Besides a nurse, what additional disciplines should or are involved in the plan of care? Specify the role of thdisciplines involved in the plan of care? Explain.
PLEASE SUMMARIZE DISCUSSIONAs an oncology nurse, my role is to teach oncology patients how to manage their diabetes while undergoing chemotherapy treatment. Tcan be a challenging task as some chemotherapy and supportive therapy such as steroids can lead to hyperglycemia. Hence, my responsibility is to provide education and support to all oncology patients who might be affected by diabetes.2.Managing diabetes requia collaborative approach. The plan of care should consist of the following:Physician/oncologist: Identifying risk factors and making appropriate referral.Diabetes Educator/Diabetes Nurse Practitioner/ Clinical Nurse Specialist: Educating patient how to manage diabetes and implementing strategies to maintain compliance. Tincludes using and adjusting insulin, initiating and adjusting diabetes medications, dietary changes and exercises.Dietician: Working with each individual to identify appropriate meal plan. Setting realistic nutritional goals and negotiating dietary strategies to achieve thgoals.Social Worker/ case manager: Providing social support to diabetic patient and family is crucial. They can work closely with community agencies such as housing department, welfare officers to improve diabetes management, environment and financial challenges that are sometimes experienced by diabetes patient.3. Two primary needs that may affects oncology patients in managing diabetes are Exercise and Nutrition. Exercise -Oftentimes oncology patients are considered high fall risk because of chemotherapy administration. As a result, patients sometimes believe that once they are receiving chemotherapy walking is prohibited. The side effect of chemotherapy may also cause fatigue which affects a patient ability to exercise or even to walk. Cancer can also cause bone pain which affects activity of daily living. NutritionChemotherapy causes nausea and vomiting which altered nutrition requirement and poor intake causing hypoglycemia. Steroids are oftentimes used in combination with chemotherapy that can also increases appetite and ultimately cause hyperglycemia.4. Barriers towards maintaining exercise includes chronic or acute pain, lack of social support, and depression. Barriers towards maintaining adequate nutrition includes poor intake, nausea and vomiting, NPO and loss of appetite. Thcan be caused by chemotherapy and radiation treatment.5. Exercise: To encourage exercise, Patients should receive pain medication before receiving physical therapy or ambulating. Another way to promote physical movement is to ensure that patient receive physical therapy throughout their course of chemotherapy. Tprovides social and physical support. It encourages patient to perform activities of daily living and restore strength.Nutrition: Two methods to promote adequate nutrition are to provide healthy food choices. Having independence is very big in the oncology population as a results having choices is sometime the only independence they have. Tcan be effective in administering nausea medication before eating. Another way to encourage nutrition is having a dietician that provide nutritional meal plan.group 2message_frame.jsp1) 1) What is your role in teaching or assisting tperson or group of people in diabetes management? (e.g., primary medical nurse, dialysis nurse, daughter, wife)? As a cardiothoracic bedside nurse, one of my most important roles is educating patients on effective ways to manage diabetes. Initial therapy that patients should be taught include: lifestyle counseling, weight loss reduction, exercise, and nutrition (Approaches to Glycemic Treatment, 2015). In the more progressive phase of Type 1 and Type 2 Diabetes, patients should also be taught about monitoring carbohydrate intake, self-monitoring blood glucose (SMBG), and having A1C testing done every 3 months (Glycemic Targets, 2015).? Another important role as a bedside cardiothoracic nurse is to reinforce the importance of glycemic control after heart surgery. In the DCCT and UKPDS trial, intensive control of diabetes was associated with a lower risk of CVD events (Glycemic Targets, 2015). In the immediate postoperative period, many patients are placed on an insulin drip, which requihourly blood glucose monitoring. In tphase, it is important to educate patients about the prevention of diabetic ketoacidosis and hypoglycemia.? When surgical patients are discharged with insulin, bedside nurses are also responsible for teaching them on proper administration of insulin, checking blood glucose before meals, as well as anticipating their level of activity prior to insulin administration (Approaches to Glycemic Treatment, 2015).? I find that another important role that nurses should carry out is assessing patients? readiness for change. For example, patients can be educated on choosing healthy carbohydrates that have lower glycemic index or performing at least 30 minutes of exercises daily to help manage their weight (Prasad, Ryan, Celzo, Stapleton, 2012). However, thinterventions will not cause much effect if patients are not willing to initiate change.2) 2) Besides a nurse, what additional disciplines should or are involved in the plan of care? Specify the role of thdisciplines involved in the plan of care? Explain.? Diabetes management