Mary is a 56 year old woman who has recently been diagnosed with type 2 diabetes. She is morbidly obese and has a body mass index (BMI) of 35. She is visiting a community health clinic for assessment and education for her newly diagnosed condition.
A 40 year old male has presented with unstable blood glucose readings which are secondary to his type 1 diabetes.
1. Explain the long term complications that may occur if this patient’s disease progresses
2. Name 5 specific health care professionals that may be involved in the long term care of a client with type 1 diabetes and briefly explain the role of each.
3. Explain the services and therapies that would be provided as part of long term community care for this client.
A 24 year old male presents at the emergency department following a motor vehicle accident (MVA). He had an elevated blood alcohol reading and appears to be intoxicated. The client suffered a blow to the forehead in the accident. He is reported to have lost consciousness at the scene. On admission he is incoherent and aggressive.
1. What internal factors are likely to be affecting the client’s physical condition?
2. What external factors have contributed to this client’s condition?
3. If the client’s level of consciousness declines 6 hours after admission, what may be their diagnosis?
4. When responding, consider the onset, peak and duration of alcohol in the system and factor in your knowledge of brain injuries.What specific diagnostic tests would be required for this client?
5. Name two specific health care professionals who would be involved in the care of a client with an acute head injury and briefly explain the role of each.
A 79 year old Chinese Buddhist woman has been admitted for palliative care in a respite facility. She has requested that no opiates be given to her as she wishes to die without pharmacological intervention.
Case study 1
- It is likely that Tom’s symptoms are being caused by complications associated with the heart or in other words cardiovascular pathology.
- Tom’s condition can be assumed as congestive heart failure. The likely pathophysiology of his chest pain and swelling to his feet and ankles are correlated. The swelling is because of fluid accumulation within the system (Dean and Abraham, 2010). The fluid accumulates because of diminished flow of blood out of heart causing the blood to return to heart through veins to support. This initiates accumulation of fluid within the lower limbs.Ecocardiography, electrocardiogram is the imaging techniques available to confirm Tom’s condition (Borja et al., 2010). Other diagnosis could be blood test and angiography.
- Echocardiography also supports to decide what treatments will assist Tom, for example: medication, implantable cardioverter-defibrilator insertion or heart resynchronized therapy.The purpose of echocardiography is to apply ultrasound to find out the diastolic volume, stroke volume and ejection fraction. It also identifies valve associated heart complications and evaluates the condition of the connective tissues and sac around the heart. Electrocardiogram is used to find out arrhythmias, left and right ventricular hypertrophy and existence of abnormalities or conduction delay (Hashimoto, 2006).
- The health professionals include a cardiac specialist/ cardiologist, a trained nurse and a physical trainer. The cardiologist will concentrate only on Tom’s heart condition and recommend treatment depend upon the diagnosis report and will continue monitoring Tom. The trained nurse will look after Tom continuously, so that his requirements are met, monitor his heart condition and will administer the medications properly as recommended by the cardiologist (Brush, 2002). A physical trainer can teach him light, aerobic exercises so that the blood inside the system can circulate without any further obstruction.
Case study 2
- 5 potential health issues Mary faces as a result of her obesity include diabetes, heart disease, high blood pressure, sleep apnea and gout. Extra weight can make a patient more probable to have high cholesterol and elevated amount of blood pressure that lead to heart disease (Mantzoros, 2006). Being obese places additional stress on the system in various ways that includes system’s capacity to control proper blood sugar levels. Obesity can cause the system to develop insulin resistance. Obesity is common for those who are under the insulin administration to care for diabetes. This is because more insulin one use to uphold blood sugar level of the system, the more sugar is absorbed within the cells, rather getting eliminated from the system. This absorbed sugar is accumulated as fat that makes one obese.
- The external factors could be Mary’s standard of living, food habits, smoking and drinking habit and internal factors could be genetic history of Mary’s family and endocrinological complications.
- In case of Mary’s care a diabetologist can assist her to control her condition of type II diabetes, as she is obese Mary need to be referred to a physical trainer who can assist her with regular physical activities (Feng, Fan and Mei, 2008). Mary can be referred to a dietitian, who can structure an effective and nutritious chart for Mary that can help her to control the blood glucose level as well as can take care of her obesity.
- Nurses should educate Mary to assist her controlling her condition. This education may include lifestyle modification and self-care. This includes maintaining healthy weight, daily physical activity, opting for healthy foods, controlling blood pressure, cholesterol levels and avoids smoking (Clarke, 2011). The commonness of medication non-adherence is more in case of diabetic patients and is related with higher medical costs and health issues. Therefore, identifying cost associated medication non-adherence is of utmost importance for the health care personnel.
