Carrie Smithson    1 posts   Re: Topic 9 DQ 2         Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of Evidence Based Practice is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. There are barriers that may prevent my Evidence Based Practice change proposal from continuing to obtain the same desired results six months to a year from now. My PICOT statement is, In adults with tobacco dependency (P), would providing teaching/research about tobacco cessation (I) compared to medications to assist in tobacco cessation (C) lead to a decrease in tobacco dependency and better health outcomes (O), after four weeks of intervention/quit date (T)? One barrier is new staff coming on board and not knowing the proper way to educate patients on tobacco cessation. The current staff will receive proper education on how to educate tobacco dependent patients. To assist new staff with the process change, we can create required computer based learning assignments (CBL’s) that have to be completed before coming out of orientation. This will allow all new nurses to be up-to-date on the education process. Another barrier is language. Not only is language a barrier in education, but other forms of communication as well. Upon communicating with a patient who does not speak English, the health care team must first decide what language the patient understands best, and in what way the patient learns best. Once the assessment is completed, the nurse can obtain an interpreter. At our facility, there are interpreters on wheels; this is an IPad that we bring to the patient and an interpreter comes on live to speak to the patient in their specific language. Not only can we use the interpreter, but provide written education in different languages as well. Throughout the education process, it is important to remember communication techniques. A few communication techniques are listening, asking open ended questions, and having an open posture (Elsheikh, 2018). Change initially can be a good thing and take off quickly. It is important to sustain new change through methods like I mentioned above.  Reference  Elsheikh, K. (2018, March 21). 7 Effective Communication Techniques That Will   Make YouExcellent. Retrieved from https://medium.com/better-humans/7-  effective-communication-techniques-  that-will-make-you-excellent-89eb17e60b36

 Read a selection of your colleagues’ responses and respond on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. 

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Type 1 diabetes which is sometimes called juvenile or insulin-independent is when the pancreas produces little to no insulin. It can be seen as an autoimmune disease because the immune system mistakenly attacks the insulin-producing beta cells of the pancreas (Diabetes UK The Global Diabetes Community, 2019). Since these patients are not producing enough insulin, they are insulin-dependent for the rest of their lives, and most patients wear an insulin pump (Mayo Clinic, 2018).  Type 1 is normally diagnosed during pediatric years or people younger than the age of 30 (Diabetes UK The Global Diabetes Community, 2019).

Type 2 diabetes which is also called  adult-onset or non–insulin-dependent diabetes, is different from type 1 because in type 2 the body loses the ability to respond to insulin (Thompson & Romito, 2018). This causes the body to become insulin resistant because the body is not using insulin in the right way (Thompson & Romito, 2018). The pancreas soon becomes overworked and makes less insulin leading to insulin deficiency. Type 2 diabetes can be treated with insulin and medications, it can also be prevented if caught early and by lifestyle modifications such as in food, diet, and behaviors. Type 1 diabetes is not preventable (Diabetes UK The Global Diabetes Community, 2019).

Gestational diabetes (GDM) occurs during pregnancy. A hormone made by the placenta in the womb keeps the body from using insulin the way it should (Cedars-Sinai, 2019). Glucose builds up in the body and is not absorbed by cells leading to this disorder. GDM normally goes away after the birth of a baby. Women who are overweight are more prone to developing this disorder, and  their children are at an increased risk of developing type 2 diabetes (Cedars-Sinai, 2019). Making sure to get blood work done routinely, sticking to proper diet, exercise, medications, and insulin injections can control and prevent developing GDM (Cedars-Sinai, 2019).

I selected Aspart (Novolog) insulin pen as the drug of choice for GDM. To prepare this drug I would show the pregnant patient how to administer this drug. First, I would instruct the patient to check their blood sugar pre-meals. If the blood sugar is above 150, right before their meal then the patient should follow the range dose of insulin to give that is prescribed to the patient. If the patient plans of eating all of their food then the patient will be told to give the required dose 15 minutes before or after the meal (University of Iowa Hospitals & Clinics [UIHC], 2019). If the patient only eats half then wait till after the meal to administer insulin.

The patient will be told that in pregnancy the best place to administer insulin is in the abdomen because this is where insulin gets absorbed the fastest in the bloodstream (UIHC, 2019). It should be injected at least 2 inches away from the belly button. To use the pen I would instruct the patient to remove the cap of pen and clean with alcohol, apply needle, prime the pen by selecting 2 units making sure to see drops so you know its working right. After this, select the appropriate dose needed for the patient, point the pen towards the abdomen site and push down to inject (UIHC, 2019). The dietary considerations would consist of a balance of legumes, sweet potatoes, salmon, eggs, fruits, broccoli, green leafy vegetables, fish liver oil. Berries, whole wheat products, and lean cooked meats (Cedars-Sinai, 2019). The patient would be told to stay away from processed, sugary, and fried foods.

A short term effect that may not be talked about with GDM is the cost. On average women living with GDM spend up to two-thousand dollars more than women living without GDM (Xu et al., 2015). This is related to the cost of medications, frequent doctor visits, and symptoms of hyperglycemia that the patient experiences. This is why making sure to take insulin, following a proper diet, and exercise program can help decrease these cost and prevent developing type 2 diabetes in the long-term for patient and child. If the patient develops type 2 diabetes after pregnancy this can lead to obesity, stroke, and heart attack if not properly controlled  (Diabetes UK The Global Diabetes Community, 2019). It is clear that following and living a balanced diet regardless of the type of diabetes diagnosed with can help control, and prevent detrimental effects on the body and allow to live a satisfying life.