and education requian interdisciplinary approach from different members of the healthcare team. Tcan include: an endocrinologist, a dietitian, a nurse, a nurse practitioner, a social worker, a care manager, and a visiting nurse. Because diabetic patients are at a different stage of the disease, endocrinologists play a crucial role in modifying glycemic targets and methods of therapy depending on the patient?s comorbidities and history of glycemic episodes (Glycemic Targets, 2015). Dietitians are responsible for educating patients on healthier food choices which include: foods low in glycemic index which can help lower insulin resistance, foods low in saturated fats, and foods low in sodium such as thos included in the DASH diet (Prasad, Ryan, Celzo, Stapleton, 2012). Registered nurses and nurse practitioners are in the position to reinforce the importance of a healthy diet and increasing physical activity for weight management. They can also educate patients and family members alike about timely blood glucose monitoring, proper administration of insulin, as well as the various complications of diabetes (retinopathy, neuropathy, and increased risk for cardiovascular disease). Social workers and care managers are responsible for coordinating care for patients after they leave the inpatient setting. They can assess and determine patients? needs at home and deploy the appropriate resources such as a visiting nurse and physical therapist. Visiting nurses are in the position to reinforce teaching with patients in their home setting and also determine patient preferences in diabetes management. In the more progressive phase of diabetes, visiting nurses also perform wound care for patients with severe neuropathy and vascular disease.3) 3) What are the 2 primary needs identified which affect tperson or group of people in managing their diabetes? Provide detail.? It is important to emphasize with diabetic patients or those at risk for diabetes that lifestyle modifications must be continuous and not temporary. Continuous lifestyle counseling among thpatients is necessary in order to determine their needs and their readiness for change. A patient-centered approach should be used in determining methods of treatment, discussing potential side effects of insulin and oral agents, as well as discussing hypoglycemia risk (Approaches to Glycemic Treatment, 2015). Patients have different comorbidities and life expectancies and health care providers play a key role in modifying treatment regimens for diabetic patients. For instance, patients with little comorbidity and long life expectancy might benefit from more intensive glycemic targets, while those with a history of hypoglycemia may benefit from less aggressive targets (Glycemic Targets, 2015).? Lifestyle counseling for diabetic patients and those at risk for diabetes should also focus on prevention so as to prevent the progression of the disease and its many complications. The prevalence of type 2 diabetes is increasing in the United States and major complications include cardiovascular diseases?both microvascular disease and macrovascular disease (Grundy, 2012). Managing hyperglycemia is very important in tpopulation to prevent microvascular complications such as microalbuminuria, chronic kidney disease, retinopathy, and peripheral neuropathy (Grundy, 2012). The pathogenesis of thcomplications is related to endothelial dysfunction induced by hyperglycemia (Grundy, 2012). In terms of macrovascular disease, there is no clear evidence that diabetes directly contributes to atherosclerosis (Grundy, 2012). However, many people with diabetes have metabolic syndrome, which is a risk factor for cardiovascular disease (Grundy, 2012). By focusing on primary prevention methods such as diet and exercise, health care professionals can help decrease the risk factors for diabetes, which in turn can reduce its prevalence and alleviate the economic burden on diabetes management. The use of drugs to reduce risk factors should also be considered.4) 4) What do you think are the barriers which hinder them from changing or addressing thneeds?? Among the barriers that patients face in addressing their needs for diabetic management include culture, socioeconomic status, as well as lack of social support. Culture includes both dietary preferences and language. For instance, a staple food in the diet of many Asian Americans is white rice. White rice may be included in breakfast, lunch, and dinner. Health care providers are in the position to educate patients and family members alike in choosing carbohydrates that have a lower glycemic index. For instance, other sources of carbohydrate that have higher amounts of protein and fiber include brown rice and quinoa. Health care providers, however, should first assess the patient?s readiness for change and ability to learn prior to making educational interventions. Some patients may not be able to speak English or speak limited English, which hinders their learning process for managing diabetes. Some patients who are at risk may also not believe that they are susceptible to developing diabetes, which can make the health care provider and patient interaction more complicated. In terms of socioeconomic status, patients who make a low income may be less likely to comply with their medications due to cost. Some of thpatients may also be working several hours during the day, which can make