Diabetes is a vast problem for a society. A person dies from diabetes in every six seconds. Mrs. Raymond is a 52 year old house wife and weighs 114 kgs. She felt dizzy when walking, felt thirsty and complained of nocturia. Her blood pressure was recorded at 170/110 mm/Hg. Subsequently she was diagnosed with type 2 diabetes. Normal range of blood pressure is 120/80 mm/ hg and her blood pressure is 170/110 mm/Hg. Mrs. Raymond is extremely worried about her health condition. The lifestyle of Mrs. Roy is not healthy. She is not maintained a proper diet chart and her food habit is harmful for her health. Mrs. Raymond should maintain a proper diet chart. She is not maintaining a proper diet chart for last several years. She is known to eat ready- made meals at least 5 days a week and enjoys cream cakes every day. She rarely eats on time. She has facility to control her body weight and also her blood sugar level. If she wants to utilize all the facilities, her body weight will reduce very soon. In the other hand she has also the education to utilize the facilities of her community. She has a good community to improve her life style and also to upgrade her health condition. Mrs. Raymond needs a good lifestyle and proper nutrition counseling. By testing the blood sugar level regularly, changing lifestyle behavior, nutrition counseling and pharmacologic therapy Mrs. Roy can be cured. She should follow the proper medication and instructions made by her general physician and also maintain some good nutrition habit. Her excessive body weight is a threat for her health. There is an only solution for Mrs. Raymond is to control her blood sugar level immediately and maintain proper diet chart strictly.
Profile of a patient:
A 52 year old woman is suffering from diabetes last 10 years. She stays in proper Kolkata.
Name: Mrs. Roy
Age: 52 year
Family size: 3 members
Occupation: Home maker
Marital status: Married
Illness: Diabetes, high blood pressure, vision problem.
Morbidity data: Diabetes, high blood pressure, vision problem.
Mrs. Raymond spends her spare time by sleeping. She has not much energy to work in the spare time and she is very inactive. For that reason she is unable to utilize insulin. Insulin is the hormone which is responsible for the diabetes. Some patients are unable to produce insulin and some patients are unable to utilize the insulin. In case of Mrs. Raymond she cannot utilize insulin for her inactive nature and the insulin is stored in her body. She is suffering from diabetes for long time but she is not interested to reduce her sugar level by exercise or any physical activity. She is only take medicine for long time. Now some diabetes medicines are not work in her body system because of the so much use of medicines. She almost lost her vision. Mrs. Raymond is suffering from high blood pressure and her level of cholesterol is high. Her body weight is also excessive. She is a house wife. She has much time for exercise but she did not. Mrs. Raymond has so many facilities for improving her blood sugar level. A person dies from diabetes in every six seconds. Diabetes is a vast problem for a society. All nations (poor and rich) are suffering the influence of the diabetes epidemic. Diabetes is a group of metabolic diseases characterized by a chronic hyperglycemic condition effecting from inadequate action of insulin. An increased amount of glucose in the blood is an indication that diabetes is out of control. It happens when the body cannot use the insulin or does not have enough insulin. Signs of hyperglycemia are great thirst, dry mouth and need to urinate often.
For non-diabetic person: Pre-prandial plasma glucose: 4-5.9mmol/L
Post-prandial plasma glucose: <7.8mmol/L
For type II diabetic patient: Pre-prandial plasma glucose: 4.7mmol/L
Post-prandial plasma glucose: >8.5mmol/L
Mrs. Raymond is a 52 year old house wife and weighs 114 kgs. She felt dizzy when walking, felt thirsty and complained of nocturia. Her blood pressure was recorded at 170/110 mm/Hg. Subsequently she was diagnosed with type 2 diabetes. Mrs. Raymond is extremely worried. The lifestyle of Mrs. Roy is not healthy. She is not maintained a proper diet chart and her food habit is harmful for her health.
She should do exercise daily because of her excessive blood sugar level and also excessive body weight. She should work harder for her excessive body weight. There are many more yoga classes beside her resident. So she should go to yoga classes for her unhealthy condition. Mrs. Raymond should maintain a proper diet chart. She is not maintaining a proper diet chart for last several years. She is known to eat ready- made meals at least 5 days a week and enjoys cream cakes every day. She rarely eats on time.
