Running Head: ALTERNATIVE MEDICINE NURSING

Alternative medicine nursing

Year
Affiliation

ALTERNATIVE MEDICINE NURSING

Alternative medicine nursing

Critical Analysis of Care given and supported by research evidence, to a patient with type 2
Diabetes including 3 problems, Surgical wound, Obesity, Hypertension
Introduction
The incidence and prevalence of diabetes mellitus (type 2) has been on the rise over the
past few years. According to the report by (Kheir et al., 2011), over fifty percent of people with
diabetes type 2 are unaware of the condition while around twenty five percent of all the patients
with diabetes who undergo surgery are normally undiagnosed on admission to the healthcare
institution. There are varying dangers linked to such cases especially when the patients are
diagnosed with other illnesses such as obesity, hypertension and possible surgical wounds. These
dangers are accelerated by the fact that most of the diabetes patients are at higher risk of
acquiring cardiovascular disease, preoperative risks when they are undergoing surgery as
reflected by the compilations of diabetes conditions. The surgeons and the anesthetics
undertaking the surgical operations on patients having diabetes are required to have a clear
understanding on the risks reflected to the patients with diabetes.
Diabetes Mellitus (DM) is one of the major chronic diseases affecting people across the
globe. The disease has largely become one of the leading health corners in vast developing
nations. DM refers to a common chronic systematic Syndrome that is normally characterized
through hyperglycaemia (Mutlu et al., 2014). The disease is portrayed as one of the leading cause
of deaths. The illness is defined as the disorder of the metabolism leading to a deficit during the
production of insulin. The notion attached to the depicted analogy indicates cases where the part
of the body cells is unable to covert the food to glucose that is essential towards producing the

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body energy. Based on the World Health Organization action plan (2011), there are different
diseases linked to the impairment and disability with diabetes forming one of such implications.
Andrew is a newly diagnosed patient with type 2 diabetes as evaluated by his primary
care physician recently. The diagnosis was made after parental concerns on Andrews constituent
loss of weight despite the increased appetite witnessed. Polyphagia, polyura, and polydipsia were
some of the healthy conditions that his parents recorded on their health history. He has been
indicating that he was feeling tired, hungry all the time, and also thirsty. His parent noted that he
was frequently taking five litres of water on daily basis but still complained of feeling thirsty.
Further and detailed review indicated how he was recently sick having a flu-like symptoms a
month before his current presentation. Based on the random finger stick blood sugar on Andrew,
the physician recorded 700mg/dl. Andrews Haemoglobin A1C reached 12.9%. The rest of his
chemistry panel result read; Na+=125 mmol/L (normal is 134-145mmol/L); K+ =4.8 mmol/L
(normal is 3.5-4.5 mmol/L); CL-=90 mmol/L (normal is 95-110mmol/L); CO2= 16mmol/L
(normal is 20-29 mmol/L); BUN=15mg/dL (normal is 6-20); Creat=0.3 mg/Dl (6-20).
Urinalysis test revealed that he had glucose and ketenes in his urine (glucose=500 and ketenes=
20). Other pertinent laboratories performed to assist in the diagnosis of type 1 diabetes are GAD
65, islet cell antibodies (ICAs), insulinoma-associated antibody (IA-2A) and insulin antibodies.
At the time of the presentation, the patient looked. For advanced practice dieticians, the first
session with a client often involves a complete physical assessment, not just a nutrition history.
This includes a comprehensive medical history of all body systems. The diabetes focused
physical examination, just as performed by clinicians from other disciplines, includes height and
weight measurement, body mass index (BMI) calculation, examination of injection sites,
assessment of injection technique, and foot assessment. Assessment also includes reviewing

