The diabetes type two is the progressive condition in which patient’s body loses the capacity to form sufficient insulin in the pancreas or the produced insulin is not working or the body cells unable to respond to the insulin appropriately (Kerner, & Brückel, 2014). The patient mentioned in the case study is diagnosed with this disorder and other health-related complication such as an unhealthy diet and routine, increased weight, unbalanced BGL and blood pressure. She has also been diagnosed with disturbed cholesterol (hypercholesterolemia) level five years ago and fluctuated glucose level. She is also suffering from foot pain. She has been living alone in a three-bedroom house and used to manage daily routine works on her own. In this essay, various aspects related to her health condition will be discussed such as factors that may affect the patient's mental, physical and social wellbeing. The brief overview related to Ms. Smith's main health condition which includes the pathophysiology, sign and symptoms and prevalence of the disorder will also be discussed. The main components of the self-management support to provide effective assistance to the patient in order to manage her health condition and the role of a nurse in supporting the family and working with them and the multidisciplinary team will be mentioned in this essay.
The unbalanced production of insulin and its resistance leads to develop the pathophysiological condition. Abnormal secretion of insulin is actually the glucose responsiveness, which can be observed before the diagnosis of the disorder (Perry, Samuel, Petersen, & Shulman, 2014). The insulin secretion id decreases after meals responsible for causing postprandial hyperglycemia. The impaired secretion is increases with the time and the progression includes glucose toxicity and lipo-toxicity. The untreated condition leads to cause a reduced level of pancreatic beta cells mass. This impaired beta cells progression leads to effects the long-term blood glucose level control. This will further cause a permanent elevation of blood glucose (Kitamura, 2013). Insulin resistance is the condition in which insulin does not exhibit sufficient action to its blood concentration. The insulin impairment majorly targets organ like liver and muscles which is the most common pathophysiological characteristics of diabetes type 2. The genetic factors associated with diabetes type 2 include polymorphism of IRS-1 genes, thrifty genes like beta-adrenergic and uncoupling protein. IRS-1 polymorphism affects the insulin signals, and thrifty genes and uncoupling protein are responsible for visceral obesity and insulin resistance (Kaul, & Ali, 2016). Glucolipotoxicity and the inflammatory mediators also contribute to impaired insulin secretion and signal impairment of insulin (Akash, Rehman, & Chen, 2013). In the given case scenario Ms. Smith has been diagnosed with a 54-year-old female who has diagnosed with hypercholesterolemia 5 years ago and recently diagnosed with Diabetes type 2. She has been fallen at home which causes her left leg injury, because of this she is facing problems to do daily life activities and she put on extra weight. Living alone is another factor that is contributing to her decreasing health condition because she can manage her diet and another essential exercise on her own. She is also suffering from increased systolic blood pressure which is 150/70 mmHg and high cholesterol level, low LDL and high HDL, increased triglycerides and HbA1c.
According to the Centers for Disease Control and Prevention (2016), diabetes type 2 accounts for nearly 90 to 95 % of all the cases of diabetes in adults, one out of three adults has pre-diabetes. around 30 million people have diabetes particularly in united states, nearly 8 million are undiagnosed and unaware about their health condition. It was also found that nearly 1.5 million people are diagnosed with diabetes in the US every year (Dabelea, Mayer-Davis, Saydah, Imperatore, Linder, Divers, & Liese, 2014). The symptoms of diabetes type 2 include excessive thirst, increased urination, fatigue, excessive hunger, and blurry vision (Zeitler, Fu, Tandon, Nadeau, Urakami, Barrett, & Maahs, 2014). A report published in Australian Bureau of Statistics (2015), nearly 7.1 percent people of Australia reported to have high cholesterol level in 2011, and one in four people aged seventy-five years or old having a high level of cholesterol in 2014-15. Sign and symptoms of hypercholesterolemia include chest pain, small bumps on the skin, xanthomas, and small deposits of cholesterol under the eyes or near eyelids (Sjouke, Van der Stappen, Groener, Pepping, Wevers, Gouw, & Alleman, 2015).