Case study 3
- The long term complications may include cardiac and associated blood vessel disease, for instance: chest pain or angina, stroke, heart attack, narrowing down of arteries or atheroscelrosis and high blood pressure; neuropathy or nerve damage that mean excess blood sugar can harm the blood vessel walls which nourish the nerves (McDevitt, 2005). This condition can cause numbness, tingling, pain or burning sensation which usually initiates at the finger or toe tips and slowly spreads upward. Poorly managed blood glucose level could initiate lose of senses in affected limbs. Damage to nerves which affect the gastrointestinal tract can source complications with vomiting, nausea, constipation or diarrhea.
- General practitioner continues to offer medical care for diabetes type I. An endocrinologist can be a central part. They frequently visit the general practitioners in between times. This is might be because of blood pressure checks and checks on HbA1c/A1c molecules, prescriptions, flu shots and controlling other concerns and diseases. A podiatrist assesses general health of foot and foot function. Podiatrist checks whether there is a presence of neuropathy or nerve damage and also checks blood circulation in the feet. As diabetic people are more prone to different type of infections, keeping feet healthy is very essential. Diabetic foot is a main threat for amputation, so consulting with a podiatrist is of utmost important. Diabetes educator gives supports, advice and counseling to the patient.
- Recommended care is said to be the evidence based care that is cost efficient with good health care funding and improved systems (Gottlieb, 2004). This need to be available to all the diabetic sufferers and the purpose of any health care set up should be to accomplish recommended care level.
Case study 4
- The internal factors which are likely to be affecting the client’s physical condition may include his level of unconsciousness, post traumatic stress disorder, elevated level of alcohol in blood, confused and aggressive. A blow to the forehead can also cause tremendous pain.
- The external factors that have contributed to this client’s condition may include rash driving, drink and driving, disobedience of traffic signal, lack of personal safety measures.
- If the client’s level of consciousness reduces 6hours after admission, the diagnosis would be a brain injury. The responsiveness of this patient can be recorded with the help of Glasgow coma scale rating (Raghupathi, 2004). The unconsciousness stage ends with opening eyes. It is difficult to actually state the duration of being unconscious in this case. Coma commonly describes a victim whose eyes remains closed continuously and failed to arouse to a restless condition. Nevertheless, another type of reduced conscious exists like coma stage is termed as vegetative state. IN this stage victim’s eyes are open and can temporarily track sounds or objects but in many cases, sufferers’ limbs are convulsive. In this case it can be said that the patient might have attained coma stage.
- The diagnostic tests would include computerized tomography scan that applies a sequence of x-rays to generate a comprehensive view of the brain (Vos and Diaz-Arrastia, 2014). CT scan can rapidly visualize fractures and reveal the presence of hemorrhage, hematomas, tissue swelling and contusions. Another suggested test would be magnetic resonance imaging which helps to generate a detailed image of brain, but this test is significant after the client’s condition get stabilized.
- Neurologists are likely to check after a head injury. The neurologist deals with nerves and brain and consults with general physician for the injured patient. Neurosurgeon performs surgery on damaged nerves and brain (Smith, 2012). A neurosurgeon is required to stop brain bleeding. This is because the process requires surgical intervention.
Case study 5
- The goal of such end life palliative care is to offer relief in a morally suitable way to the client, the family members and health care personnel but frequently voice focuses whether such type of treatment is significant or whether treatment associates to euthanasia or health care professional assisted suicide. Another ethical issue that would need to be considered is the religious aspect of this old lady (Mahon, 2010). As follows Buddhism, it is the health care professionals’ responsibilities to understand and take decision depend upon her religious belief. It can also happen that the patient had given the permission for no pharmacological intervention but her family members or other concerned doctors understands the necessity of such pharmacological interventions.
- The enrolled nurse could seek advice from the duty officer, so that they can go through the available guideline and rules set by the organization in terms of medication free death. The enrolled nurse should go along with the respective guidelines approved by the state government (BROECKAERT and JANSSENS, 2002). As this case includes different legal and ethical issues the enrolled nurse should seek advice from the legal advisory committee of that particular state.
- Non-pharmacological approaches to pain relief may include art therapy, complementary therapy, biofield therapy, massage. Biofield therapies may include healing touch, Reiki that can improve acute pain. Massages potentially have a helpful effect on various symptoms associated with pain (Svendsen and Bjørk, 2014). Spinal cord stimulation can also be helpful. In this case an electrode is placed near the spinal cord and this uses safe and mild electrical signals to reflex nerves which cause the pain. Music therapy can increase the energy level and improve the mood. It may reduce pain by triggering the system to discharge endorphins. These are sad to be the natural body chemicals which decrease pain.
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