drawing up a full-fledged picture of the development of this disease. It is necessary to understand correctly that each person should have his own medical history, in which all analyzes are made and observations and conclusions are made about the patient's state of health. In this case, another important point for which the nursing process is conducted in diabetes mellitus is the collection of information about the patient, as this also helps to make an accurate picture of the problem.
• At the second stage, a diagnosis is made that takes into account not only the obvious problems of the patient that are present at the moment, but also those that may appear during the treatment. It is only natural that, first of all, the reaction of specialists should be on the most dangerous symptoms that threaten the life and health of the patient, for which the nurse process in diabetes mellitus is used. The patient's problems are determined by the nurse, and she makes up a list of ailments that can make some complications in the life of the patient. In this case, checking the card and a simple survey are far from all, what is limited in this case, the nursing process in diabetes mellitus. Stages of this kind already require the implementation of preventive and psychological activities, including also work with close relatives.
• At the third stage, all information is systematized, after which the nurse is given certain goals that are not only short-term, but also can be calculated for a longer period of time. All this is indicated in the action plan, and then recorded in the individual history of the patient, who was diagnosed with diabetes mellitus. The nursing process for this disease will already depend directly on what specific problems have been identified.

Further, the nurse begins to act in accordance with the developed plan and takes a number of complex measures aimed at ensuring the improvement of the patient's condition.

Ultimately, based on the dynamics of the development of the disease, as well as various positive changes in the overall health of the patient, the doctor determines how effective the nurse was.

It should be noted that for each individual patient an individual nursing process can be prescribed for diabetes mellitus. The organizational stage here depends entirely on how difficult the disease is and what measures the doctor should take to rid the patient of this ailment. In the standard case, the nurse will work under the constant supervision of the doctor, following all his instructions. It often happens that the nursing process in case of type 1 diabetes, or even the second one, involves interaction between the doctor and the nurse, that is, when they work, and at the same time they coordinate the arrangements beforehand.

Among other things, absolutely independent nursing intervention can be appointed. In this case, the features of the nursing process in diabetes mellitus provide for independent action on the part of the medical officer to provide the assistance that the patient requires at the moment, without the need for prior agreement with the attending physician.

Key Features

Regardless of the type of the nurse's actions, she should control and anticipate the possible development scenarios, which includes the organization of a nursing process (diabetes mellitus of any type). It does not matter whether there is direct observation by the doctor or whether she performs all the work herself - the nurse will be responsible for the health and life of the patient, therefore, this issue must be taken very seriously.

As mentioned above, nurses have to solve a fairly large number of patient problems, and they must help them adapt to the new realities of life. In particular, even the nursing process in type 2 diabetes requires the introduction and compilation of a new menu, the provision of initial information on the management of the counting of XE, calories and carbohydrates, as well as counseling relatives who must learn to help the patient. If we are talking about insulin-dependent diabetics, then in this case an additional lecture is given regarding the injections, the drugs used, and the correct introduction of each of them. The daily norm in this case is selected exclusively by the doctor and is not included in the nursing process in diabetes mellitus. The collection of information during the initial examination and advice on where to put the injections and how to get the medicine - these are the main tasks of this specialist in this case.

It is necessary to understand correctly that with diabetes, the influence of a nurse is extremely important, because this is the person with whom you can communicate, find support or get valuable advice if you want. Each such specialist is a little psychologist who helps to accept the ailment and helps to teach the patient how to fully live with him and what physical exercises will need to be done.

Examination

As mentioned above, this process begins after the appointment of the treatment and the transfer of the patient to the nurse. She is engaged in a thorough examination of the patient, studying the history of his illness and a detailed survey in order to find out the following facts:

• Are there any endocrine and other diseases?
• Whether the insulin was taken by the patient before the examination, and if so, what exactly was taken and in what dosage, what other antidiabetic and other drugs were used;
• Whether he is currently following a specific diet, is he using the table of grain units correctly?
• If a glucometer is present, then the nurse checks whether the patient can use it;
• Is inspected, the person injects insulin with a standard syringe or a special syringe-pen, how correctly this procedure is performed and whether a person knows about the possible occurrence of complications;
• How long the given disease is present, whether there were hypoglycemic or hyperglycemic coma and other complications, and if this happened, what exactly became the cause, and also whether a person can act in such situations.

