There are multiple risk factors associated with the patient’s condition. The main risk factor is the chronic condition of diabetes and hypertension that the patient is struggling with. The patient is also having a high bodyweight that adds to his misery (Hausmann, 2019). These conditions are cumulatively causing cardiovascular risk in the patient. The patient also had an episodic event of hyperglycemia and this can add to the comorbidity of the patient. The patient is not having close monitoring of his parameters. He is also not adhering that well to the medication routine prescribed to him. Despite having such chronic condition, that is being left unevaluated, the patient has not had any follow-ups for keeping a track on his overall health status. He can also be observed to be socially withdrawn and is having a depressive mental health status. The smoking and drinking, although being occasional, still adds to the underlying risk factors of the patient. The smoking factor along with diabetes can be harmful to the patient and can also subject the patient to an increased risk of developing cardiovascular disease (Daly, 2017). The patient is also having a poor dietary control tagged along with poor glycemic index monitoring. He is also not that aware of the repercussions of his condition and the harm related to the same.
The patient is in the dire need for complete evaluation and assessment. The main nursing intervention can be monitoring for his blood glucose levels. As the patient is having a chronic as well as a family history of diabetes, from both maternal as well as paternal side, the blood glucose levels must be monitored constantly. These blood glucose levels will help in reflecting on the present clinical status of the patient and will thus, help in enabling the nurse to apply intervention for the same. As the patient has been on the same dosage of medication of metformin, noting the blood glucose levels are also vital from medication reconciliation (Turchin, 2018). The nursing intervention of patient education is also very vital in this case, as the patient is not fully aware of his present health status. The patient is also not managing his weight that well. The nurse can work in close coordination with the dietician in helping the patient, by prescribing a diet for him, so that his daily fat and carbohydrate intake can be balanced. Weight reduction intervention is also important from reducing cardiovascular risks of the patient (Kim, 2018). Smoking cessation is another treatment method by which the patient can be helped, to lower the additional risk to his health. The counselling and group therapy can be arranged for the patient, to help him in improving his socialization as well as promoting his mental health through positive reinforcement.
Patient self-care management is essential to help in reducing the risk to the patient. The nurse can work along with the patient, by keeping close monitoring on the healthcare status (Gatwood, 2020). The self-management, in this case, can be carried out by the means of helping the patient with monitoring his blood glucose levels. The patient can be taught to keep a track of those readings so that the fluctuation in the readings can be monitored. Other vitals such as blood pressure and heart rate can also be easily noted with the help of portable devices. The patient can be educated on the correct method to use these devices so that he can keep a track on the parameter himself. The patient can also be provided with an electronic dispenser for his medication (Capoccia, 2016). The machine has an alarm which lets the patient know as to when to take medication. By doing so the patient can be complied for practising medication adherence. The patient can also be advised to keep a weight scale with him so that he can measure his regular weights. It will provide positive feedback to the patient, by making him come to terms with his reality. The patient can also be taught adverse signs and symptoms so that he can note for the same, in case of manifestation. These can be complications associated with diabetes, such as retinopathy, neuropathy and so on.
The SMART goal in this case study will be mainly based on measuring blood glucose levels. As a part of self-assessment, the main goal will be measuring blood glucose levels regularly. The measurements will be urged to be noted daily and a log of the same will also be maintained. The patient will be taught about the normal blood glucose levels and this will be set as a target for the patient to attain. The barriers and limitations of the patient will be keenly evaluated for this process, so that the same can removed or resolved in helping the patient, achieve his required targets. The family of the patient also plays a crucial role in this process (Swoboda, 2017). The goals will be set following the reality of the patient. Mr Storey and the family will be taught about the limitations the patient is having and how gradually he will be able to attain the set goals. regular counselling of the patient will be done to keep him motivated in achieving the targets. The blood glucose levels will also be monitored weekly so that the same can be regularly examined for timely interventions.
Goal setting technique will help provide the patient with a directional approach in managing his condition. By making the person come to terms with his condition, will help get full cooperation of the patient. It will also help reduce the myths and disbeliefs of the individual, regarding his condition. By getting visual feedback through the measurements, the patient will be motivated in constant engagement in his journey towards better health status. The sustainability of the intervention will ensure, improved healthcare outcomes and appreciably visible good quality of health and lifestyle. These interventions will also help encourage the patient for lifestyle modifications necessary to manage his chronic conditions.
In the given case scenario, by setting a limit of blood glucose for the patient to achieve, the associated harms with the increased levels can be reduced considerably (Felton, 2017). As the patient is having other comorbidities as well, managing them and the risk about these diseases can also be reduced subsequently. The goal-setting will help in attaining the desired targets promptly and will help the patient in staying focused on achieving his goals.
Capoccia, K., Odegard, P. S., & Letassy, N. (2016). Medication adherence with diabetes medication: a systematic review of the literature. The Diabetes Educator, 42(1), 34-71. https://doi.org/10.1177/0145721715619038
Daly, B., Tian, C. J. L., & Scragg, R. K. R. (2017). Effect of nurse-led randomised control trials on cardiovascular risk factors and HbA1c in diabetes patients: a meta-analysis. Diabetes Research and Clinical Practice, 131, 187-199. https://doi.org/10.1016/j.diabres.2017.07.019
Felton, A. M., McGill, M., & Global Partnership for Effective Diabetes Management. (2017). Perceptions, attitudes and beliefs among allied healthcare professionals managing people with Type 2 diabetes: an international cross-sectional survey. International Diabetes Nursing, 14(2-3), 83-89. https://doi.org/10.1080/20573316.2017.1409868
Gatwood, J., Shuvo, S., Ross, A., Riordan, C., Smith, P., Gutierrez, M. L., ... & Bailey, J. (2020). The Management of Diabetes in Everyday Life (MODEL) program: development of a tailored text message intervention to improve diabetes self-care activities among underserved African-American adults. Translational Behavioral Medicine, 10(1), 204-212. https://doi.org/10.1093/tbm/ibz024
Hausmann, J., Waechtershaeuser, A., Behnken, I., Aksan, A., Blumenstein, I., Brenner, M., ... & Stein, J. (2019). The role of adipokines in the improvement of diabetic and cardiovascular risk factors within a 52-week weight-loss programme for obesity. Obesity Research & Clinical Practice, 13(5), 440-447. https://doi.org/10.1016/j.orcp.2019.09.006
Kim, D., Koh, K., Swaminathan, S., & Trivedi, A. N. (2018). Association of diabetes diagnosis with dietary changes and weight reduction. Expert Review of
Pharmacoeconomics & Outcomes Research, 18(5), 543-550. https://doi.org/10.1080/14737167.2018.1468257
Swoboda, C. M., Miller, C. K., & Wills, C. E. (2017). Frequency of diet and physical activity goal attainment and barriers encountered among adults with type 2 diabetes during a telephone coaching intervention. Clinical Diabetes, 35(5), 286-293. https://doi.org/10.2337/cd17-0023
Turchin, A., Sosina, O., Zhang, H., Shubina, M., Desai, S. P., Simonson, D. C., & Testa, M. A. (2018). Ambulatory medication reconciliation and frequency of hospitalizations and emergency department visits in patients with diabetes. Diabetes Care, 41(8), 1639-1645. https://doi.org/10.2337/dc17-1260
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