Chronic Care Across the Lifespan Case Study Sample

• Subject Code : NUR2101 
• University : University of Southern Queensland My Assignment Services is not sponsored or endorsed by this college or university.
• Subject Name : Medical Sciences

NUR2101 Chronic Care Across the Lifespan A

Part A

Diabetes is a chronic disease that one gets when the pancreas fails to form sufficient insulin or when the body can fully consume the insulin that it has formed. Insulin is a body hormone which controls the sugar in the blood (Baden et al, 2019). Hyperglycemia or increased sugars in the body is a frequent consequence of when diabetes is not regulated and could cause severe damages to the systems of the body such as the blood vessels and nerves. There are two types of diabetes type 1 where there is insufficient insulin formation hence the daily administration of insulin is necessary. Type 2 diabetes occurs when the body fails to effectively utilize the insulin in the body. Most individuals presenting with type 2 diabetes could be physically inactive or overweight. Manny who is 42-year-old presented with type 1 diabetes in the case study provided and also had an amputated forefoot.

The pathophysiology of type 1 diabetes includes the accumulation of the infiltration and the damage of the beta cells that produce insulin in the islets of Langerhans in pancreas. When the beta-cells decrease in number, the production of insulin is reduced to a level where they are no longer available to regulate the normal blood sugars (Katsarou et al, 2017). As the percentage of the damaged beta cells reaches 90, one starts to develop hyperglycemia and diabetes can then be diagnosed. A patient requires insulin administration to reverse the condition and normalize the metabolism of lipids and proteins. Some of the symptoms of the diabetes type 1 include; increased hunger, frequent urination, extreme weight loss, increase in thirst, blurred vision, weakness and fatigue, mood changes and irritability. As explained above, the anatomy and physiology of diabetes type 1 involves the reduction in the beta cells due to the attack and destruction by the immune system. The beta cell deficiency in turn leads to the reduction in the amounts of insulin in the body.

The diagnostic test for diabetes type 1 is the glycated hemoglobin (A1C). The tests is used to check the average blood sugar levels in the previous months (Paschou et al, 2018). The tests evaluate the percentage of the blood sugar which is found in the hemoglobin. When the blood sugar levels are high, the hemoglobin will definitely rise and sugars are attached. If the test comes out above 6.5 percent, then there is an indication of diabetes. When the A1C is not available, there are alternative tests that may be carried out for diagnosis. One test is the random blood sugar test.

The test involves the collection of the blood samples and checking the sugar levels. The sugar levels should be 200mg/dL regardless of the last meal that one took. Increased sugar levels indicate diabetes and if other symptoms are present like increased thirst and frequent urination, it helps in the diagnosis.

The other diagnostic test is the fasting blood sugar test. It involves the collection of the blood sample after fasting overnight. After fasting, a sugar level of 100mg/dL is termed as normal and if the levels are higher than that on two consecutive tests, it indicates diabetes (Baynes, 2015). An individual diagnosed with diabetes may require additional blood tests to check for antibodies that are frequently found in the type 1 diabetes. The tests are useful in assisting the doctor to differentiate between the two kinds of diabetes in cases where there is uncertainty. The ongoing tests for diabetes type 1 include repeated A1C tests which best indicates the success of the treatment plan. Additionally, the doctor could be checking the urine and blood samples for thyroid functions, liver function, kidney functions and cholesterol levels.

The potential complications for type 1 diabetes include the damage to the eyes where the patient may develop cataracts or retinopathy in eyes. Both damage to retina and cataracts may cause the loss of vision and in order to avoid the problem, one should regularly check their blood sugar levels (Barutta et al, 2018). The other possible problem is the damage to the heart where there is formation of plague which could accumulate and finally cause heart attack. One should control their blood sugars well to avoid the problems of the heart. Other heart –healthy choices are also necessary to prevent the complications for instance avoiding smoking, controlling the blood pressure and maintaining low cholesterol levels.

The proper checkup and management of the issues to do with psychosocial is necessary in the life of the person with type 1 diabetes. In adults one is the center of care and family should be engaged in the management. The discussions and the assessment of the depression are among the factors to be checked in a diabetic patient. There is attention to the diabetes-related issues like hypoglycemia, eating disorders, and clinical depression (DiMeglio et al, 2018). The progressive assessments of the patient generally and the quality of life is necessary and this calls for an association with a mental health specialist. The other consideration is the nutritional status where if the patient drinks alcohol, they should be advised to drink moderately. Exercising is a good practice in people with diabetes as it is for individuals preventing diabetes. Manny should be given multiple everyday insulin injections. The patient should also be taught on how to match the insulin doses to the intake of carbohydrates, the blood glucose before meals, and the expected activities for the management of the condition.

