Chronic Care Across the Lifespan B

Identification and Explanation of Risk Factors

Mr. James is a retired 66 year old male who has been suffering from type 2 diabetes. He has a medical history of hypertension followed by family history of cardiovascular disease and diabetes type 2. Risk factors for developing diabetes type 2 in case of James are increased weight, lack of awareness about diabetes, family history of diabetes and cardiovascular disease and excessive carbohydrate intake in the diet (Kilkenny et al., 2017). The national strategic framework for chronic conditions is a set of documents that sets up the directions and outcomes for healthy living in Australia through greater prevention and management of the chronic conditions (COAG health council, 2017). The document is inclined toward greater management of health education and literacy for the patient.

Lack of awareness about a condition can be a risk factor for the development of the condition for the person. According to a research conducted by Pimpin et al., (2018), a number of people in Australia are unaware about the preventive measures and risk factors of diabetes which lead to increased prevalence of the condition. It is not important for a person to have high sugar intake in order to develop diabetes as in the case of Mr. James. Having a family history in addition to a carbohydrate rich diet can contribute to development of diabetes. Moreover, poor weight management with greater consumption of alcohol contribute to another risk factor of diabetes.

Identification and Explanation of Nursing Assessments

Nursing assessment for Mr. James if focused on assessing the progression of diabetes for him with the available information. The assessment is primarily focused on assessing glycemic control for the patient for addressing it. It then focus on assessing and improving complications of diabetes followed by assessing overall health of the patient for any coincidental illness. According to the national strategic framework for chronic conditions COAG health council (2017), the patient assessment is done at high standards with appropriate support.

Accessible, equitable and affordable services for all the Australians. The patient will be assessed for his weight, abdominal circumference, height and BMI for checking the physical conditions. Increased weight is a major risk factor for developing diabetes (Kudo et al., 2019). Further, the assessment will follow urinalysis for available proteins, nitrite and ketones in the urine which are also a sign of infection. Patients with diabetes are at risk of cardiovascular disease. Moreover, Mr. James has a family history of cardiovascular disease so he will be assessed for his blood pressure, pulse rate and carotid bruits.

Promote Health and Reduce Risk

It is important for patients at risk of diabetes or patients suffering from diabetes to follow some self-management activities. According to Salvo et al., (2017), diabetic patients are highly vulnerable to foot ulcers and wounds. These foot ulcers can even lead to mortality and morbidity for the patients. Having a regular foot examination can prevent complexities in the patients but unfortunately a number of patients are not aware about the services that can help them. Mr. James have never had any foot examination so it is important for the nurse to educate him about the importance of timely foot examination in diabetic conditions. James do not have a proper diet plan for better carbs and weight management. Moreover, he feel fatigue and stressed all the time.

The principle of health literacy from the national strategic framework for chronic conditions (Australian government department of health, 2020), suggest the importance of supporting health information to the patients while helping them make best possible decisions regarding their health. The patients must be informed about the importance of carb control and physical exercise for the management of diabetes. Greater glycemic control with increased control over alcohol can reduce risk of diabetes and enhance health so a person must always include alcohol control in the self-management strategies for diabetes (American Diabetes Association, 2020).

Application of SMART Goals

The SMART framework for setting up nursing goals strive to develop goals that are specific, measurable, achievable, and realistic and time bound in nature (Parsons et al., 2018). The SMART goal for the patient will be to bring up greater glycemic control with a decreased blood glucose level to 4.0 to 5.4 mmol/L when fasting and up to 7.8 mmol/L after meal within a time period of 1 weak with greater education and awareness regarding risk factors of diabetes.

The SMART goals are measurable in nature. Glycemic control for the patient can be managed and measured hence it can be considered as an effective SMART goal for the patient. It is realistic for the patient to gain awareness and education regarding diabetes and risk factors of diabetes in order to have proper glycemic control. Achieving glycemic control for the patient can reduce stress and fatigue and enhance physical activity in the patient. Time bound goals can set up milestones for the patients which can make it easy for the patient to reach them with efficiency.

Active Engagement of Patients in Their Own Care

According to Bokhour et al., (2018), patient-centered care is an effective nursing strategy which keeps the patient at the center of care and involve the patient in their own care. The national strategic framework for chronic conditions include the principle of person-centered approaches. These approaches are designed to value and recognize the needs of the patients. Active engagement also include the engagement of patient families and care providers in the care and treatment of the patient. James can be included in his own treatment by properly educating him about his condition.

Informing James about the risk factors of diabetes such as family history, sedentary life style, higher alcohol consumption and diet rich in carbs can help him develop self-management strategies which can be effective for glycemic control. Helping the patient identify complexities such as foot ulcers and heart disease can prevent him from any such complexities in the future. Patient-centered care is highly ethical in nature and it involve the nurses to provide care with effective communication and empathy toward the patients (Khera et al., 2017). Educating the patient in culture specific way can speed up the recovery for the patient.

Reference for Mr. James Case Study

American Diabetes Association. (2020). 6. Glycemic Targets: Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Supplement 1), S66-S76. https://care.diabetesjournals.org/content/43/Supplement_1/S66

Australian government department of health. (2020). National strategic framework for chronic conditions https://www.health.gov.au/resources/publications/national-strategic-framework-for-chronic-conditions

Bokhour, B. G., Fix, G. M., Mueller, N. M., Barker, A. M., Lavela, S. L., Hill, J. N., ... & Lukas, C. V. (2018). How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC Health Services Research, 18(1), 168. doi: 10.1186/s12913-018-2949-5

COAG health council. (2017). National strategic framework for chronic conditions. https://www.health.gov.au/sites/default/files/documents/2019/09/national-strategic-framework-for-chronic-conditions.pdf

Khera, N., Martin, P., Edsall, K., Bonagura, A., Burns, L. J., Juckett, M., ... & Majhail, N. S. (2017). Patient-centered care coordination in hematopoietic cell transplantation. Blood Advances, 1(19), 1617-1627. doi: 10.1182/bloodadvances.2017008789

Kilkenny, M. F., Dunstan, L., Busingye, D., Purvis, T., Reyneke, M., Orgill, M., & Cadilhac, D. A. (2017). Knowledge of risk factors for diabetes or cardiovascular disease (CVD) is poor among individuals with risk factors for CVD. PloS One, 12(2). doi: 10.1371/journal.pone.0172941

Kudo, A., Asahi, K., Satoh, H., Iseki, K., Moriyama, T., Yamagata, K., ... & Kondo, M. (2019). Fast eating is a strong risk factor for new-onset diabetes among the Japanese general population. Scientific Reports, 9(1), 1-8. https://www.nature.com/articles/s41598-019-44477-9

Parsons, J. G., Plant, S. E., Slark, J., & Tyson, S. F. (2018). How active are patients in setting goals during rehabilitation after stroke? A qualitative study of clinician perceptions. Disability and Rehabilitation, 40(3), 309-316. https://unidirectory.auckland.ac.nz/profile/j-parsons

Pimpin, L., Cortez-Pinto, H., Negro, F., Corbould, E., Lazarus, J. V., Webber, L., ... & EASL HEPAHEALTH Steering Committee. (2018). Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. Journal of Hepatology, 69(3), 718-735. doi: 10.1016/j.jhep.2018.05.011

Salvo, P., Calisi, N., Melai, B., Dini, V., Paoletti, C., Lomonaco, T., ... & Romanelli, M. (2017). Temperature-and pH-sensitive wearable materials for monitoring foot ulcers. International Journal of Nanomedicine, 12, 949. doi: 10.2147/IJN.S121726

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