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which medications the client is taking, evaluating their effectiveness and side effects, and
determining the need for adjustment based on lifestyle, dietary intake, and blood glucose goals.
When carbohydrate counting is added to therapy, dieticians calculate carbohydrate-to-insulin
ratios and teach clients how to use carbohydrate counting instead of a sliding-scale approach to
insulin. Medications are adjusted based on clients lifestyles until blood glucose goals are
achieved. The therapeutic problem solving, regimen management, case management, and selfmanagement training performed by advanced practice dieticians exceed the traditional role of
most dietetics professionals. Examination of the patients lower limbs demonstrated a tender
swelling over the poster medial aspect of the right calf. The right calf had a maximal
circumference of 53 cm and the left calf 40 cm. He had bilateral Charcot joints of the ankles with
a plantar ulcer on his right foot. He had good pedal pulses. There was a severe sensory/motor
neuropathy evidenced by loss of sensation to touch, pinprick, and vibration sense to the knees
with absent knee and ankle reflexes. Recently he was diagnosed with obesity after increased
weight with hypertension symptoms noted by his physician. Furthermore, the recent accident
leading to a surgical operation poses a challenge for his parents ability to take care of him. The
following analysis critically examines the care given to a patient like Andrew with Diabetes
Mellitus (Type 2) with the three problems; surgical wounds, hypertension, and obesity.

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Analysis
There are different studies related to genetic susceptibility and an environmental aspect in
relation to the viral exposure or the infection to an allergen hence indicating an influence on the
development of type 2 diabetes. Interactions between genetics, environmental exposure, and
autonomy are also some of the factors linked with the occurrence of the diseases. Furthermore,
generic determination of susceptibility diabetes lies normally within the history compatibility of
the complex chromosome 6. Thus, combination of DR4-DQ and DR3-DQ haplo types are
present in 90% of children who develops type 1diabetes (Adams et al., 2007). A third heliotype,
DR15-DQ6 is found protective gene and found in less than one percent of children with type 2
diabetes (Banasik, 2013).Viruses such as rotavirus, muphs, cytogalovirus, and retrovirus are
linked with the development of Type diabetes as facilitated by different studies. Furthermore,
studies in UK and US tends to conflict on the role of cows milk protein, cereal or gluten in
relation to the development of the disease.
Type 2 diabetes occurs from an insulin imbalance that results in the destruction of the
immune-mediated beta cells in the pancreas. The islets of Langerhans are infiltrated by the Tcells lymphocytes that destroy the beta cells through the secretion of cytokines and direct
cytotoxic action of the CD8 cells. Dendrite cells and T-cells are the major contributions to the
islet cell destruction and breach. Specific antibodies develop against glutamic acid
decarboxylase 65; insulinoma-Antigen 2 (1A-2) frequently appear in the initial stages of immune
mediated diabetes (Mortesan et al, 2010). During the period of diagnosis, a patient has already
lost 70-90% of the beta cell function.
The antagonistic collaboration between insulin and glucagon for the maintenance of
plasma glucose concentration at normal range is fashionable. The increased blood sugar levels

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after meals stimulate insulin; the absence of insulin results in the continuous progression of
blood glucose. The persistence of insulin deficiency diminishes the uptake of nutrients and
inhibits the cellular metabolism. This results in metabolism of adipose tissue and fatty acids. In
the liver, fatty acids are converted into ketone bodies in the liver. Persistent hyperglycemia leads
to osmotic diuresis. As a result, tubular absorption in the kidneys is exceeded. Renal threshold
is exceeded when the plasma glucose is greater than 180 mg/dl (Silverthorn, p. 763). The
presence of glucose and other solutes (sodium, potassium, chloride and hydrogen) further
exacerbate osmotic diuresis. Uncorrected, diuresis leads to dehydration and hypovolemia.
Diagnostic approach and Symptoms
At the time of the presentation, the patient looked. For advanced practice dieticians, the
first session with a client often involves a complete physical assessment, not just a nutrition
history. This includes a comprehensive medical history of all body systems. The diabetes focused
physical examination, just as performed by clinicians from other disciplines, includes height and
weight measurement, body mass index (BMI) calculation, examination of injection sites,
assessment of injection technique, and foot assessment. Assessment also includes reviewing
which medications the client is taking, evaluating their effectiveness and side effects, and
determining the need for adjustment based on lifestyle, dietary intake, and blood glucose goals.
When carbohydrate counting is added to therapy, dieticians calculate carbohydrate-to-insulin
ratios and teach clients how to use carbohydrate counting instead of a sliding-scale approach to
insulin. Medications are adjusted based on clients lifestyles until blood glucose goals are
achieved. The therapeutic problem solving, regimen management, case management, and selfmanagement training performed by advanced practice dieticians exceed the traditional role of
most dietetics professionals.

