Report On The Impact Of Chronic Illness
Introduction
Chronic illness is increasing globally which is resulting in increased unhealthy lifestyle, life expectancy and advances in interventions and treatments. Therefore people with such conditions along with their families have greater responsibility in managing such situations (Larsen and Lubkin, 2019). This paper aims to determine the impact of chronic illness on the activities of daily living of an old man who is interviewed as he is suffering from type 2 diabetes. The paper begins with providing background of health status as well as personal background of interviewee, followed by discussion about the impact of the illness on the life and family of interviewee, using RLT model of nursing. Next, two nursing care priorities/health education areas of need are identified that have developed with the interviewee and goals of care that have developed the interviewee using the NSQHS Partnering with Consumers Standard are determined.
Background
Background of the Interviewee
Mr. Ram Sharma, a 74 year old male has a chronic illness diabetes which has led him to high blood pressure. He weighs 94kgs and is obese. He possess a sedentary lifestyle with almost no physical activities. Despite all these, his eating habits are quite unhealthy comprising mainly of processed food. Additionally, he possess hypertension.
Given his health, he is on regular medication. He is prescribed Metformin for diabetes and Amlodipine for hypertension. Moreover, Mr. Sharma’s father too had diabetes and he passed away two years ago.
Pathophysiology
Type 2 diabetes is characterized by a combination of inadequate insulin secretion by pancreatic beta cells and peripheral insulin resistance. Impaired insulin secretion is induced by a decrease in glucose responsiveness in insulin secretion as well as a decrease in additional secretion after meals resulting in postprandial hyperglycemia (Chang and Johnson, 2018). The decrease in early-phase secretion is an essential characteristic of the disease and is progressive in nature involving lipo-toxicity and glucose toxicity. If not treated, they decrease beta cells mass in pancreas which significantly affects the long term control of blood sugar (Philips et al., 2016).
Insulin resistance means insulin in the body does not perform sufficient action as compared to its blood concentration (National Institute of Diabetes and Digestive and Kidney Diseases, 2020). This impairment mainly occurs in organs like muscles and liver. Once the disease onsets, insulin resistance develops and expands. The resistance elevates levels of pro inflammatory cytokines and free fatty acids in plasma leading to elevated hepatic glucose production, decreased glucose transport into muscle cell and increased breakdown of fat (Baynes, 2015).
An increase in postprandial blood glucose is seen as a result of decreased early-phase secretion and insulin resistance thus progressing the deterioration of pancreatic beta cell function which then results in permanent elevation of blood glucose (Kaku, 2010). Both these are important components. For instance, insulin resistance could be seen in all overweight individuals, however, diabetes develops in those who do not increase insulin secretion sufficient enough to compensate the insulin resistance (Kahn et al., 2014).
Moreover, this diabetes displays intra-abdominal obesity which clearly shows the insulin resistance. Moreover, dyslipidemia and hypertension could be seen in these individuals. Being one of the most common types of diabetes, it is associated with obesity, family history of diabetes, lack of exercise and old age (Baynes, 2015).
Discussion
Impact of Type 2 Diabetes on Life and Family
Type 2 diabetes affects the life of Ram Sharma. Primarily, low blood sugar due to the intake of insulin affected Ram. Whilst he was taking medications, he began to eat less. As a result, his blood glucose dropped significantly, increasing his heartbeat and increasing dizziness, and shaking. Shriraam et al. (2017) confirmed that suffering from type 2 diabetes experiences hypoglycaemia that drops glucose levels of patients. It can also lead to dizziness, shaking, as well as increased heartbeat (Shriraam et al., 2017). Hypoglycaemia increases the risk of cardiac arrest (Yun and Ko, 2015). Apart from this, Ram always feel tired. Fritschi et al. (2012) claimed that type 2 diabetes causes fatigue. This was evident when Ram became lazier after he got type 2 diabetes.
