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Dynamics of Practice

According to the given case scenario, Mrs. Mabel Winter is a 90-year old lady who lives alone at her home, and had several falls in her past experiences like diabetes, fractures and many more. For maintaining her care plan as a registered nurse, these falls should be counted to provide the best possible care for her early recovery and fitness.

Registered nurses and multidisciplinary team work to provide care and support to the patient for their better recovery. Elders usually prefer to get healthcare facilities at their comfort places rather than hospitalization, so for them residential aged care facilities are initiated where registered nurse would assist them for their healthcare routines. It will be beneficial for the patients as well because they get appropriate treatment and care by residing at their comfort places, which will eventually lead to reduced stress and mental illness. Registered nurses are important to assist care for specifically for those individuals who do not want any hospitalization services and medications, just like Mrs. Winter in the given case study.

The three prioritized care needs that are identified for Mrs. Mabel Winter are shown below:

  1. Healthy eating habits- The rationale to prioritize the healthy eating habits for Mrs. Mabel to maintain her weight and well-being by reducing the respective risk of falls. It is mentioned that weight of Mrs. Mable is 45 kgs, which is very less as compare to the ideal weight. It is reported that ideal weight of 90-year-old women is 57.1 kgs, according to which Mrs. Mable needs to gain at least 10 kg weight for a healthy life.

In this case, role of registered nurse is to maintain an appropriate diet chart of the patient which justifies healthy eating habits (Dietary guidelines, n.d.). They can also educate Mrs. Mabel for a healthy lifestyle and apply practical strategies that may assist her to manage adequate nutrition. Nurse should monitor her weight weekly and review the diet plan accordingly. They can also educate about her nutritional body requirements and can administer glucose solutions if required that involves mixture of half-normal saline and dextrose. It is also mentioned that she is malnourished and has reduced mobility, which is the due to her improper body weight. This can be maintained by intake of healthy diet that contains beans, fruits, vegetables and whole grains. Improper body weight can lead to risk of falls, such as increased mortality and morbidity, obesity, cancer, and heart and circulatory disease I(Healthy Eating for a Healthy Weight, 2020).

  1. Increase physical and mental activities- The rationale to choose this as a priority care plan is to increase the concentration level of Mrs. Mable, which can eventually lead to reduce her stress, dizziness, obesity, and hypotension levels. It is mentioned in the case scenario that she has reduced mobility because of recent operation, feels dizziness after eating, stress, and poor concentration levels. This all can be maintained by doing routine exercises, so it is highly prioritized for her to do on regular basis (Lourenço et al., 2017). Registered nurse and multidisciplinary teams can set daily target of her physical and mental exercises for approximately 30minutes each day, and maintain a weekly exercise dairy to maintain the record. It must be recommended to Mrs. Mable to do yoga, meditation, and routine walking as much as possible. This can also enhance the actions of insulin that was provided to maintain her diabetes levels. Physical inactivity can lead to several risk factors like obesity, high blood pressure, stress, trauma, and heart diseases. Mediation, yoga, and moderate exercises are important to maintain a healthy lifestyle. Nurse can educate Mrs. Mable about her exercise routine, which helps in maintaining her schedule along with improved learning about self-care. Also, nurse must review the patient’s lifestyle status, diet plans, schedule appointments for check-up and develop strategies to maintain their health (Promoting an active lifestyle, 2020).
  1. Long term diabetic control- Rationale to prioritize this care need for Mrs. Mable is that she has pat experience of uncontrolled diabetes during hospital administration which was controlled by providing insulin treatment. But there is risk of again getting this condition at her age, so it is important to manage this condition for long term. Long-term management of type-2 diabetes includes, weight loss, healthy diet, insulin therapy, diabetes medications or drugs like metformin and insulin, regular exercise, and Blood sugar monitoring. Metformin is used to treat type- II diabetes by reducing the glucose content that liver releases to blood, and makes the body more responsive for insulin (Wexler, 2020). If type-II diabetes are not controlled timely, then it may lead to long-term poorly controlled hyperglycemia conditions like nephropathy and hypertension. Diabetic nephropathy are the kidneys diseases due to diabetes. Diabetes cause high blood glucose levels which diminishes the filters of kidneys that are used to filter the blood, due to which protein comes out by urine. Moreover, Type-2 diabetes and hypertension are metabolic syndromes that consists of cardiovascular disorders and obesity. In this, insulin starts accumulating in blood which may damage kidney and blood vessels, and eventually leads to rise in blood pressure (Cosmo et al., 2016). Registered nurse set goals to provide Mrs. Mabel a clear understanding of diabetes and its management strategies, which helps her as she can also work on the factors that she is able to modify at her end. Nurse must review her diabetic educator reports, and evaluate her understanding about diabetes through review questions. Moreover, nurse can also educate the patient for monitoring physical activities and exercise, diet plans, and regular check of blood glucose levels. Risk factors associated with type-II diabetes mellitus are high blood pressure, gestational diabetes, stress, disturbed sleeping patterns, and obesity. This can be maintained by regular exercise and maintenance of ideal body weight (Vuohijoki et al., 2020).

