Concept Map of Diabetic and Hypertensive Patient

Concept Map of Diabetic and Hypertensive Patient

This paper provides an analysis of a concept map of a known diabetic and hypertensive patient. The concept map contains the patient’s biodata, nursing diagnoses, treatment and interventions, interprofessional collaboration, and the desired outcomes. This analysis includes a justification of the value and relevance of evidence and the interprofessional approaches utilized to ensure desired outcomes are achieved.

Additional Evidence

The patient, R.K., is a fifty-year-old male. He is a known hypertensive and diabetic patient. His presenting complaints are fatigue, polyuria, orthostatic hypotension, paresthesia, anorexia, and erectile dysfunction. His vitals demonstrate an elevated temperature of 38^oC, a normal respiratory rate of 19 breaths per minute, and elevated blood pressure of 150/86. Furthermore, laboratory tests reveal serum osmolality of 350mOsm/kg, plasma glucose level of 620 mg/dl, and bicarbonate levels of 16 mEq/L.

The three nursing diagnoses are made based on subjective and objective data findings. Findings such as orthostatic hypotension, fatigue, polyuria, altered mentation, serum osmolality of 350 mOsm/kg, plasma glucose level of 620 mg/dl, bicarbonate levels of 16 mEq/L indicate a risk for fluid volume deficit (Alghamdi et al., 2021). Osmotic diuresis can result from hyperglycemia. This leads to the loss of water and other electrolytes from the body. The fluid deficit leads to an increase in plasma osmolality (Alghamdi et al., 2021). The elevated plasma osmolality and a hyperglycemic state indicate the hyperosmolar hyperglycemic state (Alghamdi et al., 2021). According to Duarte et al. (2018), persistent anorexia, diarrhea, low body mass index, and poor muscle tone indicate imbalanced nutrition. This could be caused by a lack of enough quantities of the recommended daily intake (Duarte et al., 2018). Imbalanced nutrition applies to all food nutrients, including carbohydrates, proteins, and fats.

According to Cannarella et al. (2021), erectile dysfunction, diminished peripheral pulses, and a score of 8 when subjected to the International Index of Erectile Function questionnaire indicate a risk for sexual dysfunction related to peripheral neuropathy. Sexual dysfunction in patients with type 2 diabetes mellitus is a manifestation of peripheral vascular disease (Cannarella et al., 2021). Therefore, Mr. R.K. should receive individualized care that fulfills his needs.

Interprofessional Strategies

 The interprofessional team involved includes nutritionists, physicians, nurses, and pharmacists. The whole team should emphasize patient education and promote the use of evidence-based clinical interventions. Nutritionists should provide knowledge on appropriate nutritional practices. This includes the recommended daily calories and the quantity to be consumed per meal (Johnson & Carragher, 2018). They should also enlighten patients on foods with a low glycemic index and encourage their consumption. This will help to address the patient’s imbalance. Nurses should ensure that the right quantity of medication is administered at the right time (Johnson & Carragher, 2018). This increases adherence levels and leads to tight glycemic control, hence better clinical outcomes. The nursing team is also involved in patient education concerning appropriate drug use and the importance of compliance.

Pharmacists are involved in providing information about medications. This includes the contraindications, potential interactions, and adverse effects. They should educate patients on appropriate drugs, such as insulin injection techniques (Johnson & Carragher, 2018). They uphold patient compliance by utilizing visual aids such as drug calendars and charts (Johnson & Carragher, 2018). Physicians are involved in the prompt diagnosis of diabetes mellitus and early initiation of therapy (Johnson & Carragher, 2018). This leads to a better clinical prognosis. They should also educate the patient on the importance of compliance and tight glycemic control. The interprofessional team should apply evidence-based approaches to ensure that the best treatment plan is selected.

Value and Relevance of Evidence

Poorly managed diabetes mellitus can lead to acute diabetes emergencies and long-term macrovascular and microvascular complications. The risk for fluid volume deficit is an urgent nursing diagnosis that should be addressed promptly. Orthostatic hypotension, fatigue, polyuria, altered mentation, serum osmolality of 350 mOsm/kg, plasma glucose level of 620 mg/dl, and bicarbonate levels of 16 mEq/L are indicators of fluid volume deficit (Alghamdi et al., 2021). Furthermore, elevated plasma osmolality and a hyperglycemic state indicate the hyperosmolar hyperglycemic state (Alghamdi et al., 2021). This state clinically presents with plasma glucose levels above 600mg/dl, severe dehydration, and bicarbonate levels above 15 mEq/L (Alghamdi et al., 2021). Fluid resuscitation helps to improve organ perfusion and avert the collapse of the cardiovascular system. Improved mentation is an indicator of better perfusion. Intravenous insulin therapy helps to lower glucose levels (Alghamdi et al., 2021). Potassium replacement therapy helps to avert hypokalemia.

