Diabetic Case Study Jill Davis University of Phoenix Amanda Brooks, FNP-BC October 5, 2009 Diabetic Case Study In this case study, we are presented with a man who has Type II diabetes signs and symptoms. He has recently gone through several psycho-social adjustments and is a busy professional man. A plan needs to be developed to assess, teach, and evaluate the patient’s health care needs by covering topics such as incidence, signs and symptoms, potential effects of the disease, educational needs, and challenges presented by diabetes.
The Incidence of Diabetes in the United States Diabetes is a broad term covering three distinct types of this disease: Diabetes Mellitus is a disease that has two categories type I and type II, Diabetes insipidus, and Gestational Diabetes. Charles has found himself in the rising population of persons affected by this disease. “Diabetes now affects nearly 24 million people in the United States” (CDC, 2008, ¶ 1). Even though the number of people now affected by diabetes has risen, the number of people unaware of their condition has decreased.
The Typical Presenting Signs of Diabetes Often, the first signs of type II diabetes are nonspecific and occur so slowly that the person does not realize the symptoms of the disease. “Some of the most common manifestations associated with type II diabetes include: fatigue, recurrent infections, prolonged wound healing and visual changes” (Lewis, Heitkemper, & Dirksen, 2004, p. 1272). Fatigue happens because of the present difficulty of the body to obtain energy from glucose. Recurrent infections and prolong wound healing are signs of elevated glucose circulating in the system.
The symptoms presented by Charles are more severe. The weight loss is a sign that the body cannot absorb glucose because of insufficient insulin or receptor sites on the cells. Instead, the body is using fat and protein reserves for energy. Another common sign is excessive urination (polyuria), which occurs when the body is trying to excrete the excess glucose from the system. Increase thirst (polydipsia) results from constant urination and dehydration. Polydipsia is the body’s compensation mechanism to replace lost fluids.
The Potential Effects of Diabetes on the Body as a Chronic Process Long term complications of diabetes do not show up until many years or decades after the onset of the disease. Charles is exhibiting signs and symptoms of high blood glucose levels. Uncontrolled diabetes can affect the eyes, kidneys, nerves, heart, blood vessels, and peripheral areas of the body. Diabetic retinopathy involves changes in the retina where small blood vessels become damaged. Diabetics should understand the importance of yearly vision testing and maintaining normal blood sugars to prevent eye damage.
Diabetic nephropathy occurs when glucose levels are poorly managed. High blood pressure and smoking potentiates this complication. Kidney disease, if discovered early enough, can be treated effectively (ADA, 2009). Diabetic neuropathy is nerve damage that affects many parts of the body. Early symptoms include numbness, tingling, or sharp pains in the lower extremities. Individuals should examine their feet on a daily basis to monitor for open areas and signs of infection. Teaching Requirements of Diabetics with Measurable Objectives
Initial assessment of Charles’ basic knowledge of diabetes will be done and a teaching-plan created. The cognitive educational and problem-solving modules will be used to educate Charles. The “Diabetic Knowledge Questionnaire …. designed to assess overall diabetes knowledge according to…the National Standards for Diabetes Patient Education Programs” (Redman, 2007, p. 63) will provide a measurable starting point. Diabetic self care maybe established through evaluating Charles’ problem-solving skills; since, Social problem solving has been identified as an important factor in psychological adjustment and effective functioning” (Hill-Briggs, 2003, p. 187). Dietary changes require carbohydrate control with added protein. Medications include Insulin or oral agents that stimulate insulin production and increase receptor sites. Instructions on blood glucose monitoring and keeping a log will lessen the incidents of hyperglycemia and hypoglycemia. Symptom recognition and treatment is important. Excessive carbohydrates or insufficient insulin cause hyperglycemia.
Signs and symptoms progress slowly; frequent urination, excessive thirst, lack of energy, and a gradual slip into a coma. Hypoglycemia results from excess insulin, insufficient carbohydrates, or excessive exercise. Hypoglycemia occurs rapidly with sweating, light-headedness, and trembling that leads to coma if not treated quickly. Evaluation will include repeating the Diabetic Knowledge Questionnaire and comparing initial score, verbal recall, blood glucose monitoring, and checking the HbA1c within three months. Psycho-Social Challenges of Diabetic Patients
The recent changes to Charles’ life may be the cause of his denial that there is a physical reason for the changes he has noticed. He is a busy professional man and obviously does not take the time to have regular physical examinations that are recommended for men his age. Often men in his position ignore their health as they are thought to be ‘hale and hearty’ by others and think that they need to live up to this social standing. Assessing Charles learning needs and understanding the challenges he faces, will facilitate implementation and evaluation of a solid plan of care.
Consequently, the health care team will be able to teach this patient how to prevent complications and maintain a healthy life style. References American Diabetes Association (ADA). (2009). Type 2 Diabetes Complications. Retrieved September 28, 2009, from http://www. diabetes. org/type-2-diabetes/complications. jsp. Centers for Disease Control & Prevention (CDC). (2008). Number of people with diabetes increases to 24 million in the USA. Indian Journal of Medical Sciences, 62(6), 255-256. Retrieved October 1, 2009, from EBSCOhost database. Hill-Briggs, F. 2003). Problem solving in diabetes self-management: A model of chronic illness self management behavior. Annals of Behavioral Medicine, 25(3), 182. Retrieved October 1, 2009 from eBook Collection. UOPX Lewis, S. M. , Heitkemper, M. M. , & Dirksen, S. R. (2004). Medical surgical nursing: Assessment and management of clinical problems (6th ed. ). United Sates: Mosby. Redman, B. (2007). The Practice of Patient Education: A Case Study Approach (10th ed. ). p. 62. St. Louis, MO: Mosby Elsevier. Retrieved October 1, 2009 from eBook Collection. UOPX3
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