Role of multi-disciplinary team for this case scenario is more clarified by the table shown below:

Referral to health professional

Specific actions to the service

Rationale

Dietician

Maintain personalised healthy eating plans according to lifestyle, requirements, and the type of diabetes.

Maintain healthy body weight.

Psychologist

To deal with psychological part of diabetes, psychologists are needed.

This would help to minimize mental stress.

Diabetes educator

They help to assist the patient and educate more about her health conditions and ways to get relief form it.

This can enhance the knowledge of patient about diabetes for better treatment.

Exercise physiologist

They assist patient to exercise and prepare their activity plans according to their health and lifestyle.

Uphold physical health.

Endocrinologist

Provide support and care to people with complex diabetes conditions.

Deliver expert guidance to manage diabetes.

(Education and Support, 2019)

Table 1: Multi-disciplinary team involvement

References for Mrs. Mabel Winter Case Study

Cosmo, S. D., Viazzi, F., Piscitelli, P., Giorda, C., Ceriello, A., Genovese, S., . . . Pontremoli, R. (2016). Blood pressure status and the incidence of diabetic kidney disease in patients with hypertension and type 2 diabetes. Journal of Hypertension,34(10), 2090-2098. doi:10.1097/hjh.0000000000001045

Dietary guidelines. (n.d.). Chapter-1 Key Elements of Healthy Eating Patterns. Retrieved October 27, 2020, from https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/chapter-1/a-closer-look-inside-healthy-eating-patterns/

Education and Support. (2019). Retrieved October 27, 2020, from https://www.cdc.gov/diabetes/managing/education.html

Healthy Eating for a Healthy Weight. (2020). Retrieved October 27, 2020, from https://www.cdc.gov/healthyweight/healthy_eating/index.html

Lourenço, B. D., Peres, M. A., Porto, I. S., Oliveira, R. M., & Dutra, V. F. (2017). Physical activity as a therapeutic strategy in mental health: An integrative review with implication for nursing care. Escola Anna Nery,21(3). doi:10.1590/2177-9465-ean-2016-0390

Promoting an active lifestyle. (2020). Nursing in Practice. Retrieved October 27, 2020, from https://www.nursinginpractice.com/cpd/promoting-an-active-lifestyle/

Vuohijoki, A., Mikkola, I., Jokelainen, J., Keinänen-Kiukaanniemi, S., Winell, K., Frittitta, L., . . . Hagnäs, M. (2020). Implementation of a personalized care plan for patients with type 2 diabetes is associated with improvements in clinical outcomes: An observational real-world study. Journal of Primary Care & Community Health,11, 215013272092170. doi:10.1177/2150132720921700

Wexler, D. J. (2020). Retrieved October 27, 2020, from https://www.uptodate.com/contents/initial-management-of-blood-glucose-in-adults-with-type-2-diabetes-mellitus/print?search=oral+hypoglycemics+adult

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