According to Cannarella et al. (2021), sexual dysfunction in type 2 diabetes mellitus is due to peripheral vascular disease. Sexual counseling helps to uplift the patient’s self-esteem. It also helps to identify other stressors that could worsen the condition. Phosphodiesterase type 5 inhibitors promote vasodilation by increasing cyclic guanosine monophosphate and nitric oxide (Cannarella et al., 2021). Tight glycemic control that entails compliance leads to a better prognosis and helps to avert any microvascular and macrovascular complications (Cannarella et al., 2021). Imbalanced nutrition results from inadequate or inappropriate dietary habits. A concerted effort should address the recommended daily intake and modifications, such as limited alcohol and cigarette intake (Duarte et al., 2018). The patient’s preferences should form the basis of designing the meal plans.

Conclusion

Poorly managed diabetes mellitus can cause diabetic emergencies and macrovascular and microvascular complications. An interprofessional approach to management is important to provide a good prognosis. The team comprises nutritionists, nurses, pharmacists, and physicians. The team should ensure that evidence-based practice guides the choice of treatment plans.

References

Alghamdi, M. A., Muidh Alzahrani, A., Alshams, H. A., Himeed, M., Saif, A., Moafa, A. M., Alenzi, M. M., Seadawi, L. E., Kamel, A., Ali, A., Saleh, N., Hufayyan, A., & Mujallid, M. F. (2021). Hyperosmolar Hyperglycemic State Management in the Emergency Department; Literature Review. Jubail General Hospital, Eastern Province, KSA. 5 General Practitioner, 12(1), 37–40.

Cannarella, R., Barbagallo, F., Condorelli, R. A., Gusmano, C., Crafa, A., La Vignera, S., & Calogero, A. E. (2021). Erectile Dysfunction in Diabetic Patients: From Etiology to Management. Diabetology, 2(3), 157–164. https://doi.org/10.3390/diabetology2030014

Duarte, A. A., Mohsin, S., & Golubnitschaja, O. (2018). Diabetes Care in Figures: Current Pitfalls and Future Scenario. EPMA Journal, 9(2), 125–131. https://doi.org/10.1007/s13167-018-0133-y

Johnson, J. M., & Carragher, R. (2018). Interprofessional Collaboration and the Care and Management of Type 2 Diabetic Patients in the Middle East: A Systematic Review. Journal of Interprofessional Care, 32(5), 621–628. https://doi.org/10.1080/13561820.2018.1471052

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Assessment 1 Instructions: Concept Map
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Create a concept map of a chosen condition, disease, or disorder with glucose regulation or metabolic balance considerations. Write a brief narrative (2-3 pages) that explains why the evidence cited in the concept map and narrative are valuable and relevant, as well as how specific interprofessional strategies will help to improve the outcomes presented in the concept map.

Introduction
Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you should complete the assessments in this course in the order in which they are presented.

The biopsychosocial (BPS) approach to care is a way to view all aspects of a patient’s life. It encourages medical practitioners to take into account not only the physical and biological health of a patient, but all considerations like mood, personality, and socioeconomic characteristics. This course will also explore aspects of pathophysiology, pharmacology, and physical assessment (the three Ps) as they relate to specific conditions, diseases, or disorders.

The first assessment is one in which you will create a concept map to analyze and organize the treatment of a specific patient with a specific condition, disease, or disorder.

The purpose of a concept map is to visualize connections between ideas, connect new ideas to previous ideas, and to organize ideas logically. Concept maps can be an extremely useful tool to help organize and plan care decisions. This is especially true in the biopsychosocial model of health, which takes into account factors beyond just the biochemical aspects of health. By utilizing a concept map, a nurse can simplify the connection between disease pathways, drug interactions, and symptoms, as well as between emotional, personality, cultural, and socioeconomic considerations that impact health.

