Capstone Project Topic Selection & Approval

Topic Problem

Diabetes is a disease characterized by hyperglycemia emanating from improper insulin secretion, defects in insulin actions in the body or both.  In the United States, diabetes is one of the leading causes of death, accounting for more than $250 billion in lost productivity and medical costs annually (Menke et al., 2013). According to the Department of Health and Human Services, at least 29 million Americans have the disease while another 89 million at a high risk of contracting the disease (Menke et al., 2013). It is estimated that one out of every three adults in the United States could have diabetes by the year 2050.  Most of the deaths caused by diabetes can be avoided by ensuring that diabetes does not hit chronic levels. Eighty percent of diabetes related deaths are caused by improper management of glucose levels in the blood which is also known uncontrolled diabetes (Menke et al., 2013). Worse, diabetes patients that do not take medication as instructed do not follow dietary, physical exercise, and lifestyle guidelines provided by caregivers are at a risk of suffering uncontrolled diabetes. 

Context

 Uncontrolled diabetes mellitus is common among people between the ages of 50 and 60 who are less likely to manage their diabetes than younger people. It exists simultaneously with conditions such as obesity, hyperlipidemia, depression, and nephropathy (Yang et al, 2016). It is also common among low-income earners who cannot afford proper care to manage the disease.  In fact, uncontrolled diabetes is more prevalent in middle and low-income countries and neighborhoods.  Furthermore, long-standing DM2, total hypercholesterolemia, and cigarette smoking are factors that led to poor control of blood glucose (Kitabchi, 2009).  Finally, uncontrolled diabetes is prevalent among people with busy working schedules which make it hard for them to exercise, eat healthy meals, or take medications. This includes civil servants.

Description

Uncontrolled diabetes happens when blood sugar levels rise beyond the recommended targets which include an A1C above 7.0 percent.  Studies indicate that 54.5 percent of people with diabetes mellitus are not able to control their blood glucose levels (Rother, 2017).  Inability to control glucose levels leads to deterioration of the condition to untreatable levels. When diabetes is not properly managed, it develops into uncontrolled diabetes whose dangerously high levels of blood glucose leads to several conditions which include, eye complications, kidney disease or even organ damage (Grams & Garvey, 2015). When caring for patients with uncontrolled diabetes mellitus, the goals are the elimination of symptoms and prevention of development of complications or slow down their development if they have already started.

Impact of Uncontrolled Diabetes

The consequences of failure to control blood sugar level can be fatal. They include cardiovascular complications and a high risk of stroke or heart attack, vision problems, which include total blindness, kidney failure, nerve damages, dental problems, and amputations due to infected feet.  One of the impacts of uncontrolled diabetes on the workplace is that it must be controlled using non-traditional approaches to healthcare (Haw & Galaviz, 2017). To manage people with uncontrolled diabetes, a healthcare facility must build enough team care practices such as shared medical appointments and telehealthcare. For example, telehealth programs directed by pharmacists can improve blood pressure outcomes and medication management among diabetics. In short, health care settings must be ready to use non-traditional approaches to manage patients with uncontrolled diabetes to reduce their fatality risks.

Significance of Uncontrolled Diabetes for Nursing

 The prevalence of uncontrolled diabetes is expected to double by 2030. Already, many health care organizations are under significant pressure to create cost-effective interventions to care for the diabetics. One of the implications of this reality is that nursing practitioners need to be integrated into primary care teams. They can provide innovative support methods that will improve diabetes type 2 patient metrics (Polonsky, 2012). This is a cost-effective method of providing care. Nurse practitioners in primary settings are effective in the improvement of clinical values among patients with uncontrolled diabetes. Improved clinical values such as LDC-L, BP and HbA1c reduce micro and macro-vascular complications associated with uncontrolled diabetes. These clinical values can be further improved through e-visits, which give convenient care to patients and reduce the financial cost of visiting healthcare facilities for managed care. E-visits and telehealth services can also improve patient’s adherence to medication and treatment plans.

Proposed Solution to the Problem

The best solution to the problem is nursing management. Nurses should provide up-to-date and accurate information about the condition of a diabetic patient so that healthcare teams can craft intervention and management strategies. Nursing priorities in the management of uncontrolled diabetes should include restoration of thee electrolyte or fluid balance, reversal of metabolic abnormalities, prevention of complications, identification of underlying causes, and provision of information about patient treatment needs (Umpierrez & Pasquel, 2017).

There are several nursing interventions that can provide solutions to uncontrolled diabetes. One of them is education about glucose monitoring to help patients to identify and also manage variations in glucose levels (Brunström & Carlberg, 2016). The second is a review of factors that cause glucose instability and address them. Furthermore, nurses should encourage patients with diabetes to read labels and teach them to low-fat, high-fiber, and low glycemic index foods.  Nurses should also help patients in checking the viability of insulin, emphasizing on expiry dates and proper storage.

Conclusion

The quality of care given to patients with diabetes mellitus should ensure that it does not degenerate to uncontrolled diabetes. Diabetes mellitus is not fatal if it is managed well. Diabetes patients that take their medications as instructed, monitor their blood glucose levels, observe healthy diets, exercise regularly, and avoid unhealthy lifestyles choices such as smoking and alcohol are at a lower risk of their condition degenerating into uncontrolled diabetes. The fact that 54.5 percent of diabetics have uncontrolled diabetes means that the nursing practices must use non-traditional approaches to deal with diabetics. The practice also needs to create innovative solutions for managing diabetes to ensure that blood glucose levels remain under control.

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