ALTERNATIVE MEDICINE NURSING

Examination of the patients lower limbs demonstrated a tender swelling over the poster
medial aspect of the right calf. The right calf had a maximal circumference of 53 cm and the left
calf 40 cm. He had bilateral Charcot joints of the ankles with a plantar ulcer on his right foot. He
had good pedal pulses. There was a severe sensory/motor neuropathy evidenced by loss of
sensation to touch, pinprick, and vibration sense to the knees with absent knee and ankle
reflexes.
As proffered above, Andrew pathophysiology factors of diabetes largely impacted his
ability to interact in the respective settings. The impaired insulin secretion and insulin resistance
are linked to contributing more or less jointly to the development of the diabetes mellitus
pathophysiology conditions. These factors are examined in the following analysis. They are:
Impaired insulin secretion
As reflected in Andrew case above, impaired insulin secretion entails the decrease in the
glucose responsiveness as observed prior to the clinical onset of the disease. The commonly
experienced is the IGT (Impaired Glucose Tolerance) which is indicated via a decrease in the
glucose responsive early phase insulin secretion especially after the meals causing postprandial
hyperglycaemia. An OGTT or the Oral Glucose Tolerance Test in the IGT scenarios reflects over
response in some of the people in the hospital especially Western and the Hispanic indivisibles
reflecting high insulin secretion. The impairment of insulin secretion pose a challenge in relation
to ensuring patients stabilizes their health conditions. The outcomes are worsened by the attached
cases of obesity, hypertension, and surgical wounds. The progressive nature of impaired insulin
secretion entails glucose toxicity and lipo-toxicity. Thus, when untreated, the outcomes are
decrease in pancreatic beta cell function affecting the long-term control of the blood glucose.

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Thus, there are differing implications in relation to the resulting outcomes based on the resulting
outcome as reflected in the insulin secretion on the long-term basis.
Hypertension
This refers to the condition that forces the blood towards the artery walls at a high rate
likely to lead to health complications such as heart disease (OBrien et al., 2007). The resulting
impairment of insulin normally targets some of the major organs such as muscles and liver
forming a major pathophysiological feature of type 2 diabetes. It develops and also expands prior
to disease onset. According to the study by (Wild, 2004), the molecular mechanism for the
insulin action depicts how insulin resistance can be related to the genetic factor and also some of
the environmental factors such as free fatty acids, hyperglycaemia, and inflammatory
mechanism. Furthermore, the known genetic factors such as insulin receptor and the insulin
receptor substrate leading to the reflected outcomes on gene polymorphism affecting insulin
signals plus the polymorphisms of some of the thrifty genes like the beta 2 adrenergic receptor
gene and also uncoupling protein (UCP) gene as attached to visceral obesity and also promoting
insulin resistance. Some of the other significant mechanism for the impairment of insulin
secretion and insulin signalling impairment are the glucolipotoxicity and inflammatory
mediators. Thus, the treatment programs are based on some of these imbalances with an aim to
create a balance in secretion of insulin. The major goal of the diabetes treatment is aimed at
enabling the patient such as Andrew to be able to secure Quality of Life (QOL) and lifespan
which is comparable for the healthy people and also a requirement on attaining the goal is aimed
at preventing of onset and also progression of the vascular complications. Furthermore, the
attached risk of vascular disorder or atherosclerotic lesions is via being used increasingly in some