Preparation
As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

The assessment will be based on the case of a specific patient with a specific condition, disease, or disorder. Think about an experience you have had treating a patient with a condition, disease, or disorder that interests you, or one of the cases presented in the Vila Health: Concept Maps as Diagnostic Tools media simulation.

What is the primary condition, disease, or disorder affecting the patient?
What types of experience have you had working with patients with this condition, disease, or disorder?
How does this condition, disease, or disorder typically present?
What are the recommended treatment options?
What, if any, characteristics of an individual patient should be kept in mind when determining a course of treatment.
How have you used concept maps to help plan and organize care?
What are the advantages of concept maps, from your point of view?
How could concept maps be more useful?
How can interprofessional communication and collaboration strategies assist in driving patient safety, efficiency, and quality outcomes with regard to specific clinical and biopsychosocial considerations?
What interprofessional strategies do you recommend health care providers take in order to meet patient-centered safety and outcome goals?
Scenario
You have already learned about evidence-based practice and quality improvement initiatives in previous courses. You will use this information to guide your assessments, while also implementing new concepts introduced in this course. For this assessment, you will develop a concept map and provide supporting evidence and explanations. You may use the case studies presented in the Vila Health: Concept Maps as Diagnostic Tools media, a case study from the literature or your practice that is relevant to the list of conditions below, or another relevant case study you have developed. This case study will provide you with the context for creating your concept map. You may also use the practice context from the case study or extrapolate the case study information and data into your own practice setting. Think carefully when you are selecting the case study for this assessment, as you may choose to build upon it for the second assessment as well.

Some example conditions, diseases and disorders that are relevant to metabolic balance and glucose regulation considerations are:

Cancer.
Diabetes (type 2).
HIV/AIDS.
Hyperthyroidism.
Hypothyroidism.
Metabolic syndrome.
Obesity.
Polycycstic ovary syndrome.
Prediabetes.
Pregnancy.
Instructions
Develop a concept map and a short narrative that supports and further explains how the concept map is constructed. You may choose to use the Concept Map Template as a starting point for your concept map, but are not required to do so. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your evidence-based plan addresses all of them. You may also want to read the Concept Map scoring guide and the Guiding Questions: Concept Map document to better understand how each grading criterion will be assessed.

Part 1: Concept Map
Develop an evidence-based concept map that illustrates a plan for achieving high-quality outcomes for a condition that has impaired glucose or metabolic imbalance as related aspects.
Concept Map Template [DOCX]. You may choose to use this template for completing this component of the assignment.

Part 2: Additional Evidence (Narrative)
Justify the value and relevance of the evidence you used as the basis for your concept map.
Analyze how interprofessional strategies applied to the concept map can lead to achievement of desired outcomes.
Construct concept map and linkage to additional evidence in a way that facilitates understanding of key information and links.
Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.
Use the APA Style Paper Tutorial [DOCX] to complete this narrative component.

Example Assessment
You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Assessment 1 Example [PDF].
Additional Requirements
Length of submission: Your concept map should be on a single page, if at all possible. You can submit the concept map as a separate file, if you need to. Your additional evidence narrative should be 2-3 double-spaced, typed pages. Your narrative should be succinct yet substantive.
Number of references: Cite a minimum of 3-5 sources of scholarly or professional evidence that supports your concept map, decisions made regarding care, and interprofessional strategies. Resources should be no more than five years old.
APA formatting:
For the concept map portion of this assessment: Resources and citations are formatted according to current APA style. Please include references both in-text and in the reference page that follows your narrative.
For the narrative portion of this assessment: use the APA Style Paper Tutorial [DOCX] to help you in writing and formatting your analysis. You do not need to include an abstract for this assessment.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Design patient-centered, evidence-based, advanced nursing care for achieving high-quality patient outcomes.
Develop an evidence-based concept map that illustrates a plan for achieving high-quality outcomes for a condition that has impaired glucose or metabolic imbalance as related aspects.
Justify the value and relevance of the evidence used as the basis for a concept map.
Competency 4: Evaluate the efficiency and effectiveness of interprofessional care systems in achieving desired health care improvement outcomes.
Analyze how interprofessional strategies applied to the concept map can lead to achievement of desired outcomes.
Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.
Construct concept map and linkage to additional evidence in a way that facilitates understanding of key information and links.
Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.