Care Plan - The Patient is a 56-year-old Obese Orthodox Woman

Patient Care Plan Patient Demographics The patient is a 56-year-old obese orthodox woman. She has past medical conditions of poorly controlled diabetes, HTN, obesity, anxiety, and hypercholesterolemia. She was admitted to the Emergency Department after complaining of hyperglycemia of more than 230 in over ten days. Other chief complaints include malaise, frequent urination, dyspnea on exertion, and mild abdominal discomfort. The patient was later diagnosed with Ovarian Cancer on 05/12/19. It is evident that the patient lacks the knowledge to not only control but also interpret blood sugar levels. Previously on Metformin oral medication, the patient is now on insulin to regulate her level of glucose in the blood. Nursing Diagnosis The patient is diagnosed with poorly controlled diabetes. She also has HTN that is unresponsive to Lisinopril 20mg. Additionally, the patient is obese and a combination of Xanax 0.25 prn anxiety hypercholesterolemia and Pravastatin 40 mg po bid for hypercholesterolemia has not lowered her LDL levels. The patient has also been diagnosed with stage IV cancer that requires surgery and chemotherapy/radiation. Subjective Data Subjectively, the patient is living in a multi-level home. She resides with two teenage children and her husband. Besides being a wife, she doubles as a primary caregiver for mothers who are elderly and suffering from dementia. Family responsibilities include childcare for the two teenage boys and providing physical care for the elderly mother with dementia. Additional responsibilities include meal preparation, shopping, managing home, business finances, and cleaning. Her primary concern is her mother’s care. Her sister who resides in Florida is not providing any form of care to the mother. She has adult children. Though the daughter could be of certain help, she has two small children to take care of. Besides, the spouse is working full time. She is living nearby her son, though she does not believe she could provide the care the mother requires because she is deeply into substance abuse. The plan entails meeting Snyder and discussing options for discharge and care with the primary care provider and care coordinator. Mrs. Snyder is an orthodox Jew who strictly follows the religious requirements. She has stated that she would prefer to live in a hospice for her end-of-life care that caters to Jewish patients. A rabbi would be much appreciated by the patient and her family. Additionally, the hospice should provide kosher food as per the patient’s beliefs. Her family members are having nut allergies, intolerant to lactose, and the mother requires her meals to be purred because of cognitive difficulties that affect her nutritional status. Mrs. Snyder has pet dogs and would like them to be close to her in her final days. The Jewish community is very close and would like to be able to visit one of their own hence, a hospice that is closer to Mrs. Snyder’s community would be preferred. Objective Data Mrs. Snyder, a 56 years old obese orthodox woman. She demonstrated a poorly controlled HTN, DM, anxiety, hypercholesterolemia, and obesity. She admits c/o hyperglycemia and frequent urination. She was admitted to the ED with hyperglycemia of more than 230 for more than ten days, malaise, regular urination, dyspnea on exertion, and mild abdominal discomfort. Her vitals and lab results are as follows: glucose 399; CA-125 at 1700u/mL; V/S: 36.7, 102, 171/93, 24. O2 Saturations 92%. On room air; Blood glucose 200 on insulin gtt.; Abd. ultrasound approximately 450 ml of peritoneal fluid. Collaborative/Nursing Interventions Different nursing interventions will be applied to guarantee the delivery of high-quality safe nursing care. Education is one of the interventions that will bring about change. It is imperative to educate the patient on the significance of monitoring the level of blood sugar in the blood as well as interpreting readings. A demonstration will be done to ensure the patient is aware of how to take blood glucose readings. Also, the nurse should educate the patient on the importance of taking insulin as prescribed while comprehending the use of sliding scale reading. The patient will be educated on how often to check the blood sugar level and the best time. The nurse is anticipated to organize a meeting with the dietician to educate the patient regarding diets and nutrition and the daily diets (Porter et al., 2019). Also, education on lancets, insulin, and syringes will be done. In addition to the above, the nurse will also be educated on self-care and Ovarian Cancer. Concerning cancer, the nurse will educate the patient on the side effects of radiation and chemotherapy. The nurse will give the patient an opportunity for honest questions and credible answers. The nurse is to stay with the patient during consultations and highly anxious procedures. After education, the patient will be able to understand the effects of radiation and chemotherapy as well as the need to take medication as prescribed. The dietician will need to create a mela plan that is low in sodium, high in fresh fruits and non-starch vegetables, and appealing to sight to enable the patient lose weight whole getting the necessary nutrients in her body. The patient’s prescription will be packaged in a smart pill dispenser for her HTN medication while her insulin medication will be complete with an InsulCheck. The patient will be educated on how to use these two technologies for increased medication adherence. Why Nursing Intervention is Therapeutic The nursing interventions mentioned above are critical to maintaining the blood glucose level. The goal would be to ensure the diabetic patient is subjected to lifestyle changes and a healthy diet to properly regulate blood sugar levels. The optimal level of glucose in the blood should be between 90 and 100. To lower the risk of heart diseases and diabetes, a moderate weight and healthy lifestyle should be maintained. It is imperative to maintain the required level of glucose to prevent heart diseases, pressure ulcers, hypertension, and kidney failures (Cárdenas-Valladolid et al., 2018). The nursing staff have crucial responsibility and function when taking care of patients diagnosed with diabetes. Such nurses should have the essential knowledge and skills to provide care to such patients. For the new diagnosis made, ovarian cancer, the goal is to lessen fear and display a range of feelings. The intention is to make the patient appear to relax to reduce anxiety to controllable levels. Similarly, it is intended to display active participation in the treatment process as well as an appropriate coping mechanism. Nurses should provide therapeutic education to patients while ensuring they clearly understand how to prevent adverse healthcare events (Siddharthan et al., 2016). Moreover, they should be encouraged to not only use but also integrate their personalized care plan, which can work better for them. The above nursing intervention is therapeutic because it aids adherence to medication and medication knowledge, hence fostering the provision of high-quality nursing care. Evaluation of Outcomes The patient will demonstrate what she learned and how to effectively test her level of sugar in the blood. Also, she is in a position to inject herself with insulin using the sliding scale. She is capable of preparing daily meals that are in line with her diabetic needs. In addition to comprehending her new diagnosis (Ovarian Cancer), she is also in a better position to assess the best treatment options. She will be able to understand how to best take care of herself. Her BP levels should decline with medication and lifestyle changes. Her weight loss should be evident following the lifestyle modifications. Her blood glucose levels should be within normal range.