it difficult to abide by a healthier diet or a workout regimen. They may also live in neighborhoods with little options for healthier and fresh foods, which makes them susceptible to eating preserved foods that are cheaper and high in sodium and transfatty acids. Lastly, patients who are at risk or newly diagnosed with diabetes may face a psychosocial challenge due to lack of social support and lack of self-confidence in making the necessary adjustments in managing diabetes.1) 5) How would you assist them in addressing each of the needs identified in the previous question? For each need identified, provide 2 examples of how you would address each of the needs.? Cultural Interventions:? As mentioned in the previous question, it is important for health care providers to assess patients? readiness for change prior to making any interventions. In order to help patient realize the changes that need to be made, HCPs must learn about the patient?s cultural preferences so as not to make any unrealistic suggestions for change. By being sensitive and aware of thcultural definitions, patients can adopt lifestyle habits that have been tailored to their cultural needs. For instance, if an Asian American patient proposes that it is too difficult to eliminate or lower white rice consumption, the HCP can suggest mixing it with brown rice to help initiate change. Tgoal would be more realistic to achieve than eliminating white rice altogether from that patient?s diet.? In order to overcome language barriers, using family members, language-concordant physicians, and professional interpreters can help improve communication between HCPs and patients who have little or no ability to speak and understand English (Okrainec, Booth, Hollands, Bell, 2015). Studies have shown that immigrants who have access to language-concordant physicians have improved glycemic control compared to those without (Okrainec, Booth, Hollands, Bell, 2015).? Socioeconomic Interventions:? As literature has shown, there is currently no universal national program to screen for pre-diabetes due to costs (Grundy, 2012). In our health care system we are currently using clinical judgment to initiate testing for diabetes (Grundy, 2012). In 2012, it was approximated that more than 22.3 million people were diagnosed with diabetes in the U.S. (Economic Costs of Diabetes in the U.S., 2012). It cost the nation a total of $245 billion, which includes $176 billion in direct medical cost and $69 billion in lost productivity (Economic Costs of Diabetes in the U.S., 2012). While tis a problem that will require multidisciplinary remedies, health care providers can: a) emphasize the importance of primary prevention and lifestyle modification, which focuses on weight management and increasing physical activity and b) advocate to policy makers the importance of allocating research and funding for diabetes management. By focusing on primary prevention methods such as diet and exercise, health care professionals can help decrease the risk factors for diabetes, which in turn can reduce its prevalence and alleviate the economic burden on diabetes management. And, by advocating for the need for more research and funding for diabetes management, policy makers can identify which health care resources are attributed to diabetes.? Pyschosocial Interventions:? Diabetes management is a great responsibility that requimany behavioral changes. There are strict behavioral standards on diet, exercise, self-monitoring of blood glucose and insulin administration (Sabourin and Pursley, 2012). Tmight cause patients to feel overwhelmed and make them question their ability to perform self-care (Sabourin and Pursley, 2012). Health care providers can help overcome tbarrier by: a) allowing patients to openly discuss their health beliefs and b) limiting the number of targeted goals to no more than 2 or 3 (Sabourin and Pursley, 2012). In doing so, HCPs, can determine the patient?s own reasons for change and positive sources of motivation to help drive change. In addition, by letting patients set their own goals, feelings of being overwhelmed can be minimized and efforts for change won?t be abandoned (Sabourin and Pursley, 2012).? Group 3? 1. As a neurology/stroke nurse in a high risk population, teaching patients about diabetes is a very important part of my job. Most patients already had a diagnosis of diabetes or were discharged with a new diagnosis. Diabetes is one of the most common risk factors for stroke, and in order to prevent a secondary stroke, extensive education is needed. Diabetics are also at higher risk for stroke due to atherosclerosis from elevated blood glucose levels and hypertension which makes education that much more important.? 