Case study of a Middle-Aged Women Suffering From Diabetes Mellitus type 2

1. Introduction:

The case study involves the clinical scenario of Mrs. Valmai White, a middle-aged women female suffering from Diabetes Mellitus type 2 for almost seven years, and associated many crippling comorbidities as well. She was accommodated to an aged care nursing home when her condition could not be managed at home. This case study includes the case details, personal history, past medical and surgical history, lab investigations, details from the treatment notes, nursing diagnosis, the management, and treatment plan. The case study reviews the nursing interventions and the resulting outcomes after the efforts. Education and training about case management, communication barriers, and a short analysis are given in various parts.

2. Considering the patient:

The patient, a middle-aged female, married, resident of California, a former teacher by profession, and had no child. She was admitted to the aged care nursing home fortnight ago. She is a diagnosed chronic patient of Diabetes Mellitus type 2 for almost seven years. This was previously managed by insulin administration. On admission to the nursing home, she was tested for Diabetes Mellitus, hypothyroidism, depression, osteoarthritis, chronic kidney failure, osteoporosis, and back problems- diffused idiopathic skeletal hyperostosis. She was found positive for Diabetes Mellitus Type 2, osteoarthritis, and osteoporosis. She suffered from many complications that are frequently associated with Diabetes Mellitus, like overweight, higher Body Mass Index, and higher blood glucose levels, etc. After admission to the aged care nursing home, thorough investigations and examination helped the precise assessment of the problems she was suffering from.

3. Collecting the cues:

The patient has been a diabetic for years with a variety of signs and symptoms. The patient’s vital and blood glucose were highly disturbed, and her condition was worsening with time. She was unconscious for some time due to hyperglycemia, her blood glucose was measured, and it was about 300 g/dL. She was immediately given a calculated dose of insulin (as ordered by the physician). Her consciousness was restored. The patient was unable to move on her own. She needed assistance for locomotion. She had a previous history of multiple falls in the past. She had paranoia and fear of falling as well. She refused to walk on her own and needed an assistant who could help her move from one place to another. She complained about back pain and decreased bone strength that further increased her risk of falling. She had variable episodes of diverse symptoms like tremors, headache, lethargy, weakness, eye ache, dizziness, confusion, and irritability. These signs were monitored and recorded regularly from the patient and conveyed to the medical team.

4. Analysis of the situation:

Analysis of the situation was the key to manage the deteriorating condition of the patient. The problems of the patient ought to be recognized first. She was a diabetic with fluctuating blood glucose levels. Her glucose was prevented from exceeding the limits using insulin therapy. She had mobility issues; She was totally bed-ridden so that she could sit up or lie down on the bed. Other conditions like osteoporosis and osteoarthritis led to the signs and symptoms of body aches, weakness, joint pain, and risk of falling.  She was irritated and confused due to anxiety and pain. She could easily get irritated by history taking and physical examination. She refused to consent to physical examination three times. She was considerably disturbed and confused. She had severe urinary inconsistency that made her uncomfortable. She asked the staff to change her pads several times in a day. Likewise, she needed assistance in hygiene. She preferred taking a shower before breakfast in the morning that was managed by using a shower chair. Her respiratory function and cardiovascular performance were fairly normal. Regarding her Advance Care Plan, she had the capacity to think it over and make the decision whether she wanted the treatment or not.

5. Understanding the patient’s problem:

The patient is a diabetic who needs assistance in managing her condition due to old-age and chronic back pain. Diabetes requires longterm and peculiar care by the patient herself that she is unable to provide due to her back problems (Pursey et al., 2020). She can not move, and she is unable to administer insulin herself. She needed assistance in her personal hygiene, as well. She got confused when she was tired or when she could not find anyone to administer her insulin or give her medications. She required her blood glucose monitoring regularly. The chief barrier in this was her lack of ability to move freely and get access to the glucometer. She frequently complained about numbness, tingling, and burning sensations in the limbs. Diabetes is frequently associated with peripheral neuropathy that manifests itself and tingling or burning sensations in the limbs (Chamberlain, Rhinehart,  Shaefer Jr, & Neuman, 2016). She feels difficulty in defecation; she suffers from constipation. The straining of the bowel led to pain in the anal sphincter. She is immobile and dehydrated that precipitated chronic constipation in the patient.

6. Planning and the implementation of the interventions:

The management of the patient involved the following strategies:

Diabetic Management Agreed Care was provided for control of blood glucose levels. The imbalance in blood glucose was controlled by administering insulin. The assessment of insulin requirements is a must in insulin therapy (Pursey et al., 2020). The dose calculation for the insulin by the medical staff helped in the assessment of the glucose levels (Yuanyuan, 2010). After assessing the needs of the patient depending on the fluctuation in the glucose levels, the dose was calculated (Chamberlain, Rhinehart,  Shaefer Jr, & Neuman, 2016). She was carefully monitored for the signs of hypoglycemia. Hypoglycemia frequently occurs in insulin therapy, so monitoring for possible complications is necessary.  Personal Hygiene Agreed Care was provided to compensate for her disability to preform hygiene practices. She was provided with assistance in taking showers. She was assured to assuage her anxiety. For the management of back pain and associated fall risk, fall risk agreed care was provided that diminished the risk of falling (Ravelli, Schiappapietra, Verazza, & Martini, 2017). Her management was specialized to minimize the risk of falling (Mao et al., 2013). Continence agreed care for urinary incontinence problems in the patient (Wagg, Newman, Leichsenring, & van Houten, 2014). Her blood pressure was monitored regularly, as well. The medication therapy included Atenolol, a beta-blocker for the management of chest pain and hypertension. Captopril for hypertension, ostiomol  for pain relief, xardolotus for pain relief, and spiractin for hypertension. She was administered laxatives for constipation.