Risk factors associated with diabetes type 2 include Age, excessive weight, family history, cardiovascular disease, hypertension or hypercholesterolemia, and ethnicity. Having extra weight is the clear risk factors for developing diabetes type 2. The probability of being resistant to insulin increases with the presence of unwanted fatty tissues. The risk of developing this disease increases if the parents also had the same health issue. The probability of having this health condition may also increase if as the person gets older, mostly after 45 years of age due to they exercise less and lose muscle mass (Gast, Spijkerman, Van der, Jacobs-van der Bruggen, & Verschueren, 2012). However, diabetes type 2 cases also increasing among the children’s, teenagers and younger adults (Scott, Leslie, 2013). As discussed in the case study the some of the factors that may affect Smith's physical well-being are her age, gender, increased body weight, high cholesterol level, and increased systolic blood pressure. Another physical factor was her leg injury because of that she was facing a problem in daily life activities which might be associated with her increased body weight. Factors that may affect the patient mental and social wellbeing are that she has been living alone and managing things on her own. She also reported that she has not consumed sugar and doing exercise on regular basis, then how she develops this condition, this might be the associated risk factor with her health condition. She has been admitted to the hospitals only two times in her life, once for surgery during the birth of her son and recently for diabetes. Therefore she is not very familiar with the hospital environment. She also does not have enough knowledge about diabetes; this may be the reason for her not able to manage the sugar level properly. The patient has also revealed that she feels angry due to her sugar level.
Diabetes is the chronic disorder that requires the diseased person to follow the Self-management protocols on daily basis. It is the key factor associated with improved health quality in the patient with diabe6tes type 2. Diabetes self-management education (DSME) is the process of includes knowledge building, skill developing and enhancing abilities that are necessary for the diabetes self-care (Powers, Bardsley, Cypress, Duker, Funnell, Fischl, & Vivian, 2017). Diabetes self-support or DSMS provide support in implementation and sustaining the skills and positive behaviors required to be followed in self-manage on regular basis. The components of self- management support include nutrition, exercise, emotional support, socialization, medication, and weight management. Nutrition can play a vital role in diabetes management (Holmen, Torbjørnsen, Wahl, Jenum, Småstuen, Årsand, & Ribu, 2014). A disturbed diet is a key factor in developing both Diabetes type 2 and hypercholesterolemia and a balanced diet rich in nutrition such as vitamins, minerals can help to manage the healthy weight in the patient with these disorders. Fibers are the most important nutrients that should be added to the diet of a diseased person to confer the metabolic benefits for glycaemic control, and plasma lipids (Cahill, Polo, Egan, & Marasti, 2016). Fructans are the indigestible fiber that has the glucose-lowering effect (Ley, Hamdy, Mohan, & Hu, 2014). Vitamins D and can also be provided to the patient. Resistant starches are also found to be effective in postprandial response and to reduce hypo or/ and hyperglycemia. These resistant starches are the starches that enclosed within the intact cell walls. Doing exercise at regular basis found to be to be effective in reducing the issues related to diabetes and hypercholesterolemia. There are numerous benefits to doing exercises. Most of the people with this disorder have the high level of glucose in their blood because the body does not produce enough insulin or not use it properly as already mentioned above. Exercises can reduce the glucose level in blood, and help the muscles to use glucose without insulin. The muscle use the glucose not matter the person is insulin resistant or not, the body needs energy after exercise and for this, muscle takes glucose they need and the blood glucose level is ultimate decreases (Swift, Johannsen, Lavie, Earnest, & Church, 2014). Another component t self-management is the emotional support which is also required for motivation and encouragement (Miller, & DiMatteo, 2013). Diabetes is the chronic illness that cannot be easily cured, it needs complete treatment and support from others. Psychological support is very important as it provides a person a reason and push to complete the essential task like exercise and maintaining the healthy diet. As discussed in the case the patient has developed the “Why Me” type of thoughts and she was angry because she hardly consumes sugar and doing exercise daily, this may develop stress (Ma, Zhou, Zhou, & Huang, 2014). Therefore psychological support is the key component in this case scenario which can be provided with socialization with others. Implementing these components to the patient’s self-management plan can help the person to reduce the issues related to diabetes and hypercholesterolemia (Chrvala, Sherr, & Lipman, 2016).