2. It is imperative that diabetes education is interdisciplinary. A diabetes educator (NP, CNS) should be involved in order to do extensive teaching for new onset diabetics. Diabetes can be very complicated for patients and time must be given to make sure they understand meal planning, medications, and monitoring blood glucose levels. A dietician is an integral part of the team. A dietician can teach the patient and their family correct food choices, carb counting, and meal planning. They can assist in offering options that are still within a patient?s cultural cuisine, but may be better choices for a diabetic. One of the biggest life changes a diabetic has to make is their eating habits, which makes a dietician a crucial part of the team. An endocrinologist may need to be included if a patient has sugars that are difficult to control or require different types of insulin. Social workers also provide an imperative role with patients with diabetes. They can assist in having visiting nurse services set up to the home, insurance needs, and assisting patients in getting medications for free or that they can afford. In order for patients to be compliant with medications, the medications must be accessible to them. A primary doctor should also be involved in a patient?s care. Diabetics are at high risk for cardiovascular disease, neuropathy, microvascular disease, amongst many others. A patient should have someone they can see that knows their history and can provide monitoring for any change in condition, as well as change medications as needed.? 3. One of the primary needs in the stroke population is lifestyle changes. The patients I see are already having comorbidities related to diabetes, like hypertension and hyperlipidemia, and need to change their diet and exercise in order to prevent further damage. Another primary need is access to medications and follow up appointments. I work in Washington Heights and have a large population of hispanic patients. Many patients don?t have health insurance and need assistance with obtaining it, if possible. Without the ability to access affordable medications, patients become non compliant.? 4. One of the major barriers is a lack of desire to change. Most patients are willing to take a pill, but not to completely change their diet and add exercise to their routine. Also, many of the patients have a very distinct culture, which includes food and rituals related to it. When tis involved, asking someone to change what they have lived with for generations, is extremely difficult.? A major barrier to access to healthcare is affordability and lack of knowledge. Many patients do not have primary care providers, health insurance, or knowledge on how to obtain these. Even if a patient is sent home with prescriptions, it is imperative that they follow up and continue to take medications. I see a lot of patients that stopped taking their medication because they ran out, didn?t realize how important it was, and then ended up having a stroke because of it.? 5. When I educate patients on lifestyle changes, I try to keep in mind that if you give people a list of things they can?t have or can?t do, it is going to be harder to have them comply. I try to sit and discuss their current lifestyle, and try to make changes that aren?t as severe, and are actually doable for them. For example, I recommend using ground lean turkey as opposed to ground beef for a healthy alternative that can be utilized in many meals, and may not have the patient feel like they can?t have what they are used it. If a patient does not exercise, it is going to be very hard to get them to go to the gym 5 days a week for 30 minutes a day. I try to add it in to their lives by walking more. For example, getting off the subway a stop early, walking to the store instead of taking a bus, or just walking around the block on a nice day. The goal is that the more a patient does it, the more routine it will become.? One of the most important aspects of discharge, is education. I educate the patients on the importance of each of their medications, including why they are taking them and what happens if they don?t take them. I give handouts that way the patients can read them after they leave, in case they forget what each medication is. I also explain to the patients why going to their provided follow up appointment is necessary, what the doctors are going to be monitoring, and how taffects their health. We make sure that patients have follow up appointments that are accepted by their insurance as well also being in close proximity to where the live. I also involve the social workers in order to make sure that all patients can begin a Medicaid application if needed, in order to have further access to primary care. It a patient is ineligible or does not have any health insurance, the doctors will make every effort to substitute medications for the cheapest one. I then advise patients on where to access the most affordable medications.Group 4? What is your role in teaching or assisting tperson or group of people in diabetes management? (e.g., primary medical nurse, dialysis nurse, daughter, wife)? I currently am a Clinical Nurse in a Neurosurgical/Neurological Step-down Unit. A major contributing factor for stroke is diabetes. On admission to our unit with a diagnosis of stroke we are immediately prompted to send a Hemoglobin A1C. Ttest measuthe amount of glucose attached to the red blood cells. Ttest will show your average blood glucose for the past three months. At tpoint, we sometimes will see undiagnosed diabetes or uncontrolled known diabetes. Tis the point when education comes into play. The main focus for nursing is education on diabetic management and lifestyle changes necessary to deal with tdiagnosis. We first must assess for self-efficacy and readiness to change. When that has been established, we can begin to educate on the process of monitoring blood glucose and treatment. We also will discuss eating habits and lifestyle changes that may be necessary. Tight glycemic control is priority in preventing long term complications.? ? Besides