7. Evaluation of outcomes:

Management and treatment played an essential role in the restoration of the patient’s health (DING, LI, & WU, 2010). Her vitals were observed, and the vitals were made stable. The symptoms associated with hyperglycemia were long gone. At the start of the treatment, her vitals, blood glucose levels,  and heart rate were markedly disturbed. After the deterioration of her condition, the insulin therapy and fluid administration restored the normal glucose levels, and the altered state of consciousness of the patient subsided.  After that, the nursing care team in the intensive care unit performed various interventions. Her low blood sugar levels and tremors were minimized. She was at ease and comfortable. She was passing her bowels without straining. Her behavior was a lot better at the end of the shift. She did not complain about tingling sensations or numbness in the limbs. Her back pain was minimized. The pain killer caused marked relief in her back pain. She was wailing from the back pain at the start of the shift, but after the administration of painkillers, she was calm.

8. Reflection and Learning from the process:

The presented case study was a novel experience for my  colleagues and me. Looking after patients with physical disabilities is a different sort of challenge as these patients need physical assistance and special care. After her admission to the aged care nursing home, the patient’s condition was stabilized. This case study made me learn about the possible complications that non-insulin-dependent diabetes, combined with immobility, and debility, can develop in a patient. Keeping the record of the blood glucose levels was an essential practice in a patient with diabetes. Blood pressure measurement was essential for her cardiovascular assessment. That’s why blood pressure measurement was regularly monitored. All these interventions were vital requirements for the management of such patients. Learning in control of the present case will help in the future management of such patients.

9. Conclusion:

The patient suffers from diabetes, back pain, osteoporosis, difficulty in locomotion,  arthritis, and hypertension. The patient’s status deteriorated due to hyperglycemia and the nursing interventions aimed at stabilizing the patient’s conditions helped in maintaining the patient’s vitals at a reasonable level. Her blood glucose levels were stabilized through intensive care. The communication and reporting between the care team and the nursing staff played an important role in preventing the condition of the patient from deteriorating to a dangerous level (Nursing and Midwifery Board of Australia – Framework for assessing standards for practice for registered nurses, enrolled nurses and midwives, 2020). I felt that the nursing diagnosis was made timely. The diagnosis was precise and clearly described the patient’s problem. After the diagnosis of the patient, the delay in the onset of the treatment strategies was minimal. The staff assessed the patient thoroughly and followed the protocol for diabetes management. The vitals were taken several times in a day and recorded in the record register. The BGL chart, treatment charts, and vitals record were beneficial in communication with the medical care team.

References:

Chamberlain, J. J., Rhinehart, A. S., Shaefer Jr, C. F., & Neuman, A. (2016). Diagnosis and management of diabetes: synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes. Annals of internal medicine, 164(8), 542-552..

DING, L., LI, S. H., & WU, L. (2010). Effects of family-centered nursing management of community patients with diabetes [J]. Chinese Journal of Nursing, 11.

Mao, X. R., DU, W. J., XU, Y. Z., Chen, R. M., Gong, C. T., Jiao, N. M., & Li, X. H. (2013). Comprehensive Nursing Intervention for Prevention of Accidental Falls of Community Elderly Patients with Hypertension or Diabetes. Chinese General Practice, 16(5), 575-578.

Pursey, K. M., Hart, M., Jenkins, L., McEvoy, M., & Smart, C. E. (2020). Screening and identification of disordered eating in people with Type 1 Diabetes: A systematic review. Journal of Diabetes and its Complications, 34(4), 107522.

Nursing and Midwifery Board of Australia – Framework for assessing standards for practice for registered nurses, enrolled nurses and midwives. (2020). Retrieved July 7, 2020, from Nursingmidwiferyboard.gov.au website: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/frameworks/framework-for-assessing-national-competency-standards.aspx

Ravelli, A., Schiappapietra, B., Verazza, S., & Martini, A. (2017). Juvenile idiopathic arthritis. In The Heart in Rheumatic, Autoimmune and Inflammatory Diseases (pp. 167-187). Academic Press.

Wagg, A. S., Newman, D. K., Leichsenring, K., & van Houten, P. (2014). Developing an internationally-applicable service specification for continence care: systematic review, evidence synthesis and expert consensus. PloS one, 9(8), e104129.

Yuanyuan, G. (2010). Nursing intervention on self-monitoring of blood glucose of elderly patients with type 2 diabetes [J]. Chinese General Nursing, 28.

‌