CARE PLAN #8

What evidence-based protocols can the nurse utilize for prevention of pressure injuries?       Develop a nursing CARE PLAN for an older adult at risk for pressure injury using wellness and North American Nursing Diagnosis Association (NANDA) diagnoses. .

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Running head: CARE PLAN 1

Class: NUR3400

Professor: Maikel Y. Portal APRN, FNP-BC

Miami Regional University

CARE PLAN 2

Abstract

Patient care has received much attention in today’s healthcare system. It enhances the treatment

plan by involving different health specialists in caring for the patient. Interdisciplinary approach

involves elements such as leadership, teamwork, patient-centered practice, and through

communications. The care providers ensure effective assessment of the condition thus meeting

patient’s desires and needs. The team pools their knowledge and expertise together towards the

recovery of the patients not just the treatment of the disease. Ideally, effective patient outcomes

can be achieved through a collaborative approach to the treatment plan. This reduces readmission

rates and avoids duplication of duties during the treatment process. The future of health care

delivery depends on how effectively the health providers implement the interdisciplinary

approach. In this paper, the interdisciplinary care plan will be drafted for McKay Johnson, a

patient diagnosed with diabetes and heart disease.

Keywords: interdisciplinary, therapy, diabetes, heart disease.

CARE PLAN 3

Background Information

Patient Name:?

Age: ?

Sex: ?

Demographics: ?

Condition: (Diabetes and Heart Disease) or any other PMH

Situation: Patient is forgetful and lives alone

Medical History

Johnson was diagnosed with type 2 diabetes in 2013, but he reports he had symptoms one

year before the diagnosis. The medical record shows that he had fasting blood glucose records

showing values of 118-127 mg/dl, which categorized his condition as “borderline diabetes.” In

2016, he was diagnosed with heart problem. Johnson has been controlling diabetes until last year

when his family physician referred him to our hospital for special treatment of the disease. His

wife reports that her husband began to experience abnormal heartbeats, difficulties in breathing,

and high blood pressure. The diagnosis shows that Johnson recorded a pulse of 115 per minute

while the systolic blood pressure was 180 mm/Hg. He had bulging neck veins, swelling in the

legs, and fluids in the lungs. He had been on glyburide (2.5 g every morning), Gymnema

Sylvester, and chromium picolinate to control diabetes. Johnson was also given Angiotensin II

receptor blockers and Statins to control heart disease.

CARE PLAN 4

Johnson’s physical examination results show a BMI of 33.4 kg/m2, Pulse of 85 bpm,

fasting glucose of 164 mg/dl, blood pressure of 160/96 mmHg, JVP of 7 cm H2O, and 20

respirations per minute. He has lung crackles, no retinopathy, swelling legs, non-palpable

thyroid, no carotid bruits, and diminishing vibratory sense to the forefoot. He reports regular

wheezing and dizziness throughout the day. The lab results presented by the nurse show that

Johnson has cholesterol-to-HDL ratio of 4 (normal < 5.0), HDL cholesterol of 46 mg/dl (normal

< 40 mg/dl), triglycerides of 180 mg/dl (normal < 155 mg/dl), AIC of 7.5 % (normal 4-6 %),

sodium of 137 mg/dl (normal 136-146 mg/dl), potassium of 4.0 mg/dl (3.5-4.3 mg/dl), blood

urea nitrogen 34 mg/dl (normal 6.1-30 mg/dl) and Urine microalbumin of 42 mg (normal < 30

mg).

Medical Assessment

Based on Johnson’s medical history, physical examination, and lab tests, it is evident he

has uncontrollable type 2 diabetes and heart disease. His hemoglobin level (7.5%) is slightly

more than the normal indicators (4-7%). He has a BMI of 32. 4 kg/m2 and it is way above the

BMI of a normal person. When an individual exceeds a BMI of 30, he is termed as obese (Pop-

Busui et al., 2017). Johnson has elevated urine microalbumin and blood urea nitrogen. These are

the indicators of heart problem and diabetes. Swelling legs, lung crackles, and regular wheezing

are also the signs of heart disease.

Care Plan

Johnson presents uncontrollable type 2 diabetes and heart disease, which require a

coordinated treatment process from all nurses across the concerned disciplines. The first step of

the interdisciplinary team is to select the most pressing health issue and prioritize his medical

CARE PLAN 5

care in order to formulate an effective treatment plan. The team has to follow the care plan for

the two diseases.

Nursing Intervention Rationale

Assess the signs of hyperglycemia A patient who uses insulin to treat type 2 diabetes
is at risk of developing hyperglycemia. Signs of
hyperglycemia include headache, fatigue,
tachycardia, dizziness, and visual changes.

Assess glucose level before and after the
meals

The glucose level should be between 140 mmHg
and 180 mmHg. Non-intensive care patients
should be maintained at less than 140 mmHg
(American Diabetes Association, 2019).

