Ineffective Health Care for Diabetes

<Definition>
It is difficult for patients and their families who need medical treatment due to illness or sequelae, management of symptoms, recovery of physical function, and maintenance of physical function to incorporate treatment into their daily lives, and it tends to be insufficient to lead the desired life. The condition is called “ineffective health care”.

<Differences in how to use “ineffective health maintenance” and “ineffective health management”>
“Ineffective health maintenance” is used for individuals who want to change their unhealthy lifestyle such as overeating, lack of exercise, and smoking, and is used for primary prevention to prevent the onset of illness.
“Ineffective health care” is used for patients who need education on self-management of illness or health condition.

<Nursing care plan>

Target
Acquire knowledge and skills necessary for medical conditions and self-management
Be able to notice and deal with problems in daily life
Get the support you need and live a quality life

O observation plan
1. Age, cognition, comprehension
2. Family structure, family relationships, family support
3. Medical condition, treatment content, side effects, presence or absence of complications, impact on ADL / IADL
4. History
5. Presence or absence of symptoms of hyperglycemia and hypoglycemia
-Hyperglycemic symptoms: thirst, polydipsia, polyuria
-Hypoglycemic symptoms: sweating, yawning, palpitation, tachycardia
6. Presence or absence of complications, signs
-Presence of vision loss or visual field defects
-Presence or absence of foot lesions
-Presence or absence of paresthesia
7. Test data (blood glucose, HbA1c, 75gOGTT, TP, GA, urinary sugar, urinary ketone, urinary C peptide, renal function, fundus examination, chest X-ray, electrocardiogram)
8. How to accept diseases and treatments
9. Whether the patient or family has anxiety or difficulty
10. Understanding and reaction of instruction content
-About diet
-About exercise therapy
-About drug therapy
11. Contents of self-management
Patient situation, what do you think you should do
Contents of self-management performed by the patient
Are you able to continue self-management?
12. Life before hospitalization
-How to spend one day
-Eating habits / smoking / drinking
-Residential environment, local environment
-Occupation, hobby
Domestic role, social role
-With or without religion
13. Who and how is the prevention of illness and complications explained?
14. Utilization of social support

Care plan
1. Understand the patient’s illness and treatment, their values, and the decision-making process.
2. Be close to the patient’s thoughts and treat them with respect
3. Listen to the thoughts, concerns, and difficulties of the patient / family
4. Check the reason for the patient / family’s remarks, facial expressions and behaviors.
5. Respond to poor or abnormal blood sugar control
6. Adjust a place where you can explain to the whole family so that the family can have the same care.
7. Hold a pre-discharge conference in collaboration with multiple occupations
-Support patients and their families to express their needs and anxieties, and speak for them when necessary.
-Tell local supporters about the content of discharge guidance
8. Before leaving the hospital, stay overnight to clarify problems and try to solve them.

Education plan
1. Explain diabetes
-About diabetes, causes of diabetes, classification of diabetes, symptoms of diabetes
-Diabetes complications
-Diabetes test
-Diabetes treatment (diet / exercise drug therapy)
-For hypoglycemia, what to do when hypoglycemic symptoms appear
-Thick day
-Diabetic coma
-Caution in daily life
-Foot care (foot bath / how to cut nails)
2. Educate how to self-inject insulin
-Type and effect, indicated amount and injection time, injection site and procedure
-Use checklist when needed
3. Educate how to carry out the instructional exercise therapy and precautions
-Walk () km in () minutes () times in 1 day
-Be sure to carry glucose with you when exercising
-Use a pedometer to help you reach your daily goal
-Think about exercises that can be incorporated into your daily life
4. Educate about self-management
-Confirm how to understand the management method based on the life after discharge
-Check how you are trying to act on diet, exercise, medication, and prevention of complications based on your life after discharge.
-Make sure diet, exercise, medication and complication prevention are done in the right way
-Explain any deficiencies in diet, exercise, medication, or prevention of complications
5. Explain the need to see a medical institution regularly even after discharge
6. Explain how to use social support


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