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of the individuals having marginal blood glucose levels and also underscoring the essence of
early interventions (Healy et al., 2007).
To effectively treat and control to the vascular complications entails enacting strategies
acting as interventions on preventing the onset of diabetes, improving prognosis, and controlling
complication. These methods have demonstrated varying facts in relation to implementing a
treatment program for patients such as Andrew in the society. Some of these facts are (Kheir et
al., 2011):
Lifestyle improvement and also anti-diabetic drugs such as metaformin, thiazolidine, and
glycosidase on treating IGT suppressing the reflected risks of developing diabetes mellitus; SU
drugs use such as metaformin and also insulin hence effective ways of controlling the micro
vascular disease and the macro vascular disease while also acting as some of the early
interventions; through comprehensive intervention such as blood pressure management and the
liquid management (sugar) is vital towards facilitating effective management of the vascular
complications and the lowering the mortality rate; and pioglitazone normally surpasses the
recurrence of the cardiovascular disorders. The reflected effective treatment is essential towards
addressing the respective complications in linked to progressive stages of diabetes mellitus. The
essence of enacting such measures is aimed at ensuring the set standards are met while lowering
mobility rate. The most effective treatment program considering some of the linked problems
experienced by Andrew is through early interventions and compressive approaches such as blood
glucose, lipid, and blood pressure. They not only facilitate recovery but also enable the patient
avert cardiovascular complications while also improving prognosis.
Treatment Plan

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The Andrew was admitted for three days on insulin. Hyperglycemia is corrected through
administration of insulin. If a patient presents with diabetic ketoacidosis, insulin is administered
by continuous infusion rate of 0.1 units/kg per hour until ketoacidosis is resolved. Continuous
infusion of insulin gradually decreases serum glucose to the normal level before resolution of
acidosis. Hypoglycemia is prevented during continuous infusion of insulin by adding dextrose
containing fluids when the serum level goes below 250 mg/dL (Steinmann, p.72II). Insulin
infusion is stopped and replaced by insulin injection once the target blood glucose is achieved.
Since JA was not in diabetic ketoacidosis, his insulin regimen goal was slowly to correct the
hyperglycemia with a target blood sugar of 150mg/dL using the insulin correction factor
equation. The insulin correction factor calculates the unit of insulin needed to correct blood sugar
at a given time. It is normally administered before meal time or snack. The goal is to return the
blood sugar to a given range. The three types of rapid-acting insulin are Aspart (Novolog),
Lipsro (Humalog) and Glulisine (Apidra). Aspart injection was administered based on JAs
blood sugar and carbohydrate consumption. Asparts onset of activity beings at 10-15 minutes
after injection, peaks at 95 minutes and effectively last for three to four hours. To ascertain
sufficient insulin coverage is given, a blood sugar fingerstick was done every 2 hours (before
each meal, 2 hours after each meal, at bedtime and 2:00 am or the first 48 hours of his
hospitalization. Before each meal and snack, JAs carbohydrate intake is calculated and covered
with insulin injection using the carb-to-insulin ratio. Carb ratio involves counting the grams of
carbohydrates that are to be eaten and giving a matching dose of insulin. Carb counting requires
knowledge of dietary portions and reading food labels. JAs initial carb-to insulin ratio is; 1 unit
of Aspart covers 40 grams of carbohydrates. Besides Aspart, JA also received Glargine (Lantus),
a long-acting (basal) insulin administered every 24 hours. Glargine insulin lasts for 24 hours

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without any peak activity. It similar to basal insulin in an insulin pump except given once a day
as an injection (Chase, p. 67) Frequent monitoring of JAs blood glucose was required to assess
response to therapy.
The patient was admitted to the hospital with a diagnosis of probably a right deep venous
thrombosis and acute chronic deterioration of the renal function. Tests were conducted in the
laboratory on abdominal and calf ultrasound examination followed by a diagnostic magnetic
resonance and guided tomography biopsy. A diagnosis was carried out and the patient was
diagnosed with skeletal muscle infarction and perennial decomposition of established diabetes
nephropathy.
The treatment of diabetic muscle infarction is inclusive of the administration of
analgesics and short term immobilization of the involved leg. The short period prognosis is
excellent as the symptoms resolve spontaneously over a period several weeks to months..
Advanced practice RDs offer comprehensive diabetes patient care service inclusive of
patient goals and expected outcome that assist in the consideration of pharmacological and nonpharmacological treatments (Abdul-Ghani et al., 2008). The problems discussed with patients
range from acute and chronic diabetic complication, to cormorbid conditions, other conditions,
preventive interventions and self-management Advanced practice
RDs also review patients health care resources and order laboratory tests if information
is not available from referral sources. They provide supportive counselling and referral to
specialists, as needed. And, they provide full report of their findings and any regimen changes
and recommendations they make to referring clinicians after each visit. These activities and
responsibilities go beyond the scope and standards of practice for the RDs and for RD, CDEs.
They will be included in this cope of practice document for RD, BC-ADMs that is now being

