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Question 4.  What types of diagnostic errors can be made in this case?

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Question 4.  What types of diagnostic errors can be made in this case?

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Metformin and Gliclazide together can cause abnormally low blood sugar. Mair was taking all her tablets together to stop herself from forgetting any, this could be a factor. If the medication regime was taken as prescribed this problem may be lessened.
History of MI so dismissing it could be an error.
Suffering from SOB, obesity could mask Oedema.

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MAIR JONES, 69, Collapsed 9pm- Unresponsive. ****

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(Courtney) Question 1- What is Type 2 Diabetes?

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(Courtney) Question 1- What is Type 2 Diabetes?

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Type 2 Diabetes is a serious long term condition that results in hyperglycemia (high blood glucose levels) due to the body not being able to produce enough insulin and/or where the insulin the pancreas makes cannot work properly. Everyone needs insulin to live because it allows the glucose in the blood to enter our cells and fuel our bodies.

When you have Type 2 diabetes, your body still breaks down carbohydrate from your food and drink and turns it into glucose. The pancreas responds to this by releasing insulin. But because this insulin can’t work properly, blood glucose levels keep rising. So more insulin is released. For some people with Type 2 diabetes this can eventually tire the pancreas out, meaning their body makes less and less insulin. This causes even higher blood glucose levels which over time may damage the organs of the body.

(Diabetes.co.uk 2018).

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(Courtney) Question 2- Considering NANDA, what is the nursing diagnosis and goals of care for this patient?

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(Courtney) Question 2- Considering NANDA, what is the nursing diagnosis and goals of care for this patient?

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Nurses Diagnosis:

Having uncontrolled diabetes is mostly common caused by the patient’s poor knowledge and understanding of not knowing how to manage their diabetes properly and have had the lack of education. In Mrs Jones case it is now the nurse’s responsibility to educate her about diabetes as her medical diagnosis is Hypoglycaemia. This is related to a lack of concordance with diabetes management.

The goals of care for Mrs Jones:

The nurse needs to discuss with Mrs Jones if she has any equipment at home for her to take her blood sugars and to see if Mrs Jones understands how to manage her diabetes correctly, if not education and support will be given.

The nurse will ask Mrs Jones to:

·       Demonstrate how to take his blood sugar and interpret the results.

·       Demonstrate how to give insulin injections using the sliding scale.

·       Demonstrate how to properly dispose of insulin syringes and lancets.

·       Verbalise how often and when she needs to check her blood sugar.

If Mrs Jones is unable to do this, the nurse will educate her and go through everything step by step to make sure she understands.

Nursing Interventions:

·       The nurse will refer Mrs Jones to a dietitian to educate her on a suitable diet for an individual with diabetes.

·       The nurse will encourage Mrs Jones to develop a daily menu that meets her diabetic needs.

·       The nurse will supply Mrs Jones with testing strips, lancets, glucometer and insulin if required.

The nurse looking after Mrs Jones will have to make sure that Mrs Jones is happy and understands how to control her diabetes well. The nurse should also provide Mrs Jones with leaflets that she can refer back to when needed.

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How do you think you can achieve shared approaches to planning care with clearly stated goals?(in line with NANDA)

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Describe how you would implement health education and deliver effective health care?
Health education and effective health care would be given in a manner that is timely and appropriate for Mair. She is in a great deal of distress so overloading her with information would not lead to long term compliance.
I would deal with the immediate situation and work through her ADL's. Using this as a framework I would then implement national guidelines(see link below) and utilise risk assessment tools such as MUST,WAASP and NEWS.
Taking her husband aside, I would suggest raising the lack of a timely appointment was a combination of factors, and that an ambulance would have been necessary due to the urgency of her collapse. This could de-escalate the situation and lead Mair and her husband to contacting the GP before it becomes a matter of urgency.
When Mair is more stable,I would suggest an MDT where Mair and her husband can access the Health Care Professional best able to support them in their understanding of diabetes and its potential complications.

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What might be the alternative causes of fainting  in this case related to her medication,physical status and potential comorbidities

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Q7: ABEY- What are the potential interactions between Statins and Anti Hypertensive drugs?

Statins are a group of medications that can assist with lowering the level of 'low density lipoprotien' (LDL)- or cholesterol in the blood stream. Low density lipoprotein is considered the 'bad' or harmful cholesterol within our bodies.

Statins in this instance are used to reduce the production of LDL within the inside of Mairs liver.       Hence- Pat takes 40mg of Simvastin Daily.

High levels of LDL can lead to serious health risks such as; hardening and narrowing of the arteries or Atherosclerosis or Cardiovascular disease.(Nhs 2018)

Statins have the potential to interact with a whole range of other medications and contraindications do occur with drugs prescribed for cardiovascular disease. Hence- Pat also takes Ramapril 10 Mg Daily. It is important to highlight that some Statins can interact with Grapefruit juice also. (Nhs 2018)

Anti hypertensives are a group of medication which target hypertension or high blood pressure. A consistent blood pressure of 140/90mmhg or above is considered; hypertension which requires either life style changes, (diet/ exercise/smoking) or medication or a combination of both interventions. (Nhs 2018)

It would be good to offer Mair some health promotion around how exercise can assist with helping her hypertension and considering smoking cigarettes is a major contributor to HB, it is good that Mair gave up smoking 20 years ago. (Mardsten 2016)

It is also important to advise Mair to checks her glucose levels more frequently whilst taking Ramipril. As this medication can lower blood glucose levels, especially when new to taking the medication or when starting a higher dose. (Mardsten 2016)

Simvastin (Statins) taken with Ramapril (Anti hypertensives) require close monitoring of symptoms. This is because, when they are combined, they can heighten the normal symptoms and side effects of taking Statins alone. Mair must be observant for problems with her muscles such as; pains, weakness, cramps, tenderness and muscle breakdown which can potentially lead to kidney damage. Mair must be observant, but must never stop these medications without seeking a Drs advice.

Other symptoms of these drug interactions include: dizziness, blurred vision, nausea, vertigo, epilepsy, lethargy, depression, cognitive disorders, skeletal disorders, rectal bleeding, abdo pain and diarrhea. (BNF. 2016)

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In looking at NICE guidelines,what might be the next steps in controlling her diabetes?

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In relation to this, how would you plan an education programme within the patients careplan to help them understand new treatments?

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What plans  could you put in place to address the psychosocial of the disease process on Mrs Jones?