She has facility to control her body weight and also her blood sugar level. If she has knowledge to utilize all the facilities, her body weight will reduce very soon. In the other hand she should has also the education to utilize the facilities of her community. She has a good community to improve her life style and also to upgrade her health condition. Because of her age she is unable to do heavy work (Uknowledge.uky.edu, 2015). Mrs. Roy is very slow and she felt dizzy when walking. She should aware of her health condition which is decreasing day by day. Mrs. Roy is an educated woman. She should have the basic knowledge about the health. The nurse should encourage Mrs. Roy to improve her life style and the awareness about the health. Mrs. Roy needs a general physician for her daily check up. The blood pressure of Mrs. Roy is not in range. She takes medicine for diabetes and high blood pressure. Her mother and two brothers have also been diagnosed with type 2 diabetes ('National Service Framework for Diabetes: Standards', 2015). Obesity, poor diet, physical inactivity, family history of diabetes is the main risk factors for a diabetic patient. And for Mrs. Roy’s case all the possible reason of diabetes are present. So she should follow the routine which is advised by her general physician. But Mrs. Raymond has given every indication that she is not prepared to change his lifestyle or to follow the advice the Community Nurse attempts to offer him. The objective is to enable Mrs. Roy to manage his diabetes and optimize her health in the future. Mrs. Raymond is a diabetic patient with obesity and high blood pressure (Nice.org.uk, 2009). Obesity and type 2 diabetes are closely linked. The reduction of bodyweight enhances glycemic control, morbidity and mortality. The most effective anti- obesity treatment is bariatric surgery. Bariatric surgery causes long term reduction of diabetes in many patients. Because of the high cost and complications Mrs. Raymond is unable to undergo this therapy. The choice of active drugs for obesity along with diabetes is very limited ('Pathophysiology of Type 2 Diabetes and Its Treatment Policy', 2015).
Diabetes is the major problem for Mrs. Raymond. Firstly she needs to control her blood sugar level. Because of diabetes she almost lost her vision. She is very fat. Obesity is not good for health and because of the obesity her blood pressure level is not in the range. There are many reasons for the obesity. In case of Mrs. Roy cholesterol level of her is very high and she is not even doing exercise. She has many facilities to do exercise in her community. She is very inactive because of that she consumes lots of fat. She needs a counselor for her motivation. A community of nurse should take a responsibility for her health improvement.
Fig 1: Pathophysiology of type 2 diabetes
The glucagon-like peptide-1 receptor agonists improve glycemia and bring a modest weight loss, but there are doubts over their long-term safety. New drugs such as lorcaserin and phentermine/topiramate are being approved for obesity and have humble, salutary effects on glycemia, but again long-term safety is unclear.
As per current American Diabetes Association (ADA) and European Association for the Study of Diabetes recommendations metformine is the first-line medication used for those with Type 2 diabetes. It has an recognized safety record. Patients are guided not to stop their treatment without speaking to their doctor. NICE does not advised the use of drugs without marketing approval. Thus an effect of the choice of EMA, NICE has temporarily inhibited its recommendations on the use of rosiglitazone in this gridline.
Fig 2: type 2 diabetes and obesity
Mrs. Raymond needs a good lifestyle and proper nutrition counseling. By testing the blood sugar level regularly, changing lifestyle behavior, nutrition counseling and pharmacologic therap Mrs.Roy can be cured. In pharmacological therapy glycemic management is a major work by insulin or non-insulin therapy and also the blood pressure manage by angiotensin-converting enzyme (ACE) inhibitors, thiazide diuretic and angiotensin II receptor blockers (ARBs). Education and self management (nutrition therapy program, weight management, exercise, foot care, and community resources) are very important for initial stage of diabetes. If not controlled, diabetes can influence every organ of the body. Diabetes is the leading reason of kidney failure and blindness. Over time high blood sugar level can harm nerves. As per National Institute for Health and Clinical Excellence the marketing authorisation for rosiglitazone has been suspended. The advices for Mrs. Raymond according to the National Institute for Health and Excellence guidline are
- Diabetic education programs.