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developed by the Diabetes Care and Education Practice Group of The can Dietetic Association.
The following case study illustrates the clinical role of advanced practice Dieticians in the field
of diabetes
The BC-ADM credential acknowledges this professional autonomy while promoting
team collaboration and thus improving the quality of care for people with diabetes. The new
certification formally recognizes advanced practice of dieticians as they move beyond their
traditional roles and into clinical problem solving and case management. Acute complications of
type 2 diabetes are hypoglycaemia, hyperglycemia, and diabetic ketoacidosis. Diabetic
ketoacidosis is a life-threatening medical emergency that results from inadequate insulin
administration. Approximately 30% children presents in DKA when initially presented for
medical care (Steinmann, 72GG). Long term complications are cardiovascular disease,
nephropathy, retinopathy and foot diseases.
Surgical wounds
There are varying dangers linked to patients with diabetes mellitus in relation to the
complications of the disease. These can be termed as Preoperative risks and the complications
linked of diabetes mellitus. Complications risks are linked to coronary artery likely to be
increased in diabetes. In the study by (Kheir et al., 2011), the complications are linked to the
risks involved in controlling body reaction during surgical operations. According to (Mutlu et al.,
2014), there is increasing need to assess some of the risks of complications in the patients with
diabetes undergoing surgery in relation to considering the type or form of surgery and also the
aesthetic technique. There is vast evidence illustrating the vast dangers of patients with diabetes
undergoing surgical operations. According to (Ammar, 2005), patients with diabetes when
undergoing operations, the healthcare professionals are required to enact strategic measures

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aimed at monitoring the operation to minimize on the following risks. They are (Abdulbari et al.,
2005):

Cardiac arrest as a result of autonomic neuropathy

Problems with lower limb ischemia; where consistency with high incidence of peripheral

vascular disease
Heel pressure sores especially linked to the peripheral neuropathy
The postoperative wound infection
Stoke; which is consistent with some of the generally increased risks in diabetes mellitus
Patients diagnosed with diabetes mellitus undergoing the PCI or the percutaneous
coronary intervention are likely to experience increased risk of the adverse results in

relation to the surgical operations

Worsening and disruption in relation to controlling of diabetes as linked to the

unfavourable results such as; infra-inguinal bypass surgery

Prolonged intensive care after cardiac surgery as attributed by diabetes mellitus
The poor intraoperative blood glucose control is linked to worse results after a cardiac
surgery in patients diagnosed diabetes
Critical care analysis on some of the proffered risks requires a closer analysis by the

healthcare professionals during the operations. These risks are likely to reflect marginal
complications to the patients diagnosed with diabetes mellitus (Matsuda, 1999). The
preoperative assessment of the patients with diabetes is also vital as availed in the following
analysis. Some of the attached issues at the period of referral from the primary care are essential
in relation to enhancing the recovery of the patient. Some of these issues in relation to offering
the needed care to patients with diabetes after a surgical operation are (Wild et al., 2004);

Ensuring that some of the potential effects linked to diabetes and also the associated comorbidities in relation to the result of surgery are inoculated prior to referral for the
respective elective procedures. This is aimed at ensuring the healthcare professionals are

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aware of some of the medical complications likely to occur while offering medical care to

these patients.
Relevant medical information should be communicated throughout during the referral
period. This is vital towards ensuring the patient is provided with the standard care to
respond to the varying implications as linked to the pathophysiology of diabetes mellitus

as linked to the impaired insulin secretion and insulin resistance.

Through ensuring diabetes and comorbidities are optimally managed prior to the
procedures. Such assessments in relation to the type of medical care offered are vital
towards ensuring the patient is stable from the attached pathophysiology of diabetes
mellitus. The healthcare professional through optimally managing diabetes prior to the

operation ensures some of the attached complications are averted.