              

                                                    References

Cedars-Sinai. (2019). Gestational Diabetes. Retrieved from https://www.cedars-sinai.org/health-library/diseases-and-conditions/g/gestational-diabetes.html

Diabetes UK The Global Diabetes Community. (2019). Differences Between Type 1 and Type 2. Retrieved from https://www.diabetes.co.uk/difference-between-type1-and-type2-diabetes.html

Mayo Clinic. (2018). Type 1 Diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011

Thompson, E., & Romito, K. (2018). Diabetes: Differences Between Type 1 and 2. Retrieved from https://www.mottchildren.org/health-library/uq1217abc

University of Iowa Hospitals & Clinics. (2019). Insulin use during pregnancy. Retrieved from https://uihc.org/health-topics/insulin-use-during-pregnancy

Xu, T., Danielli, L., Yu, K., Ma, L., Silva Zolezzi, I., Detzel, P., & Fang, H. (2015). The short-term health and economic burden of gestational diabetes mellitus in China: a modelling study  []. BMJ Open, 7(12). Retrieved from https://bmjopen.bmj.com/content/7/12/e018893

Peer replies

1-Alberto :

Polypharmacy is an area of concern for many patients, especially the elderly.  Elderly patients are at a greater risk for adverse drug reactions (ADRs) because of the reduced drug clearance associated with aging and because of metabolic changes (Boris, Cafiero & Smith, 2014).  Some risk factors associated with polypharmacy are potential of drug-drug interactions because it is further increased by use of multiple drugs.  Another risk factor is hip fractures, associated with adverse drug reactions and losing balance or fainting (Boris, Cafiero & Smith, 2014).  Polypharmacy may sometimes lead to “prescribing cascades.”4 Prescribing cascade is said when signs and symptoms (multiple and nonspecific) of an ADR is misinterpreted as a disease and a new treatment/drug therapy is further added to the earlier prescribed treatment to treat the condition (Piere & Farrell, 2012).

       In my practice working with the elderly population, to reduce the incidence of polypharmacy medication, patients are evaluated on a monthly basis.  Additionally, a single drug is be prescribed instead of multiple drugs for the treatment of a single condition, if possible.  Another strategy we use is staring medication with the lower drug dosage and slowly increasing as indicated.

           A strategy that seems to be effective, according to research, is prescribe drugs that can be given once or twice a day instead of prescribing drugs that require to be taken three times a day (Thomas, Liao, & McCliar, 2016).  The reasoning behind this is to lower the risk of forgetting to take the medication or taking the medication together with other drugs.  Another strategy that can be employed is that if the drug taken has no therapeutic beneficial effect or clinical indication it should be eliminated. Unessential drugs should be identified and eliminated prescribed by different health care providers for the same condition/disease (Thomas, Liao, & McCliar, 2016).

2-maceda 

Polypharmacy refers to the effects of taking multiple medications concurrently to manage coexisting health problems, such as diabetes and hypertension (Piere & Farrell, 2014).  Too often, polypharmacy becomes problematic, such as when patients are prescribed too many medications by multiple healthcare providers working independently of each other. Also, drug interactions can occur if no single healthcare provider knows the patient’s complete medication picture. Nurses have a unique opportunity to help identify patients at risk for inappropriate polypharmacy and to educate patients and families about risk reduction. Nurses can use strategies such as patient teaching and consistency in care plan (Piere & Farrell, 2014). 

Some of the risk factors of polypharmacy are age and chronic conditions.  The elderly are more sensitive to the effects of certain drugs, particularly those that affect the central nervous system.  As a consequence, drug classes such as benzodiazepines should be used with caution, and if absolutely necessary, then at a reduced dose to minimize the risk of falls and other adverse events (Thomas, Liao & McCliar, 2016). In addition, age is associated with decreased regulatory functions, therefore anti-hypertensives can more easily result in postural hypotension and opiates in respiratory depression.  Communication barriers often go undetected in health care settings and can have serious effects on the health and safety of patients. Limited literacy skills are one of the strongest predictors of poor health outcomes for patients (Thomas, Liao, & McCliar, 2016).  If the patient is deaf, can’t see or is illiterate there are various strategies the nurse can use for example, advise the patient to bring someone with them to the visit.  Nurses who are responsible for checking patients in should be friendly and helpful. The length and number of forms patients are asked to fill out should be limited.

 

Throughout the RN-to-BSN program, students are required to participate in scholarly activities outside of clinical practice or professional practice. Examples of scholarly activities include attending conferences, seminars, journal club, grand rounds, morbidity and mortality meetings, interdisciplinary committees, quality improvement committees, and any other opportunities available at your site, within your community, or nationally.

You are required to post one scholarly activity while you are in the BSN program, which should be documented by the end of this course. In addition to this submission, you are required to be involved and contribute to interdisciplinary initiatives on a regular basis.

Submit, as the assignment, a summary report of the scholarly activity, including who, what, where, when and any relevant take-home points. Include the appropriate program competencies associated with the scholarly activity as well as future professional goals related to this activity. You may use the “Scholarly Activity Summary” resource to help guide this assignment.

While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.