Michael Turnbull

Brandon Reyes
Alex Rich
Madison Hefner
Community: Professor Rendano

Diabetes

Abstract:

This paper explains how the nurse cares for diabetic patients in a home care setting and
how it is different from acute care. It will explain the description of procedure and
equipment used and the documentation needed for these procedures while in the patient's
home. By understanding the differences from hospital care and home care it will give
nurses a wider range of skills and knowledge and in turn promote better patient care.

Description of the procedure and equipment including home modifications:

When a person has diabetes, their blood sugar is not regulated by their pancreas
causing the blood glucose to fluctuate on different ends of the spectrum. Monitoring their
blood glucose is essential for the promotion of optimal health while battling this chronic
disease. Diabetes management is multifactorial on diet, exercise, and insulin
administration.

To check a blood sugar you need a glucometer, test strips, a needle, alcohol pad
and gauze. The first step of the process is washing your hands and cleaning the site that
you are going to prick with alcohol. Then you have your glucometer ready to go with the
test strip all set up, and you prick your finger with a needle. Some blood will come out,
but you need to wipe the first drop away because it can be altered by the alcohol pad and
then apply pressure to the tip of the site so more blood will come out of it. Then, you
place the tip of the test strip towards the blood so it is absorbed and calculated by the
glucometer. You will get your reading that hopefully is within normal limits of 60-100
mg/dL. After you have your reading, the patient will steadily hold the gauze on the
wound so that the blood will clot.

If you are hyperglycemic, then appropriate measures per sliding scale will be
taken where you will need some sort of insulin to regulate your blood sugar. The signs
and symptoms of hyperglycemia are increased thirst, headache, difficulty concentrating,
blurred vision, frequent voiding, fatigue and weight loss. There are different types such as
rapid acting, short acting, intermediate acting, and long lasting. It is important that you
rotate where you are injecting and pricking yourself. Some adverse effects of same place
injection are insulin lipodystrophy and hypoglycemia. Insulin can be injected into
subcutaneous tissue (fatty patches), and is best absorbed in the abdomen. There are
different types of ways insulin is injected such as pumps, pens, and syringes. It is
important that you store insulin in a refrigerator so it is out of extreme heat. If you are
hypoglycemic, which is caused by giving too much insulin, omitting meals, or increased
exercise, then you will need to drink some orange juice, or suck on some hard candies.
The signs and symptoms of hypoglycemia include sweating, confusion, tachycardia,
headache, hunger, weakness, coma and death. You must be aware if the patient is
unconscious in a hypoglycemic coma that you need to inject glucagon. If the patient
doesn’t respond within fifteen minutes then you must call 911. The extremes of being
high and low take a toll on your body.

Reasons for choosing this homecare procedure:

Diabetes is a chronic disease and very common in the United States. With obesity
being a major problem in the United States, many people are at higher risk for developing
this disease. It is important that we know the s/s of the diabetes and the steps to take in
order to reduce the risk. Getting to know and understand the disease will further help our
patient teaching in the health care field and family care. Since diet plays a big part in
maintaining and controlling this disease, promoting a healthy diet and lifestyle overall
will help decrease the incidence of diabetes. Teaching people how to properly store the
medication, when and how to take, and how to perform a blood glucose reading on
themselves is another procedure to understand when it comes to helping people
controlling this disease.

Comparison of procedures done in home that differs from the procedures done in acute
care settings:

There are many differences when it comes to procedures done at home rather than
in acute care settings. At home diabetics make their choices for what they want to eat. In
hospital settings diabetics are on a diet control to help watch what they eat and prevent
high glucose levels. Also, diabetics at home have to check their glucose levels on their
own. Blood sugar levels should be checked at least 2-4 times day. In hospitals blood
sugars are checked before meals and before glucose medications are given.

Diabetics also have to make sure they take medications at the same time every
day. In hospital settings a registered nurse helps diabetics stay on track when it comes to
taking medications on time, or following medications regimens. Biggest factor is in
hospitals if a diabetic has any serious complications such as heart attack, stroke, or
aneurysm they can receive treatment much faster, other than having to be transported
from home to the hospital, which increase the likeness of death. Since time is everything
when it comes to acute episodes. As result, Diabetics at home are completely independent
and responsible for everything they do. In an acute care setting like a hospital they are
watched over, and guided with everything they do to help reduce the rick of any serious
complications, help follow a healthy diet, and stay on schedule with medications.

Type of documentation that may be required in a home health care agency:

 Documentation has to be complete accurate and concise. Documentation is a tool
to: Ensure continuity of care as it serves as a communication tool among healthcare
providers, plan and evaluate a patient’s treatment, create a permanent record for the
patient’s future care, create a database to evaluate effectiveness of treatment, facilitate
research, substantiate billing, and recollect a memory and/or justify/defend care provided.
With everything that needs to be documented whether a patient is at home or in the
hospital documentation all has to look the same. To make sure you are documenting up to
standards with insurance companies you need to include the date, time, and your
signature on every entry, make entries immediately or soon after care is given, write
legibly, be thorough, accurate, and objective and only used approved abbreviations.
Abbreviations have led to many medical errors which is why usually each hospital has
their own “do not use” list.

For Home Health care visits the RN goes into the patient's home and does what is
called an initial assessment. On this first visit the nurse establishes a baseline of the
patient so progression in health can be seen over the next few visits. Medicare pays for
the progress the patient has made or at least the ability of the patient to maintain good
health. Services that are beneficial must be documented and clearly state how they helped
the patient in order to receive reimbursement. Assessment of the homecare patient not
only includes the physical assessment of body systems but also the psychosocial
assessment, this includes the patient’s environment, available caregivers, patient/
caregiver compliance, safety needs, financial needs, spiritual and/or cultural needs or
constraints. At the end of the visit all of the documentation must provide a clear picture
of the patient’s conditions, needs, and interventions provided to meet established goals.

The goals for the patient stated in the documentation must be “SMART”: specific,
measurable, achievable, and related to time. There should be a deadline of when the
patient should be meeting certain goals in the plan of care. Goals should be made every
visit and interventions should be given on how to achieve these certain goals. If Medicare
does not think the patient needs anymore treatment or does not think the patient is
following their plan of care reimbursement may not be given and treatment may stop.
Knowing all of this when documenting as a nurse is very important to protect yourself
along with your patient on top of receiving compensation for health care services
References:

Acollo, B. (2015). HOME HEALTH ASSESSMENT CRITERIA HOME HEALTH.

Retrieved October 30, 2016

"American Diabetes Association." American Diabetes Association. ADA, 2016. Web. 24

Oct. 2016.

Documentation - How Important Is It? . (n.d.). Retrieved October 30, 2016,

Kee, Joyce LeFever., Evelyn R. Hayes, and Linda E. McCuistion. Pharmacology: A

Nursing Process Approach. St. Louis, MO: Elsevier Saunders, 2012. Print.

Story, Lachel. Pathophysiology: A Practical Approach. Sudbury, MA: Jones & Bartlett
Learning, 2012. Print.