Manny should be advised in the use of the insulin analogs to avoid the acquisition of hypoglycemia. Glucose is the most preferred treatment form for a conscious patient with hypoglycemia but also any carbohydrate could be taken. When the blood glucose levels have returned to the normal level, the patient should take a meal or a snack to avoid the recurrence of hypoglycemia condition. Glucagon is usually prescribed for the people with the type 1 diabetes and the caregiver is given an instruction on how to administer. Undertaking A1C tests

The nursing management for patients with diabetes type 1 include; ensuring that the appropriate nutrition. Manny the person with diabetes in our case study, requires the presence of a nutritional program that offers sufficient nutrition for normal growth which ensuring that the blood glucose is within the normal ranges (Jieling et al, 2018). The food plan provided should be well prepared with foods that suit the preference, culture and lifestyle of the patient. The patient should have some carbohydrates and protein snacks to take when a certain meal has delayed. Regulation of the blood glucose levels is essential in the patient with diabetes. The sugars should be regularly monitored to be within the normal limits. Giving support as well as encouragement to the patient is essential and it makes the patient to freely express their fears concerning their condition. Checking for skin breakdown is another nursing strategy where the patient is taught to inspect their skin every day for any breaks. The skin should be taken care of and lots of fluids taken by the patient. For the case of Manny in the case study, he should take of the amputated foot and keep it dry always to avoid continuing infection.

The pharmacological interventions of diabetes type 1 include the injection of insulin subcutaneously. There are various types of insulin dependent on the start and duration of action. They include; short, intermediate and long-acting insulins. The short and the rapidly acting insulin are the only type that can be injected intravenously (Brinkman, 2017). Regarding the non-pharmacological interventions, the patient should be advising to perform exercises regularly. The patient should undertake at least 150 minutes of physical activity each week. Diabetes is said to be a self-managed condition therefore one should take the initiative of taking the medications given as prescribed. Monitoring of the blood glucose is important in maintaining the health of the patient and managing diabetes. The other intervention is the nutrition therapy prepared medically where there is the adjustment of the kind of food given to fulfill the metabolic needs of the patient. For example, carbohydrates are monitored to accomplish the targeted blood glucose. The meal approaches should also be looked into to ensure that the patient is eating healthy and at the appropriate times. Provision of snacks will help prevent the development of hypoglycemia.

References for Chronic Care Across the Lifespan Case Study

Baden, M. Y., Imagawa, A., Abiru, N., Awata, T., Ikegami, H., Uchigata, Y., ... & Kawabata, Y. (2019). Characteristics and clinical course of type 1 diabetes mellitus related to anti-programmed cell death-1 therapy. Diabetology international, 10(1), 58-66.

Barutta, F., Bruno, G., Matullo, G., Chaturvedi, N., Grimaldi, S., Schalkwijk, C., ... & Gruden, G. (2017). MicroRNA-126 and micro-/macrovascular complications of type 1 diabetes in the EURODIAB Prospective Complications Study. Acta diabetologica, 54(2), 133-139.

Baynes, H. W. (2015). Classification, pathophysiology, diagnosis and management of diabetes mellitus. J diabetes metab, 6(5), 1-9.

Brinkman, A. K. (2017). Management of type 1 diabetes. Nursing Clinics, 52(4), 499-511.

DiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018). Type 1 diabetes. The Lancet, 391(10138), 2449-2462.

Jieling, L. I., Zhong, S., Donghai, G. U., Que, F., & Zhou, X. (2018). Effect of the humanized nursing care on type 1 diabetes management outside the hospital. The Journal of Practical Medicine, 34(8), 1380-1382.

Katsarou, A., Gudbjörnsdottir, S., Rawshani, A., Dabelea, D., Bonifacio, E., Anderson, B. J., ... & Lernmark, Å. (2017). Type 1 diabetes mellitus. Nature reviews Disease primers, 3(1), 1-17.

Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C. (2018). On type 1 diabetes mellitus pathogenesis. Endocrine connections, 7(1), R38-R46.

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