Offering the current HbA1c, weight measurements, and blood pressure based on the
details of the relevant medications and complications in the attached referral letter to
ensure those receiving the patient are aware of the complications and risks. This ensures

the patient care is standardized to avert the reflected risks during the referral process
Optimizing some of the other diabetes related comorbidities
Providing a written advice to the parents undergoing through the investigative procedures
and requiring a period of starvation
The proffered analysis stipulates some of the undertakings that the healthcare

professionals are required to undertake during the time of referral from the primary care. These
approaches are aimed at ensuring some of the risks linked to failure to explore these issues.
Andrew physician was aware of some of the proffered risks hence ensuring the referral process
incorporated some of the suggested approaches above. These were vital towards ensuring the
surgical operation and wounds are maintained from infection facilitating quick recovery while
avoiding infections.

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Obesity
Traditionally a fat child meant a healthy child, who was able survive various rigors of
undernourishment and infections. However in the last few decades this notion has tend to change
other researcher developing various foundations to outdo the notion. Excessive weight or fatness
has been established as one of the primary health problem especially in the developed nations
among other regions around the globe. Childhood obesity has been established as a multisystem
disease with potential devastating consequences hence need for attention. Overweigh is defined
as the excess amount of body weight which may result from muscles, bone, fat ad water while
obesity is the excess amount of body fat within the body (Health Survey for England, 2009).
Children with diabetes type 2 which is obese may pose a challenge in relation to effectively
administering an effective treatment program.
There are numerous developed strategies and approaches aimed at increasing awareness
on the vast effects caused by the obesity to the children with diabetes type 2 like Andrew in the
hospital. Though the worldwide prevalence on the childhood obesity and type 2 diabetes has
increased, more efforts need to be undertaken in regard to the risks involved. The serious medical
and psychosocial complications developed by the obese children are greatly increased risks of
adult morbidity and mortality. The escalating prevalence and severity of obesity in children
attached with the complex complications such as type 2 diabetes have raised the spectre of the
myocardial infarction hence becoming a paediatric disease.
Body Mass Index
This is the common method or technique used to estimate the overweight and obesity in
children and adults. Under children aspect the measurements are easily executed based on the

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different rates at differing times making it easy to determine whether the child is overweight or
not. BMI charts developed for children offer a clear comparison between the height of the child
and the weigh based on sex and age. The preceding preview proffers a detailed analysis on the
BMI of children and adolescents between the ages of 2-19 years. Weight is incorporated in
treatment plan of children with diabetes type 2 as illustrated by (Silverthorn, 2012). The
researcher argues that through enacting some of the varying weight reducing approaches, the
possibility of treating obese children with diabetes type 2 is increased.
The first case of child obese were recorded in and 1997 in Pakistani under genetic
perspective where children of parents with consanguineous parents were found to have mutation
in the gene encoding leptin which is a hormone attributed with the production of adiposities and
secreted in reference to body-fat mass (Swift, 2010). From then various such cases have been
recorded indicating that obesity can be inherited based on genetic aspects. However, in the US
the rate of obesity and Type 2 diabetes in children is high and rapidly increasing with the fact
that most of the children with Type 2 diabetes are not aware of the condition illustrating the
essence of enacting strategic measures aimed at creating awareness.
According to research minor imbalances on the energy rations can gradually lead to
obesity. This is normally implicated by consistence gradual imbalances. This condition is
normally accredited by cases such inheritance on metabolic behaviours leading to adoption of the
situation. The next accredited cause is poor eating and lifestyle habits. Researchers stipulate two
types of imbalances such as, the positive and the negative imbalances. The positive imbalances is
a situation analysed by energy intake being greater than the total energy expenditure while
negative energy imbalance being a situation where the body has reduced fat storage and weight
loss mechanisms. Providing this form of information during the research ensures that the patients

