Diabetes Self-Management Education Assignment Paper
Diabetes Self-Management Education Assignment Paper
Introduction
The patient under consideration is Mr. LW, a 75-year-old male diagnosed with Type 2 Diabetes Mellitus (DM), primary hypertension (HT), and a recent episode of Non-ST Elevated Myocardial Infarction (MI). This case study will provide an overview of his clinical profile, diagnosis, pathophysiology of DM, prescribed medications, and a treatment plan.
Actual Diagnosis and Co-Morbidities
In our presented case study, the primary diagnosis is Type 2 Diabetes Mellitus. Primary Hypertension and Non-ST Elevated Myocardial Infarction (MI) are the Co-Morbidities. Diabetes Self-Management Education Assignment Paper
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The Chief Complainant and The Clinical Presentation
Mr. LW attended the family medical clinic for a checkup before undergoing surgery to remove the cataract in the left eye. It would indicate that his overall health is good, considering his age. His vitals are somewhat higher, but they still show signs of distress: a heart rate of 98 beats per minute, a blood pressure of 125 mm Hg, and a respiratory rate of 20 breaths per minute that is slightly elevated.
Patient History and Presentation
Mr. LW presents as a generally healthy individual, exhibiting normal ambulation, activity levels, and full orientation. It is noteworthy that he has chosen not to receive vaccinations. The patient carries a diagnosis of Type 2 Diabetes Mellitus and presents with concurrent conditions including Primary Hypertension and a recent Non-ST Elevated Myocardial Infarction.
The patient’s primary reason for seeking medical attention revolves around his desire to secure medical clearance for an upcoming cataract surgery on his left eye. Within the realm of diagnostic possibilities, consideration is given to three potential scenarios: the presence of a cataract in the left eye, the manifestation of Diabetic Retinopathy, and the likelihood of Essential Hypertension as contributory factors to his ocular health. Diabetes Self-Management Education Assignment Paper
Pathophysiology of Primary Diagnosis (Diabetes Mellitus)
Diabetes Mellitus is characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. In Type 2 Diabetes, there is insulin resistance and relative insulin deficiency. Insulin resistance primarily occurs in muscle, adipose tissue, and the liver, leading to decreased glucose uptake and increased hepatic glucose production (Zhang et al., 2021). This results in chronically elevated blood glucose levels, contributing to the commonly noted clinical manifestations of polyuria, polydipsia, polyphagia, and potential complications such as diabetic retinopathy.
Differential Diagnosis
Age-Related Macular Degeneration (AMD)
Age-related macular degeneration is a common eye condition in elderly individuals like Mr. LW. It can cause vision loss in the center of the visual field. Given his age and the presence of cataracts in the left eye, it is essential to consider AMD as a potential differential diagnosis alongside diabetic retinopathy.
Open-Angle Glaucoma
Open-angle glaucoma is another eye condition that can affect elderly patients. It often develops slowly and is characterized by increased intraocular pressure, leading to optic nerve damage and vision loss. It is important to rule out glaucoma as a possible contributor to Mr. LW’s ocular health. Diabetes Self-Management Education Assignment Paper
Hypertensive Retinopathy
Hypertensive retinopathy can occur in individuals with uncontrolled hypertension, like Mr. LW. It can lead to damage to the blood vessels in the retina, affecting vision. Given his history of primary hypertension, it is crucial to consider hypertensive retinopathy as a potential diagnosis alongside diabetic retinopathy.
Prescribed Medications
Empagliflozin 10 mg once daily
Empagliflozin’s mechanism of action involves reducing the reabsorption of glucose by the kidneys. This leads to an increase in the excretion of glucose through urine, ultimately resulting in the lowering of blood glucose levels (Sen & Heerspink, 2021). However, like many medications, this medication can bring about certain side effects. Among these are genitourinary infections, which affect the urinary and reproductive systems, as well as the possibility of experiencing volume depletion and low blood pressure (hypotension). Individualized assessments are crucial when managing empagliflozin, especially with regard to vigilant observation for indications of reduced hydration resulting from elevated glucose elimination via urination, which may affect the body’s fluid equilibrium. Diabetes Self-Management Education Assignment Paper
Insulin 20 Units Daily
The next prescribed treatment entails the utilization of insulin. The insulin plan recommended for this individual entails using a particular type of insulin known as Insulin 70/30, which combines NPH (Neutral Protamine Hagedorn) and Regular insulin (Phillippe & Pogge, 2022). This medication works by offering a dual-action approach that is, provides both basal and prandial insulin coverage (regulating blood glucose levels consistently throughout the day). The potential side effects to be aware of include hypoglycemia, a condition where blood glucose levels drop too low, and some weight gain. Given the patient’s age, it is also crucial to take individualized considerations into account. In this case, it involves closely and regularly monitoring for hypoglycemia. This vigilant approach to managing blood sugar levels is especially important in elderly patients to ensure their safety and well-being.
Treatment Plan
As part of the recommended treatment plan, specific diagnostic assessments have been considered essential. These involve an ocular evaluation designed to assess the potential presence of certain visual issues and to establish approval for potential medical interventions (Miller et al., 2022). The justification for this examination has a dual purpose: first, to ascertain the potential need for medical intervention, and equally significant, to guarantee the patient’s well-being during any potential procedures.
