Integrated Nursing Practice Assignment –
Mr. Michael Brennan 52yrs is attending his General Practice surgery for his regular six-monthly check-up. He presents today with complaints of fatigue, difficulty losing weight and no motivation. He denies any polyuria, polydipsia, polyphagia or blurred vision. He notes a marked decrease in his energy levels, particularly in the afternoons. He is tearful and states that he is not taking his antidepressants. He states that every time he tries to cut down on his eating he has symptoms of shakiness, diaphoresis, and increased hunger. He does not follow any specific diet and has been fearful of hypoglycemia that he often eats extra snacks.
Caring for a patient with Diabetes, Obesity and Mental Illness.
Setting the scene – Michael's holistic assessment by the General Practitioner (GP) today indicates:
Weight 140kg (up from 135kg six months ago)
Height 176 cm
BP 160/70; HR 88
Pain in his knees and ankles (rated as 4/10 on pain scale) – patient states this makes it difficult to do any exercise
Laboratory testing indicated that chemistries, Blood Urea Nitrogen, creatinine, liver function tests, thyroid function tests and urine microalbumin are all normal
Glycated Haemoglobin (HBA1c) was 7% for one year but is now 9%
LDL: 2.2 mmol/L
9-year history of diabetes
Trans-urethral prostrate resection
Medications: Nurofen, Metformin, Coversyl, Atorvastatin, Celexa
Social: Michael lives on his own after losing his wife five years ago. He has learned some cooking skills and prepares most of his meals although takeaways are an easy option for him during his work day as a taxi driver. He has good family support from one daughter, one son and two grandchildren who live close. Michael has little social engagement other than his children and often chooses not to leave the house.
Epidemiology / pathophysiology of disease processes
The National Health Priority Areas of Diabetes Mellitus, Obesity and Mental Health were established with the aim of improving health outcomes in these areas. Review your modules, references and extended reading regarding these National Priority areas.
Diabetes is a chronic condition marked by high levels of glucose in the blood caused by either the inability to produce insulin or by the body not being able to use insulin effectively. The main types of diabetes are Type 1, Type 2 or Gestational. In 2014-2015 approximately 1.2 million people (6% of Australian adults) had diabetes, based on self-reported data. This is a growing issue with increasing hospitalisations due to diabetes and one in ten Australian deaths having diabetes as an underlying and/or associated death.
In 2011-2012, almost 2 in 3 (63%) of Australian adults are overweight or obese. Obesity is a major risk factor for cardiovascular disease, Type 2 diabetes, some musculoskeletal conditions and some cancers, while making the management of and controlling of chronic disorders difficult.
Mental health and behavioural disorders describe a wide spectrum of disorders which can vary in both severity and duration. The most common disorders are depression, anxiety and substance use disorders and are important drivers of disability and morbidity. There is also an association between diagnosis of mental health disorders and a physical disorder with 1 in 8 (12%) of people with a 12-month mental disorder also reporting a physical condition and 1 in 20 (5%) reporting two or more physical conditions.
There is a clear bidirectional association between diabetes and mental illness. Statistics show that Australians with diabetes have a higher prevalence of poor mental health than those without diabetes. People with diabetes are more than twice as likely to have mental or behavioural problems as those without diabetes.
Task – Use the Clinical Reasoning Cycle review the nursing priorities in relation to the care of Michael.
1. From Michael's physical assessment, there were abnormal findings including his blood glucose level (BGL), blood pressure (BP), temperature and pain. Choose three (3) of these abnormal findings in relation to Michael's presentation. Discuss and justify with relevant pathophysiology.
2. List and justify the three (3) highest priority nursing problems for Michael.
3. For each priority nursing problem, write one (1) goal of care in SMART format.
4. Based on one goal, state and describe (2) interventions (nursing, collaborative or pharmacological) which would assist to achieve Mr. Dwight's short-term goal.
5. Provide and justify two (2) methods of how you would evaluate the outcomes.
6. Identify and discuss two (2) mental health illness risks for Michael with links to relevant literature.
7. Review Standard 3 of the NSQHS. Michael is at higher risk of healthcare associated infections (HAI's) and diabetic foot ulcers. Explain why he is a greater risk of and one (1) nursing intervention that could be implemented to reduce this risk? Justify your answer.
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