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or the study samples can adjust their lifestyle by identification of their current position (Weiss,
2007). This can be achieved through a series of questions or interviews from the patients and the
medical staffs. Similar approaches care linked to addressing diabetes type 2 in children obese in
the hospital. The balancing the energy ratios aligns with some of the approaches employed while
regulating insulin imbalances as recorded in children with diabetes 2. Thus, critical care is
offered through ensuring these children are availed with effective treatment plans that enhance
balance in energy ratios.
Food intake is the other major leading cause of obesity. Various researchers have
identified varying food intake especially in the current environment as attributed by
technological and environmental changes. The major leading contributing factors in relation to
the food intake causes and implications in leading to obesity include foods such as; fat and
alcohol. Intake of meals with high fat intakes contributes directly to obesity of the rate is high
according to various research. This is further supplemented by drinks that are rich in energy. The
major components of this drinks and foods are normally calorie foods. Calorie intake leads to
increase in the total calorie level in the body leading to obesity. Providing this information during
the research ensures that the patients used during the study are availed with adequate information
about some of the contributing factors to their problems. This information is also essential as it
can be used during the structuring of data collection mechanisms to be used in the study. The
total or type of food that a patient is using is used to use during or before the disease
identification can be essential during the treatment period. This can lead to establishment of a
detailed simple diet that can be supplemented and recommended to the patients. The information
can also be availed on the caretakers (parents) both on the medical and home based. The relatives
can use the information to regulate and monitor the intake of food on their patients. The children

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are more likely to consume food with high energy or fat intake when left unchecked. Availing
this information to them and the caretakers can help them reduce the intake. This can
consequently lead to reduction on their total mass weight limiting or reducing the cases. Aligning
such methods in relation to caring for patient with diabetes type 2 can enable patients such as
Andrew effectively recover.
The risks implicated on individuals caused by obesity continue to escalate. This calls for
a closer scrutiny on the causes, implications and ways to avert the vice. Obesity is caused by
poor nutrition leading to increased body weight which if linked to diabetes type 2 is likely to
have marginal implications. The situation affects individuals from every age brackets, this ranges
from children, youths and the old. In the study by (U.S. Department of Health and Human
Services, 2008) examining the current data through deep analysis pertaining obesity cases in
childhood and adolescent in relation to diabetes type 2, the researchers depicted that although the
treatment is challenging, incorporating early intervention measures can play a critical role in
relation to addressing the reflected challenges.

Conclusion
The medical complications facing Andrew depicts the need to be adimmitted in the
hospital where his medical conditions will be evaluated. His prior diabetes education was
provided by diabetes team that included an endocrinologist, pediatric diabetic educator nurses,
and nutritionist. Social worker provided psychological support and provided information about
support groups and camps. Newly diagnosed patients are educated about the importance of
adhering to insulin regimen, recognizing the symptoms of hyperglycemia, hypoglycemia, and

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management of sick days. Nutritionist provided guidance on dietary portions, carbohydrate

calculation, and healthy eating habits.
The study illustrated the classic initial presentation of type 1 diabetes. Laboratory values
were interpreted and incorporated with pathogenesis. The case study elucidated the importance
of fluid resuscitation, correction of electrolytes and insulin therapy to maintain metabolic
homeostasis. Insulin deficiency disrupts multi-organ and multi-system function. Rapid
symptom recognition and initiation of treatment minimize progression of the disease to
metabolic ketoacidosis. Comprehensive patient and family education is required in order to
recognize and prevent life-threatening emergencies such as diabetic ketoacidosis hence helping
patients such as Andrew. Continous outpatient monitoring and follow-up is is the key to
successful management.
Incorporating the detected problems as experienced by Andrew, early interventions are
effective approaches towards incorporating an effective treatment paradigm for diabetes mellitus.
Thus, there is need to incorporate early initiation where some of the attached medical programs
are intervened towards curbing the potential progression of the pathophysiological conditions
while facilitating recovery of the patient (Mahmoud, 2005) These efforts entails removing the
effects of glucose toxicity to the lowest level possible and preserving pancreases beta cell
function based on their essence for long-term management of diabetes. Furthermore, these entail
examining the blood glucose level and blood pressure as close long-term outcomes in relation to
achieving the desired outcomes. Incorporating the prerequisites of obesity and hypertension in
the treatment plan and the surgical wounds is essential in facilitating recovery of the patient. This
is apparent in relation to the fact that each of the proffered medical problems requires a closer
analysis prior to diagnosing or administering medicines to the patient with diabetes mellitus. The