- The recording of lipid (blood cholesterol and fat), glucose and blood pressure levels.
- The detection and ongoing management of
-Nerve damage and nerve pain.
- Dietary advice.
- The use of medications to
-Control blood glucose.
-Reduce blood pressure.
-Improve lipid levels.
-Control vascular (blood vessel) disease.
The nurse should communicate with the patient. It is the responsibility of the nurse to motivate the patient and encourage for her health awareness. In case of Mrs. Raymond she is very lazy in nature and she has not much energy to do some effective exercise. For her lazy nature nurse plays an important role to initialize her health condition. Nurse patient interaction plays an important role in the health care service. Failure in communication can start negative outcomes. The effective nursing care is the major role for the nurse because a patient and the family of the patient both are totally dependent on the care of nurse. The trust should provide to the patient and their family with a good communication. The proper conversation is needed during the delivery of a report to the family of patient. Here the patient should not be ignored. For this reason the timing and the process of communication is very crucial between the nurse and the patient. There are few factors which are influencing the faith of the family of the patient. Those are the eye contact of the nurse, body language of the nurse and tone of voice of the nurse. The family of patient does not remember the name of the nurse but they remember the activity of the nurse during the crucial time of the patient. So nurse should be able to handle the difficult situations of the patient with a quality – communication with the family of the patients. People are generally believed that the main reason for the obesity is related to the fatty substances in our daily food habit. Mrs. Raymond is not maintaining proper diet chart. If the diabetes stays for long time it can damage our kidney, eye vision and nerve. So people should take care for their health. Obesity is very dangerous for female. She is also suffering from hypertension. So she needs much more care for her health. Because of her inactive nature she needs a counselor immediately. Normal range of blood pressure is 120/80 mm/ hg and her blood pressure is 170/110 mm/Hg. High blood pressure can cause heart attack or heart failure. High blood pressure can affect our eye vision. Hypertension is very dangerous for a diabetic patient. A diabetes patient has a tendency to gain fat.
The economic condition of Mrs. Raymond is not good. She is belonging to a middle class family. She is suffering from diabetes, hypertension and obesity. So it is very difficult for Mrs. Roy to continue her medication. Diabetes is not be cured without proper medication. So Mrs. Raymond is very much worried for her health issues. She is not an earning member. She is totally dependent on her husband. Because of her obesity Mrs. Raymond is not able to help her family economically. There is an only solution for Mrs. Raymond is to control her blood sugar level immediately and maintain proper diet chart strictly.
Mrs. Raymond is a diabetic patient with high blood pressure. By changing his lifestyle behavior she can improve his health condition. She should follow the proper medication and instructions made by her general physician and also maintain some good nutrition habit. Mrs. Raymond should follow advice of the doctor. According to my opinion Mrs. Raymond is responsible for her poor health condition. She should immediately meet general physician and should maintain the instructions of the general physician. Apart from the proper medication Mrs. Roy should change her life style. She should not take such foods which are responsible for the diabetes. It is very clear that a proper diet chart is very difficult to maintain for Mrs. Raymond. Her health condition is very poor because of her ignorance. There were many things to do but she was not go for any of them. The danger level of her health is increasing day by day. Her excessive body weight is a threat for her health. She is suffering from type 2 diabetes and high blood pressure. Her body weight, life style and cholesterol level is not in range.
National Service Framework for Diabetes: Standards. (2015). Retrieved 16 March 2015, from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198836/National_Service_Framework_for_Diabetes.pdf
Nice.org.uk,. (2009). Type 2 diabetes | Guidance and guidelines | NICE. Retrieved 16 March 2015, from https://www.nice.org.uk/guidance/cg87
Pathophysiology of Type 2 Diabetes and Its Treatment Policy. (2015). Retrieved 16 March 2015, from https://. Kaku K et al . Pathophysiology of Type 2 Diabetes and Its Treatment Policy. JMAJ, January/February 2010— Vol. 53, No. 1
Uknowledge.uky.edu,. (2015). Health Promotion and Health Education: Nursing Students’ Perspectives. Retrieved 16 March 2015, from https://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1012&context=gradschool_diss