In response to the chronic disorders, The Chronic Care Model was developed by Ed Wagner in 1998. This model explains the joint efforts of patients as well as the health care team to take better care of patients with the chronic disorder. This model defines the needs of patients as well as to-dos for healthcare practitioners. Also, this model explains the SMART framework which is essential to ensure the formulation or effective and achievable goals. In this framework, both the health professionals and patient have to work in collaboration to fight against the disease. In this framework term, SMART stands for
S - Specific
M - Measurable
A - Attainable
R - Realistic
T – Time-Bound
This framework helps a lot to both health professionals and patients in fighting with the chronic disorder (Watkins, et al, 2017).
Nurses play an important role in managing diabetes and imbalanced cholesterol in a patient by supporting and working with the patient and her family other team members. The patient may not have enough knowledge about the disorder, a nurse can educate the patient and their family that how the disease affects the body and how they can manage its symptoms and associated risk factors (American Diabetes Association, 2015). They can explain the importance of weight management and the role of a healthy diet in reducing diabetes type 2. The registered nurses are skilled in providing essential knowledge to the person related to the importance of exercise in the prevention of this disorder. Motivation and encouragement are essential components of self-management as discussed, a nurse is able to motivate the person to self-care their imbalanced glucose and sugar level. A person with diabetes may develop some psychological problems like anxiety and depression. A nurse is able to manage those symptoms associated with diabetes. They also help the patient to follow the nutrition plan high in vitamins, minerals, fibers and other essential components. The nursing professionals can assist the patient in urine monitoring and blood glucose monitoring with the help of other team members. They can perform the test for urine glucose and ketone according to the instructions provided by the manufacturers. Their main role in self-management approach is to help the patient and the family members to manage medication prescribed by the physician. Nurses are expert in the safe use and administration of insulin. He or she should describe the effects and benefits of the medication. They can teach the patient and their family what precaution should be taken during the medication. A nurse should demonstrate an understanding of the current nature of the therapies being provided to the patient. They help the patient to manage the other symptoms associated with this disorder like low energy or fatigue and blurred vision. Checking the blood glucose level and cholesterol level on a regular basis is the essential part of self-management of diabetes type 2 and hypercholesterolemia. A nurse may help the patient to manage these tests whenever necessary (Shaw, McDuffie, Hendrix, Edie, Lindsey-Davis, Nagi, & Williams, 2014).
Type 2 diabetes is the progressive health condition in which the body does not produce enough insulin in the pancreas. It accounts for 90 to 95 percent of the total cases of diabetes. The patient in the case study has two main health condition including diabetes type 2 and hypercholesterolemia. The main cause of developing diabetes type 2 is the impaired insulin or insulin resistant and the progression of this disorder includes lip toxicity and glucose toxicity. If this condition is remaining untreated it leads to a reduction of beta cell mass which ultimately affects the blood glucose level. Symptoms associated with the disorder are excessive thirst, fatigue, excessive urination, more hunger, and vision problem. Risk factors associated with this disorder include age, gender, excessive weight, hypertension, hypercholesterolemia, ethnicity, and family history of the genetic factor. Following DSME and DSMS can help the patient to manage the health condition. Self-management support includes managing nutrition, diet, exercise, socialization, and medication. A nurse can help the patient and her family by providing assistance by providing knowledge about the disorder and managing the blood cholesterol level. He or she can also demonstrate the therapies that are being implemented to the patient at home and conducting the essential tests to check blood glucose and cholesterol level.
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