Type 2 diabetes also affects family of Ram Sharma. When Ram suffers from hypoglycaemia, it stresses all the family, including his children. As a result, he and his family members, including his wife and children were having several arguments and fights due to his unhealthy behaviour that leads to hypoglycemia. Grabowski et al. (2017) affirmed that family of the patient suffering from type 2 diabetes experiences fear and worry that can lead to arguments between them.
Relating information to RLT model of nursing
The Roper-Logan-Tierney Model is based on activities related to daily living (Holland et al., 2019).
| Maintaining a safe environment | Ram is aging and dependent on others for assisting him to maintain safe environment. Ram can be affected by diplopia that leads to blurred vision. During hypoglycaemic attack, others need to be aware about her condition, especially because unconsciousness is a high risk factor. |
| Communication | Ram’s communication was affected due to hypoglycaemic attack. Hypoglycaemia leads of poor communication due to neuroglycopenic symptoms related to slurred speech as well as tingling around lips (Peate, 2019). |
| Breathing | Ram’s breathing was affected due to hypoglycaemic attack. His respirations, blood pressure, pulse, and temperature were monitored. He could have become unconscious with shallow breathing on delay. |
| Eating and drinking | Insulin was the reason for hypoglycaemic attack. Blood sugar analysis to control blood sugar. Sugar drinks or sweets can be given for hypostop in absence of nurses. In hospital, he is assessed by a dietician to balance diet, exercise, and blood sugar. |
| Elimination | Polyuria is a major issue that can result in incontinence during hypoglycaemic attack. Urinalysis is done for Ram. |
| Washing and dressing | Ram does not have issue with washing and dressing. He emphasised on having normal routine in hospital to look and feel good. He was given privacy by nurses for this. |
| Controlling temperature | Ram suffered from pyrexia following the attack. He was encouraged to remove outer layers whilst using a fan to feel not too hot or cold. His temperature was monitored in hospital. |
| Mobilisation | Ram could not mobilise because of neuroglycopenic symptoms, including dizziness. But, he gained mobility whilst he was in hospital. |
| Working and playing | Ram’s social life is affected due to diabetes. A diabetes specialist helped Ram to attain knowledge regarding distinct modes to enjoy social activities, including eating out with family. |
| Sleeping | Ram suffered nocturia because of polyuria, affecting his sleep pattern. He claimed that change in bedding, lighting, and noise affects his sleep in hospital. |
| Dying | Frequent hypoglycaemic attacks can cause death. Nurses were prepared to discuss fears of Ram regarding death. |
Care Priorities and Goal Setting
Care Priorities
Below are the care priorities using the first five stages of Levett-Jones Clinical Reasoning Cycle (Levett-Jones, 2018).
Consider the patient situation: Ram is 74 years old with chronic type 2 diabetes.
Collect cues/information: With a history of hypertension, Ram takes betalblockers. His BP was 180/150 on admission to hospital. When checked after one hour, it was 110/60. He also had hypoglycaemic attack. His blood sugar before meals was 3.0 mmol/L.
Process information: Normal BP should not exceed 120/80mmhg (Grossman & Grossman, 2017). But, Ram’s BP was 150/180 mmhg. Normal blood sugar levels before meals should be between 4 to 7 mmol/L (Diabetes.co.uk, 2019). But, Ram’s blood sugar before meals was 3.0 mmol/L, which is lower than what is needed.
Identify problems/issues: Ram has type 2 diabetes which is causing hypoglycaemic attack. Even, hypertension is creating complications for Ram.
Establish goals. The goal is to improve hypoglycaemic and BP level of Ram.
Goals of Care
The goals of care that are developed with the interviewee using the NSQHS Partnering with Consumers Standard includes healthy diet and physical exercise. Partnering with patients in their own care helps in maintaining healthy diet is necessary. This will ensure him to maintain his glucose level adequately. Moreover, physical exercise for about 150 min/week during minimum three days a week can help him. In doing so, he can join yoga classes that would help him to maintain his diabetes in check. Ram shall be aware that he has the right to receive high quality highly safe and effective treatment. The staff shall treat the patient respectfully and inform and educate about the illness (WNHS, 2020).