The nurse asks a lot of questions about the daily routine, the basic habits and physical exertion of her patient. If it is a question of a child or an elderly person, then in this case a preliminary conversation with relatives or parents is mandatory. This technology survey is called subjective, because the completeness of information in this case directly depends on the experience of the nurse, as well as her ability to ask the right questions and find a common language with people.

The second part

The second part is a physical examination, which includes the following activities:

• General external examination. In this case, for example, "bags under the eyes" or similar edema may indicate that a person has certain problems with the kidneys or the heart.
• Extremely attentive examination of the skin. It is also worth noting that a particular attention is drawn to the condition of the mucous membranes, and if they are pale, this indicates that the person has dehydration.
• Measurement of temperature, respiratory movements and pulse rate, as well as a standard pre-medical examination.

After this procedure, the nursing process continues, in particular, the nursing history of the disease is drawn , which, accordingly, differs from the medical one. It should be understood that the doctor, based on the results of the analysis and examination, records what exactly is happening at the moment in the patient's body, while the nurse, recording his own observations, records what problems the patient has with regard to the violations that have arisen. In the history of her illness, a number of additional data are also written, such as the occurrence of neuroses, the possibility of self-service, and so on.

Inpatient care

Making up his own medical history, a nurse can notice some specific problems in the patient, that is, points to those that are present at the moment, and takes into account those that may appear in the future. Some of them are quite dangerous, while others can be easily prevented, but you have to be prepared for any changes. It also reveals the factors that can further provoke various complications, neurosis, the propensity to violate the established diet and other abnormalities, considering all this in the process of caring for the patient.

The management of a competent nursing process is simply impossible unless a sufficiently clear plan is drawn up. It is for this reason that the nurse writes in her own version of the medical history specialized nursing care manuals, in which she lists in great detail all possible problems, and also plans to respond.

Example

All this can look something like this:

• Certain prescriptions of the doctor are carried out, which are carried out under his direct supervision or control. In particular, we are talking about insulin therapy and the issuance of medications, preparation for treatment and diagnostic procedures, or their conduct and much more. In the process of outpatient treatment, tests and regular check-ups are taken.

Intervention Options

It should be noted that there are three main types of nursing intervention - the implementation of specific medical prescriptions, direct care for the patient, as well as various activities that are carried out together with a doctor or after a preliminary consultation.

Nursing care includes the manipulations that the nurse performs exclusively at her discretion, based on her experience and the "sister" medical history. In particular, we are talking about training in self-monitoring skills, basic nutrition principles and monitoring how patient meets the established daily schedule, diet and special doctor's prescriptions. If the nursing process is provided for diabetes in children, she will necessarily hold a conversation not only with the child, but also with his parents. The child will not be afraid of anything in the hospital, while parents will be able to learn about the peculiarities of this disease, the proper making up of menus and basic skills that will be useful in life with such ailment.

The interdependent sister process in diabetes mellitus in children and adults is a complex of measures in which the sister constantly shares with the attending physician various observations, and then the doctor independently makes decisions about the change or addition of the used treatment tactics. In this case, the nurse will in no case prescribe sleeping pills for diabetics, but she will tell the doctor about the occurrence of problems with sleep, after which he will decide on the use of a drug.

One of the most important features of diabetes is that the quality of life of a patient is absolutely the same depending on treatment, medical care and self-discipline. The nurse will not come home every day to the patient in order to track how correctly the medical prescriptions are performed. It is for this reason that the nursing process in the occurrence of diabetes is simply impossible if the patient is not used to self-monitoring in advance.