a nurse, what additional disciplines should or are involved in the plan of care? Specify the role of thdisciplines involved in the plan of care? Explain.? The diabetic plan of care is multifaceted and needs an interdisciplinary approach. While the medication plan would start with the primary care giver, they may need to call on endocrine if the blood glucose is too difficult to control with common practices. Nutrition must also be involved to not only choose a diet plan, but also to personalize that plan. Social Work will then make the plan for discharge and assess for any equipment needs, or social issues that may hinder management.? ? What are the 2 primary needs identified which affect tperson or group of people in managing their diabetes. Provide detail.? Two primary needs which affect patient?s management of diabetes are diet modification and exercise. Adjusting to a diabetic diet can be difficult. With patient returning home to the same conditions and possibly a lack of support tnew change will take time. Diabetes and exercise go hand in hand. Exercise can improve blood sugar control and reduce risk of complications, such as heart disease and stroke.? ? What do you think are the barriers which hinder them from changing or addressing thneeds?? In my opinion, the main barrier that affects change is lack of support. Everyone needs encouragement when making positive change. If the patient does not have people at home supporting tchange it is less likely to happen. Another barrier is social economic issues. If a patient is not financially stable, they are less likely to buy more costly foods that may be healthier or join a gym. Lastly, in stroke patients you can see some physical deficits that may hinder the patient from a normal exercise regimen. Tcan also be a barrier.?? ? How would you assist them in addressing each of the needs identified in the previous question? For each need identified, provide 2 examples of how you would address each of the needs.? In regard to diet modification, the goal would be to create a meal plan that not only is nutritious but also includes foods that the patient enjoys. It should be personal, not just a standard diet. I would also help research some low cost diet options, as well as places close to their home that they can purchase thitems. For exercise, we would ensure physical therapy is in place for the patient. Also for this, we would make a plan for when that ends. We would discuss getting a gym membership or ways to work out with common items within the household. The goal is always to make thinterventions interactive and appropriate for the patient.Group 5? What is your role in teaching or assisting tperson or group of people in diabetes management? (e.g., primary medical nurse, dialysis nurse, daughter, wife)? I am working at homecare setting. Most of my patients are elderly and have chronic disease. My patients who have diabetes also have hypertension and hypercholesterolemia. As a clinical assessment nurse, educating patient with life style modification such as diet changing is important. Moreover, educating family members and Home Health Aid (HHA) is crucial. Majority of my patients are not able to cook and not independent with ADLs or ADLs so they need assistance from HHA and family members. That is why, educating family member and HHA is very important in order to treat patient?s diabetes. I educate them to prepare proper diet for the patient, provide a clean environment to prevent from fall and injury and inspect patient?s skin and feet daily. Because my patients are not ambulating that much due to chronic arthritis or other health issues, HHA and family member can assist and encourage them to walk and do mile exercise daily.? ? Besides a nurse, what additional disciplines should or are involved in the plan of care? Specify the role of thdisciplines involved in the plan of care? Explain.? As a home care setting, as I explained above, family member and HHA plays vital role in patient?s care. Also, nutritionist or dietitian would be the one can take a major role in making a care plan for diabetic patients. According to American Diabetes Association (ADA), Nutrition therapy is recommended for all people with type 1 and type 2diabetes as an effective component of the overall treatment plan. Because diabetes nutrition therapy can result in cost savings improved outcomes such as reduction in A1C (ADA, 2014). Health care providers also needs to work with social workers to find out if a patient has a sufficient finance to support a healthy diet plan and medications. All in all, providing care plan for diabetes patients needs Interdisciplinary approach with health care providers, family members, HHA, social workers, nurses, and nutritionist.? ? What are the 2 primary needs identified which affect tperson or group of people in managing their diabetes. Provide detail.? It would be a life style modification and monitoring blood glucose by following medication regimen. Many of my patient have comorbidity condition such as hypertension, hypercholesterolemia and obesity. Most of my patients are having a poor diet. Due to their physical limitation, they cannot exercise as much as healthy people but it also hinder them to move around. For example, one of my patient has severe arthritis, even though she can walk, she does not want to walk because it aggravate the pain and she does not want to take