Monitor patient’s hemoglobin level A level of 4-7% is desirable and shows the
progress of the treatment process.

Monitor blood pressure, apical pulse and
peripheral pulse

Increased blood pressure is a sign of diabetes/
heart disease. Low pulse is a sign of decreasing
tissue perfusion.

Do not take an axillary temperature Elderly persons have poor peripheral circulation
which contributes to the formation of pocket airs
in axillary areas (Touhy, Jett, Boscart, &
McCleary, 2018). This gives inaccurate results.

Assess feet for temperature, and
swellings. Monitor the color of the skin

This will help to monitor peripheral perfusion.
Pale skin color is an indicator of decreased tissue
perfusion.

Assess the pattern of physical activity Regular physical activities assist in lowering the
glucose level (Naik, Dave, Stephens, & Davies,
2015). These activities prevent further
complications of diabetes and cardiac disease.

Administer basal insulin Adhering to the prescribed medical regimens
promotes tissue perfusion. This will keep glucose
at a normal level.

CARE PLAN 6

Treatment Goal

At the end of the treatment, Johnson should have blood glucose level of less than 180

mmHg, BMI of less than 30.0 kg /m2, Hemoglobin AIC level of less than 7%, blood urea

nitrogen less than 30 mg/dl, and Urine microalbumin of less than 30 mg/dl. These results will be

an indication of the successful treatment plan.

Report BP of more than 155 mmHg
(systolic)

Hypertension is a common condition for diabetes
and heart disease. Controlling blood pressure can
prevent further complications such as stroke and
retinopathy.

Monitor urine output as well as urine
albumin

Urine albumin is a sign of diabetes while urine
output shows the control of both diabetes and
heart disease.

Encourage Active ROM ROM prevents venous pooling and promotes
tissue perfusion.

Encourage bedrest with the head of the
bed elevated at 45 degrees

This position prevents blood from returning to the
heart thus increasing oxygenation and decreasing
dyspnea responsible for cardiac attack (American
Diabetes Association, 2015).

Evaluate patient’s understanding of the
medical conditions and treatment plan

This reduces medication errors. Non-adherence to
the prescribed medication can lead to more
complications such as hypoglycemia and stroke.

Administer and monitor medication
regimen

Proper administration of prescribed diabetic and
heart disease medication is important in
stabilizing glucose level, hemoglobin level, and
blood pressure.

Review the patients current diet and
nutritional needs

Proper diet helps maintain the normal level of
glucose level thus sustain the smooth flow of
blood.

CARE PLAN 7

References

American Diabetes Association. (2015). Cardiovascular disease and risk management. Diabetes

Care, 38(Suppl. 1), 49-57. Retrieved from https://doi:10.2337/dc15-S011

American Diabetes Association. (2019). Cardiovascular disease and risk management: Standards

of medical care in diabetes-2019. Diabetes Care, 42(Suppl. 1), 103–123. Retrieved from

https://doi.org/10.2337/dc19S010

Pop-Busui, R., Boulton, A., Feldman, E., Bril, V., Freeman, R., Malik, R. A. … Ziegler, D.

(2017). Diabetic neuropathy: A position statement by the American Diabetes Association.

Diabetes Care, 40(1) 136-154. Retrieved from https://doi:10.2337/dc16-2042

Naik, V., Dave, R., Stephens, J. W., & Davies, J. S. (2015). Evidence based prevention of type 2

diabetes: Role of lifestyle intervention as compared to pharmacological agents.

International Journal of Diabetes and Clinical Research, 2(6). 49-56. Retrieved from

https://clinmedjournals.org/articles/ijdcr/international-journal-of-diabetes-and-clinical-

research-ijdcr-2-049

Touhy, T., Jett., K., Boscart, V., & McCleary, L. (2018). Ebersole and Hess’ gerontological

nursing and healthy aging (5th ed.). New York, NY: Elsevier – Health Sciences Division.

https://doi.org/10.2337/dc19S010

https://www.ncbi.nlm.nih.gov/pubmed/?term=Bril%2520V%255BAuthor%255D&cauthor=true&cauthor_uid=27999003

https://www.ncbi.nlm.nih.gov/pubmed/?term=Freeman%2520R%255BAuthor%255D&cauthor=true&cauthor_uid=27999003

https://www.ncbi.nlm.nih.gov/pubmed/?term=Malik%2520RA%255BAuthor%255D&cauthor=true&cauthor_uid=27999003

https://clinmedjournals.org/articles/ijdcr/international-journal-of-diabetes-and-clinical-research-ijdcr-2-049

https://clinmedjournals.org/articles/ijdcr/international-journal-of-diabetes-and-clinical-research-ijdcr-2-049