Chronic Care Across the Lifespan

Answer 1. The patient’s risk factors are as follows: He had a history of type 2 diabetes, hypertension, cardiovascular disease, a family history of type 2 diabetes, hyperglycaemic symptoms, high blood sugar levels, increased stress, feels too tired constantly, excessive carbohydrate intake, and less physically active. Moreover, he drinks daily and smokes occasionally. This shows that his behavioral risk factors – smoking, diet; biomedical risk factors – stress, overweight; socio-economic determinants risk factors – poor knowledge about diabetes; these factors are highly responsible for the patient’s health (Australian Health Minister s’ Advisory Council, 2017). According to Becerra-Tomás et al. (2018), a person with risk factors like overweight, family history of diabetes, inactivity, and a few others are at high risk of developing type 2 diabetes. Tobacco contain chemicals or substances like nicotine or others, which contribute to increased blood glucose levels, heavy drinking increases the body’s resistance to insulin leading to diabetes, carbohydrates are broken down to glucose and excessive carbohydrate intake can lead to the development of type 2 diabetes in the patient (Becerra-Tomás et al., 2018).

Answer 2. It is found that the patient in the case study is at high risk of developing type 2 diabetes and the nursing assessment that is required to be performed for the patent are as follows: The blood glucose levels should be assessed. This will provide information about the range that should be under the normal value of less than 140 mg/dl (Livesey et al., 2019). If the levels are high the appropriate interventions will be provided. The patient should be assessed for serum ketone levels, fatty acids levels, serum insulin levels, urine assessment for glucose, and ketones. For the patient with diabetes type 2, all these levels are found to be high or elevated (Garber et al., 2019). The patient’s HbA1c-glycosylated hemoglobin levels should also be monitored to know about the measure of blood glucose over the previous 2 to 3 months. It is found that the expected normal range should be 6.5 % to 7 % only (Livesey et al., 2019); if the levels are high the effective interventions should be delivered for treatment of type 2 diabetes. The patient should also be assessed for feet pain, feet temperature, feet color, or rate of wound healing. This is so because a diabetic patient is found to have feet pain related issues and it will enable the nurse to monitor the peripheral perfusion and neuropathy (Australian Health Minister s’ Advisory Council, 2017).

Answer 3. In diabetes, self-management includes planned physical activity, planning of appropriate diet, monitoring of blood glucose levels, and medication administration on time without skipping them. The self-management priorities of the type 2 diabetes in this case study are as follows: The patient should be educated about the biomedical, behavioral, non-modifiable – age, sex, and social and economic determinants risk factors (Australian Health Minister s’ Advisory Council, 2017). He should be asked to monitor his blood glucose levels on a daily basis before and after meal intake; the patient should be asked to set alarms so that he does not miss them; the patient should be asked to involve in physical activities this will help him in reducing his weight and maintain a healthy lifestyle. He should be asked to quit smoking and drinking and there should be no skipping of medications or meals. These points will help the patient in reducing the risk of complications as well. Moreover, the family should be asked to get involved in shared decision-making and self-management of the patient to ensure that there are patient-centered care and long-term care delivered to the patient. He should be asked to have a healthy diet only with low sugar content, high fruits, high vegetables, less pasta, cookies, pastries, more wheat, and more water, at least 8 glasses a day (Garber et al., 2019).

Answer 4. As per the SMART goal, the one goal that should be set for the patient should be to reduce the high blood sugar levels and keep them under control. The goal is to have blood sugar levels in range of 70 to 130 mg/dL before meals and less than 180 mg/dL after meals. This goal is selected because if the blood sugar levels care under control then the patient’s other complications will also get under control like carbohydrate levels, work on physical activity, plan diet, and few others; all these will contribute to reducing the risk of the diseased state of the patient. For this goal, the patient will be encouraged to control hyperglycemia. This will be achieved by setting plans and goals and soon the levels will be maintained in a normal range. The patient should regularly check for weight and blood sugar levels. This can be achieved by going on a daily walk, visit the physiologist for reducing stress, nutritionist for the planning of a nutritious and healthy diet. The goal should be made realistic by encouraging the family members and friends of the patient to encourage him for a healthy lifestyle. It will take nearly two months only to set and execute the plan, and get positive outcomes as well.

Answer 5. If goals are set then it becomes easy for the patient to measure it and achieve it to get well soon. According to the Australian Health Ministers’ Advisory Council (2017), the patients who have chronic diseases should never be allowed to manage their health alone to ensure that patient-centered care is maintained effectively. Therefore, there should be the active involvement of friends, health professionals, and family members as well ineffective patient care. The patient and family members should be involved in shared decision-making. As health literacy is also a very important part of patient-centered care so that goals and plans are effectively explained and signs and information about the disease about the diseases and associated health complications so that management can be performed. If SMART goals are set then the patient will be encouraged in his self-management and care plans as well. Moreover, with the help of the latest technologies like digital alarms or platforms to connect to the patient, the patient will get actively involved in his care as it will make it easy for him to monitor and evaluate his health status (Garber et al., 2019).

References for Dietary Glycemic Index

Australian Health Ministers’ Advisory Council.(2017). National Strategic Framework for Chronic Conditions. Australian Government. Canberra. Retrieved from: https://consultations.health.gov.au/population-health-and-sport-division/national-strategic-framework-for-chronic-condition/supporting_documents/Second%20draft%20National%20Strategic%20Framework%20for%20Chronic%20Conditions%20%20Online%20Public%20Consultation%20%20May%202016%20D16458639.PDF

Becerra-Tomás, N., Díaz-López, A., Rosique-Esteban, N., Ros, E., Buil-Cosiales, P., Corella, D., &Lamuela-Raventós, R. M. (2018). Legume consumption is inversely associated with type 2 diabetes incidence in adults: A prospective assessment from the PREDIMED study. Clinical Nutrition37(3), 906-913. https://doi.org/10.1177%2F0969733019878833

Garber, A. J., Abrahamson, M. J., Barzilay, J. I., Blonde, L., Bloomgarden, Z. T., Bush, M. A., & Garber, J. R. (2017). Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm–2017 executive summary. Endocrine Practice23(2), 207-238. https://doi.org/10.1097/.0000000000000292 

Garber, A. J., Abrahamson, M. J., Barzilay, J. I., Blonde, L., Bloomgarden, Z. T., Bush, M. A., & Garber, J. R. (2019). Consensus statement by the American association of clinical endocrinologists and American college of endocrinology on the comprehensive type 2 diabetes management algorithm–2019 executive summary. Endocrine Practice25(1), 69-100. https://doi.org/10.1177%2F0969733020940371

Livesey, G., Taylor, R., Livesey, H. F., Buyken, A. E., Jenkins, D. J., Augustin, L. S., & Willett, W. C. (2019). Dietary glycemic index and load and the risk of type 2 diabetes: Assessment of causal relations. Nutrients11(6), 1436. https://doi.org/10.1016/.2019.11.005

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