Discuss about the Health Variation for Intellectual Disabilities.
Down syndrome is a genetic disorder which causes intellectual disabilities, dysmorphic facial structures and characteristic phenotypic traits. The man is a patient of Down syndrome with moderate intellectual disabilities and Type 2 diabetes (T2D). Down syndrome with intellectual disabilities and T2D distressed the usual course of life and impose several adverse effects throughout his lifespan (Chang & Johnson, 2014).
According to Taggart and Cousins (2014), people like this man experiences restrictions in communication and language skills during early school age. Verbal communications are that area where deliberate improvement is most evident. They depend more on body languages like signs and gestures. Situational anxiety is sometimes manifest during transitions to a new situation. Disrupting, restless, impulsive, oppositional and distracted behaviours are common in this age (Pikora et al., 2014 and Chang & Johnson, 2014).
In teenager a man like him with Down syndrome may develop better verbal, reasoning and communication skills but usually shows amplified susceptibility to despair, depression, nervousness, compulsive behavior, mood related problems, insomnia and reduced interest. These problems gradually cause social withdrawal (Glasson et al., 2014).
With growing age vulnerability alters in older patients. A 45 years or above aged man with Down syndrome can suffer from depression, anxiety, social withdrawal, loss of attentiveness, lessened self-care and deterioration with incapacity in social and cognitive skills. Aging may also cause dementia in a Down syndrome patient (Glasson et al., 2014).
T2D is a chronic illness triggered by insulin resistance. It is intensely related with obesity. In T2D patient experiences excessive thirst, dizziness, cramps, blurry sights, headaches, weakness and tiredness. Increased level of cholesterol and triglycerides are accumulated in blood (Craft et al., 2015). The complications of T2D grows with aging, especially after 45 years. This type of diabetes radically increases the threats of numerous cardiovascular disorders like stroke, heart attack, coronary artery disease and high blood pressure etc. There is a high chance of the patient to become overweight. It not only give him health complications but also makes him sedentary and weak.
International Classification of Functioning, Disability and Health (ICF) is a model based on the principles of health and wellbeing where the environment of a person as well as participation and activities is considered fundamental to the health and wellbeing. The ICF model is meant to enable the measurement and consequence of both health and disability in a patient. Central of this model has two core expanses that permit practitioners to appreciate the degree of disability of a patient. The two main part of ICF model are 1. Functioning and disability which deals with a) body function and structure b) activity and participations and 2. Contextual Factors a) environmental influences b) personal factors (International Classification of Functioning, Disability and Health (ICF), 2016).
The ICF model can be applied across the entire lifespan and is also appropriate for all age-groups (Rouquette et al., 2015). The man suffers from Down syndrome and T2D impairing his intellectual, physical and emotional capacities. This disorders creates activity limitations for this man as he is not able to perform like other community residents. He faces trouble in doing multiple tasks together, making conclusions, answering problems and obtaining new skills individualistically. Communication and cognitive skills are also hampered because of his disabilities. His disability made him less likely to participate in a range of domestic and social works.
Not only the Down syndrome but also his T2D caused him from being socially active. Down syndrome along with T2D causes muscle hypotonicity and this reduces the activity level and energy requirement of the patient. It also causes tiredness and weakness and is associated with the higher frequency of being obese (Craft et al., 2015). The Down syndrome makes him mentally disable and diabetes makes him physically disable. The combination of these factors illustrates how the man’s activity and participation are potentially affected across his lifespan.
Management of T2D is very tough and when the patient is a Down syndrome man with intellectual disability, caregiving becomes more challenging. The main focus of managing T2D is changing the lifestyle pattern. The main lifestyle modifications are physical activity, weight loss and nutrition management and altogether they can decrease hyperglycemia. These lifestyle modifications also decrease risks of obesity, cardiovascular diseases and dyslipidemia (Chen et al., 2012).
The best weight loss results achieves from organized interventions that include individualized counselling, meals with less fats and calories, regular exercise, and frequent contact with physicians (Ajala et al., 2013 and Ley et al., 2014). As a community nurse, it is my duty to visit the man as frequent as possible and maintain his daily regimen according to the planning structure. Besides the nutrition planning, I must recommend pattern of food intake because scheduling particular eating times benefits a person to control appetite. Spacing mealtimes approximately every four hours during the day is ideal for T2D (Ley et al., 2014). My nutrition intervention for this man is that it should be an ongoing process throughout the management of his disorder and to achieve effective results a multifaceted approach is necessary.
Only lifestyle modifications are not sufficient to keep A1C values low. A hypoglycemic medication is also vital to keep T2D in control (Chen et al., 2012). It is essential to have morning fasting blood glucose level records of this man. If this level is low, it means that there is a significant hyperglycemic peak after meals and if the level is high, increase of insulin level is required (Inzucchi et al., 2012).
According to Heinrich et al. (2015), modifying lifestyle of this man requires guidance of a nurse who can provide education, direct care and self-management to some extent by enhancing the patient’s willpower. Moving him from sedentary habits to a program of physical activities is also extremely challenging in this case. In this case, my suggestion is for moderately aerobic exercises. A counselling with the patient and a detailed interaction with the man’s support workers of community group home and disability specific program is essential for successfully implementing the health care interventions for improving his T2D.
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