Nursing Australian Diabetes Society

Question: Discuss about the Nursingfor Australian Diabetes Society. Answer: Introduction In Australia patients that have been diagnosed with diabetes are a proximately one million with over 130 000 patients diagnosed with type 1 diabetes (Australian Institute of Health and Welfare, 2014). The more number of patients diagnosed with diabetes has placed Australia at number 7 with the highest prevalence in the world and 6th with the highest incident of type 1 diabetes. Of this population nearly 10-15 % diabetes patient undergoes surgical operation with high risk of complications, mortality rate and even long hospitalization. This, therefore, necessitates peri-operative management of these diabetes patients to reduce any risk associate with surgery. Peri-operative management include health care or management practices offered to diabetes patient before or after surgery operations (Australian Diabetes Society, 2014). The main focuses of this paper is on pre-operative and post-operative management of diabetes patients considering best nursing practices to reduce risk among pati ents. Background of the Research Question The most ultimate question that clearly emerges is that what are the best nursing practices in the managing patient with diabetes in the peri-operative settings? The above question remain unanswered since it is estimated that the rate of complication and mortality rate of patients with diabetes is 5 times greater among diabetic patients as compared to patients with other diseases who undergoes surgical operation. Some of the chronic complications cited include: microangiopathy, nephropathy and macroangiopathy. There is also surgical complication resulting from infection and vasculopathies. Studies show that infections from post operation complications account for 66% of complications (Frisch, A., Chandra, P., Smiley, D., et al. 2010). The greater percentage of post-operative infections commonly includes impairment of leukocyte function such as changed chemotaxis and phagocytytic activity. Patients with cardiac surgery often have myocardial ischemia. The research question therefore fo cuses pre- operative and post operative management of diabetic patient, the researcher is allocated to peri operative ward which is combination of both pre and post operative management (Varadhan, K. Neal KR, Dejong, H. et al. 2010). There are some suggested peri-operative management practices for diabetes patients to reduce risk of post-operative infections and complications. Control of glycaemia, pre-operative assessment and proper insulin use are some of preoperative management (Dhatariya K, Levy N, Kilvert A, et al. 2012). Firstly, pre-operative assessment is important where the nurse may obtain support from anaesthetist or a diabetes specialized nurse. Studies suggest that pre-operative assessment help identify the required care during surgery operations. Secondly, control of glycaemia has been seen as the best method to reduce the post surgery mortality rate among diabetes patients. The only alternative question that presents itself is that what is the safely level of glycaemia that need to be maintained? This question result from different conflicting data presented by different researchers. The second alternative question is that how tight the glycaemia should be controlled? This is because tight control of glycaemia also results in hypoglycaemia. Control of glycaemia continues to the post-operative management since there is need to return the blood glucose level back to the normal without risking the life of diabetic patient (Duncan, E. and Soltesz, E. et al. 2010). Clinical Practices for Peri-Operative Management According to Australian Diabetes Society (2014), one of the pre-operative management strategies is tight control of glyceamia. The matter of concern is the cost of tight glycemic control since its side effect has been severe hypoglycemia. There are minimal episodes of hypoglycemia in diabetes patients treated with analogue insulin though the cost is higher limiting majority of patients. According to International Diabetes Federation (IDF) (2013), the standard of care for diabetes includes balancing the hypoglycemia risk requires maintenance of glyceamia to 80-150 mg/dL. Therefore the main goal of pre-operative management is to achieve outcome similar to patient without diabetes. However, Varadhan, K. Neal KR, Dejong, H. et al. (2010), suggest that use control of glycemia that forms the main basis of pre-operative management requires cost effective considerations. The cost effective consideration of tight glycemic control is key for both efficacy and efficiency management of diabetes patients in pre-operative settings. Post operative management normally depends on the characteristic of diabetes, diabetes complications and methods of glycemia control. According to Dellinger P, Yanez D, and Farrohki E, et al. (2013), post operative management of diabetes patients focuses on insulin use and oral glucose lowering agents. Insulin administered to patients after surgery can be intermediate-acting, short-acting or long acting insulin. Short-acting insulin work best when give as pre-meal insulin since meal timing is also a matter of concern. Intravenous insulin is limited to patient in ICU since it requires continuous glucose monitoring (Humphrey, L and Snow V et al, 2011). Oral glucose lowering agents are also used to lower glucose level in post-operative management though it is limited to patient on such program in pre-operative management. Some of the glucose lowering agents includes sulfonylurea and insulin secretagogues. Glucose lowering agents reduce glucose level acutely in post operative diabetes pa tient management. The limitation of glucose lowering agents or medications is that these agents are limited to specific patients as compared to other post-operative management. Rationale for Peri-Operative Management Practices Studies indicate that poor peri-operative care of diabetes patients increases the risk of post-operative complications and infections. According to Dellinger P, Yanez D, and Farrohki E, et al. (2013), failure to control glycaemia for instance results in hyperglycaemia that is prone to cause complications among hospitalized diabetes patient after surgery. In addition post-operative control of hyperglycaemia results in low risk of complication among diabetes patients. Proper regulation of blood glucose at 4.4-6.1 mmol/L has proved to critically reduce morbidity and mortality among diabetes patients. In some patients, different blood glucose levels are required to prevent post-operative complication in different situations such as ICU. Type 1 diabetes patients are known to develop diabetic ketosis within a few hours when insulin is not administered or withdrawn especially at times of surgical operations. This implies that if insulin is not controlled then the more the lesser the insulin the higher the risk of post surgery complications (Frisch A, Chandra P, Smiley D, et al. 2010). Alternative Peri-Operative Practices There is need for multidisciplinary team for peri-operative management of diabetes patients to optimize the outcome. The multidisciplinary team incorporate good grasp of glucose-insulin complexities effect of anaesthesia and surgery provides optimized outcome (Duncan, E. and Soltesz, E. et al. 2010). In addition, there is need for a system with automated control for internal blood glucose environment. This system will help regulate the glucose concentration at an appropriate level depending on the metabolism process taking place in the blood of diabetic patient (Australian Diabetes Society, 2014). This will compliment the limitation of various peri-operative management settings. Conclusion In conclusion, there are some changes that need to be made on peri-operative management for diabetes patients to reduce risk of mortality due to post-operative complications and infection. Some of the suggested peri-operative management of diabetes patient include control of glycemia, proper insulin use and administration of glucose lowering agents. Tight control of glycemia requires cost effective analysis for better outcome. Insulin use requires consideration of diabetes characteristic and timing. Finally, glucose lowering agents are patient specific since it requires use both in pre and post-operative management of diabetes patients. 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