pain medication because it makes her constipated. Therefore, the major part that she can control is diet. Also monitoring blood glucose is vital because it gives an idea of how much sugar has been controlled. Depends on blood glucose, patient can manage with different dosage of insulin if they are on insulin therapy. If they are not monitoring regularly it will end up make them in danger of hypo or hyperglycemic condition.? ? What do you think are the barriers which hinder them from changing or addressing thneeds?? Many of my patient has chronic illness and they are not ambulating as much as healthy people. Since they are mostly home-bound, it would be hard them to do exercise. Also they are depending on their personal care to others such as HHA and family members. If HHA and family members does not take a responsible to take care of patient, it also difficult patient to manage their diabetes.? ? How would you assist them in addressing each of the needs identified in the previous question? For each need identified, provide 2 examples of how you would address each of the needs.? First of all, since most of my patients are having a difficulty to ambulate due to arthritis and medical condition I can refer to physical therapist to do the evaluation and they can teach them how to do exercise within safety level and how to ambulate at home with cane, walker or any other devices if they are using. As far as they are moving around and it helps them to not only have muscle strength but also control diabetes. Also it is important to provide proper pain management before they walk or move. The major issue they don?t want to move is because of pain. Controlling pain in an adequate level is also important point before asking them to do exercise.? Second, as a home care setting, family members and HHA plays pivotal role. They are the one who gives direct care for the patient every day. Educate and encourage them to involve patient care is really important. Not all of my patient has a good family support. Some of them has none or some of them lives alone and barely see their families. In tcase, HHA is the one who takes care of the patient. Due to the scope of practice, HHA can?t check patient?s blood glucose but they can remind patient to do it daily and assist patient to monitor their blood glucose record.?group 6What is your role in teaching or assisting tperson or group of people in diabetes management? (e.g., primary medical nurse, dialysis nurse, daughter, wife)? As a bedside nurse, and more specifically, as a nurse on a cardiac step down unit, I find that a large percent of our patient population has diabetes. Cardiovascular disease is a major cause of morbidity and mortality for individuals with diabetes (American Diabetes Association, 2015), and it is common to find a large portion of our patient population with diabetes being admitted for cardiac stent placement, or myocardial infarction. With that being said, my role as a nurse is very important to educate thpatients on how to manage their diabetes, nutrition, and risk factors.? Besides a nurse, what additional disciplines should or are involved in the plan of care? Specify the role of thdisciplines involved in the plan of care? Explain.? Diabetes management involves an interdisciplinary approach from the patients healthcare team, and each member plays an important role. Tincludes, the patients physician, who is involved in diabetes management from initial diagnosis, but ideally they will play the main role in identifying risk factors, adjusting medications, and educating the patient and family about the disease. Another very valuable member of the team is the NP/Clinical Nurse Specialist/RN, who will ultimately do most of the teaching to ensure successful management of diabetes through education on everything from disease process, medication administration, and nutrition. Last but not least, are members of the social work team, who ultimately will aid in getting things accomplished out in the community if the patient has any needs like visiting nurse, or getting rides to follow up visits. Overall, each member of tteam wouldn?t function without the other.? What are the 2 primary needs identified which affect tperson or group of people in managing their diabetes. Provide detail.? Two primary needs affecting the cardiac patient with diabetes is nutrition and risk reduction management. It is very common for patients with diabetes and underlying (or high risk for) cardiovascular disease to not have the best diet. It is very important to teach patients and their families about following a low salt, low fat, and low cholesterol diet, in association with their diabetic diets of low-sugar and low-carbohydrate. Similarly, twill aid in risk reduction for dyslipidemia, and potentially manage blood pressure with limited sodium intake. However, the most important need for the diabetic patient is risk factor management through things like blood pressure control, dyslipidemia management, and the appropriate pharmacotherapy to reduce the risks of cardiovascular disease.? What do you think are the barriers which hinder them from changing or addressing thneeds?? There are a few barriers that can hinder patients from changing or addressing thneeds, but the most common factors are socioeconomic status, and culture. If people don?t have access to nutritional f
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