Conclusion
In essence, Ram is suffering from a chronic illness as type 2 diabetes. It affects his life since he gets hypoglycaemic attacks and remains tired all the time. It also affects his family since there is an atmosphere of fear and worry due to his hypoglycaemic attacks. The worry also leads to fights between Ram and his family members. The RLT model helped in assessing the relative and potential independence of Ram with regards to daily activities. Care priorities using the first five stages of Levett-Jones Clinical Reasoning Cycle are assessed to maintain hypoglycaemic and BP level of Ram suffering from type 2 diabetes. Finally, goals of care, including healthy diet and physical exercise are developed by partnering with the patient in his own care.
References
Baynes, H.W. (2015). Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus. Journal of Diabetes and Metabolism, 6(5), 1-9
Chang, E. & Johnson, A. (2018). Living with chronic illness and disability. Principles for nursing practice (3rd ed). Sydney: Elsevier Australia.
Diabetes.co.uk. (2019). Blood Sugar Level Ranges. Retrieved from https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html
Fritschi, C., Quinn, L., Hacker, E.D., Penckofer, S.M., Wang, E., Foreman, M. & Ferrans, C.E. (2012). Fatigue in Women with Type 2 Diabetes. Diabetes Education, 38(5), pp. 662-672.
Frier, B.M., Schernthaner, G. & Heller, S.R. (2011). Hypoglycemia and Cardiovascular Risks. Diabetes Care, 34(2), 132-137.
Grabowski, D., Andersen, T.H., Varming, A., Ommundsen, C. & Willaing, I. (2017). Involvement of family members in life with type 2 diabetes: Six interconnected problem domains of significance for family health identity and healthcare authenticity. SAGE Open Medicine, 5, 1-9.
Grossman, A. & Grossman, E. (2017). Blood pressure control in type 2 diabetic patients. Cardiovasc Diabetol, 16(3), 1-15.
Holland, K., Jenkins, J., Solomon, J. and Whittam, S. (2019). Applying the Roper-Logan-Tierney Model in Practice (3rd ed.). London: Churchill Livingston.
Kahn, S.E., Cooper, M.E., Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet, 383(9922), 1068–1083.
Kaku, K. (2010). Pathophysiology of Type 2 Diabetes and Its Treatment Policy. Japan Medical Association Journal, 53(1), 41–46.
Larsen, P. D., & Lubkin, I. M. (2019). Chronic illness: Impact and intervention (10th ed.). Sudbury, Massachusetts: Jones and Bartlett.
Levett-Jones, T. (2018). Clinical Reasoning: Learning to think like a nurse (2nd ed.). Frenchs Forest, N.S.W.: Pearson.
Medscape. (2020). Type 2 Diabetes Mellitus. Retrieved from https://emedicine.medscape.com/article/117853-overview
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Insulin Resistance & Prediabetes. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
Nursing Theory. (2020). Roper-Logan-Tierney’s Model For Nursing Based On A Model Of Living. Retrieved from https://nursing-theory.org/theories-and-models/roper-model-for-nursing-based-on-a-model-of-living.php
Peate, I. (2019). Alexander’s Nursing Practice E-Book: Hospital and Home. UK: Elsevier Health Sciences.
Phillips, L.S., Ratner, R.E., Buse, J.B. and Kahn, S.E. (2014). We can change the natural history of type 2 diabetes. Diabetes Care, 37, 2668–2676.
Shriraam, V., Mahadevan, S., Anitharani, M., Jagadeesh, N.S., Kurup, S.B., Vidya, T.A. and Seshadri, K.G. (2017). Reported hypoglycemia in Type 2 diabetes mellitus patients: Prevalence and practices-a hospital-based study. Indian Journal of Endocrinology and Metabolism, 1, 148-153.
WNHS (2020). Rights and Responsibilities. Retrieved from: https://wnhs.health.wa.gov.au/For-patients-and-visitors/Rights-and-responsibilities
Yun, J-S. and Ko, S-H. (2015). Avoiding or coping with severe hypoglycemia in patients with type 2 diabetes. The Korean Journal of Internal Medicine, 30(1), 6-16.