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most effective treatment plan incorporates the need medical complications of hypertension and
obesity plus the surgical wounds based on the operation conducted as reflected above. Thus, an
effective layout plan on the treatment and care offered to the patient with the proffered medical
complications entails ensuring the medical needs linked to obesity, hypertension, and surgical
wounds are incorporated in reference to the diabetes mellitus diagnosed to the patient. The
assumptions directed above indicates the essence of ensuring the care offered to the patient with
these medical complications is complex and also diverse to meet the linked medical problems.
Hypertension, surgical wounds and obesity linked to diabetes type 2 pose a challenge to
patients hence the need for closer and critical treatment methods. Based on the case study above
of Andrew, effective treatment plan entails incorporating some of the diverse medical
requirements on each of the proffered medical problem to suit the medical requisites of diabetes
type 2. The treatment plan effectiveness is not only determined by the ability of the healthcare
professionals to administer treatment to the patient with the disease but also efforts from the
parents and social workers and other players in the hospital (Dormandy et al, 2004).
Reflecting on the proffered medical scenario above based on Andrew condition of
diabetes type 2 with hypertension, obesity and surgical wounds, in relation to personal medical
practice, the essence of acting as an independent nursing provider towards addressing some of
the proffered health challenges in the hospital emerge. The future of nursing is based on the
capability to be an independent provider. The literature reviewed above demonstrates some of the
significant roles and the essence of independent healthcare providers in the society towards
improving the quality, accessibility, and the affordability of healthcare services in relation to
addressing diseases such as diabetes type 2 and attached health complications such as obesity
and hypertension. The discussion above illustrates the essence and the major impact of

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independent practice competencies in relation to improving level of healthcare services within

the hospital. Thus, independent practice competencies reflects the need to be an independent
provider capable of delivering quality, patient centred, affordable, cultural diversity and
accessible healthcare services to people within the hospital. Having undertaken training in
advanced pharmacology, health assessment, pharmacology, and advanced health assessment plus
Role and Issue in Advance nursing practice, the acquired diverse skills and experience
positioning me to become an independent provider ready to improve quality of healthcare in the
hospital in relation to catering for patients such as Andrew in the hospital. Pharmacology refers
to the study of drugs where it involves examining the diverse interactions of the chemical
substances with the living systems (Abdulbari, 2005). Based on the fact that the success of have
successfully undertaken the course hence understanding the properties of drugs and their actions,
I am qualified in relation to the set competencies requirements such as practicing independently
through managing preciously diagnosed and undiagnosed patients. On the other hand, the study
of health assessment exposes me to systematic, interactive, and deliberative process on critical
thinking in collecting; validating, analyzing and synthesizing the collected information hence
aligning with the core competencies availed above specifications. Roles and Issues course in
Advanced Nursing practice exposed me to diverse entities attached to competencies and the roles
of nurses in the respective settings. Thus, vital skills related to independent provision of
healthcare services is acquired hence qualifying to be an independent provider in the respective
healthcare settings. These skills aligns with the increasing need to boost medical care services in
the hospital by ensuring children such as Andrew are provided with quality healthcare to address
the medical issues in the hospital.

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22

The reflected concepts based on explored studies above, it is evident diabetes is a critical
issue affecting people in the hospital. The implications of the depicted high prevalence rate of the
disease occurrence with linked death cases and impairment affecting the society indicating the
need for detailed research towards addressing the issue. The reviewed literature sources indicate
how diabetes type 2 poses a threat not only on the current generation health status in the hospital
but also the future generation in the hospital. Thus, there is need for detailed research on
effectiveness of the current measures enacted by the government and other regulatory bodies
towards addressing the issue. Further research is required towards addressing the issue in relation
to the implications and how to lower the depicted high prevalence rate. Earlier intervention
methods are essential towards addressing the cases of obesity in the hospital as illustrated in the
analysis above. The risks and complications during preoperative surgical procedures reflect the
need to enact strategies ensuring diabetes type 2 patients are assessed prior to conducting such
operations.

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23

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