Relevant laboratory assessments have been carried out. These encompass an A1C measurement resulting in a value of 7.6%, offering valuable information regarding the extended management of blood sugar levels. In conjunction with this, a fasting glucose level of 152 mg/dL has been detected in the patient (Su et al., 2019). These laboratory evaluations are vital for tracking glycemic regulation and facilitate the adaptation of therapeutic approaches as necessary to enhance the patient’s holistic well-being. Diabetes Self-Management Education Assignment Paper
Nursing Goals
The overarching, the major long-term goal for delivering nursing care to Mr. LW revolves around managing and stabilizing the ideal management of his blood sugar levels. This plays a pivotal role in averting potential issues and fostering his general health.
Furthermore, in the immediate nursing care context, the first short-term goal encompasses educating Mr. LW about proper administration of his prescribed medications and emphasizing the significance of self-assessment for his blood sugar levels. The second short-term nursing treatment goal is to assess Mr. LW’s readiness and willingness to make necessary lifestyle modifications to manage his diabetes effectively. According to Powers et al. (2023), this includes providing education on dietary choices, exercise, and stress management, as well as collaborating with other healthcare professionals to create a personalized diabetes self-management plan tailored to his needs and preferences. Diabetes Self-Management Education Assignment Paper
References
Miller, K. M., Oetting, T. A., Tweeten, J. P., Carter, K., Lee, B. S., Lin, S., … & Musch, D. C. (2022). Cataract in the adult eye preferred practice pattern. Ophthalmology, 129(1), P1-P126.
Phillippe, H., & Pogge, E. (2022). Part Two: Diabetes Part 2: A Review of Insulin Therapy in Older Patients. The Senior Care Pharmacist, 37(5), 181-190.
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., … & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Journal of the American Pharmacists Association, 60(6), e1-e18.
Sen, T., & Heerspink, H. J. (2021). A kidney perspective on the mechanism of action of sodium glucose co-transporter 2 inhibitors. Cell metabolism, 33(4), 732-739.
Su, W. Y., Chen, S. C., Huang, Y. T., Huang, J. C., Wu, P. Y., Hsu, W. H., & Lee, M. Y. (2019). Comparison of the effects of fasting glucose, hemoglobin A1c, and triglyceride–glucose index on cardiovascular events in type 2 diabetes mellitus. Nutrients, 11(11), 2838. Diabetes Self-Management Education Assignment Paper
Zhang, H., Huang, Y., Chen, S., Tang, C., Wang, G., Du, J., & Jin, H. (2021). Hydrogen sulfide regulates insulin secretion and insulin resistance in diabetes mellitus, a new promising target for diabetes mellitus treatment? A review. Journal of advanced research, 27, 19-30.
Sample Annotated Bibliography
Autism research continues to grapple with activities that best serve the purpose of fostering positive interpersonal relationships for children who struggle with autism. Children have benefited from therapy sessions that provide ongoing activities to aid autistic children’s ability to engage in healthy social interactions. However, less is known about how K–12 schools might implement programs for this group of individuals to provide additional opportunities for growth, or even if and how school programs would be of assistance in the end. There is a gap, then, in understanding the possibilities of implementing such programs in schools to foster the social and thus mental health of children with autism. Diabetes Self-Management Education Assignment Paper
Kenny, M. C., Dinehart, L. H., & Winick, C. B. (2016). Child-centered play therapy for children with autism spectrum disorder. In A. A. Drewes & C. E. Schaefer (Eds.), Play therapy in middle childhood (pp. 103–147). American Psychological Association. https://doi.org/10.1037/14776-014
In this chapter, Kenny et al. provided a case study of the treatment of a 10-year-old boy diagnosed with autism spectrum disorder (ADS). Kenny et al. described the rationale and theory behind the use of child-centered play therapy (CCPT) in the treatment of a child with ASD. Specifically, children with ADS often have sociobehavioral problems that can be improved when they have a safe therapy space for expressing themselves emotionally through play that assists in their interpersonal development. The authors outlined the progress made by the patient in addressing the social and communicative impairments associated with ASD. Additionally, the authors explained the role that parents have in implementing CCPT in the patient’s treatment. Their research on the success of CCPT used qualitative data collected by observing the patient in multiple therapy sessions. Diabetes Self-Management Education Assignment Paper
CCPT follows research carried out by other theorists who have identified the role of play in supporting cognition and interpersonal relationships. This case study is relevant to the current conversation surrounding the emerging trend toward CCPT treatment in adolescents with ASD as it illustrates how CCPT can be successfully implemented in a therapeutic setting to improve the patient’s communication and socialization skills. However, Kenny et al. acknowledged that CCPT has limitations—children with ADS, who are not highly functioning and or are more severely emotionally underdeveloped, are likely not suited for this type of therapy.
Kenny et al.’s explanation of this treatments’s implementation is useful for professionals in the psychology field who work with adolescents with ASD. This piece is also useful to parents of adolescents with ASD, as it discusses the role that parents can play in successfully implementing the treatment. However, more information is needed to determine if this program would be suitable as part of a K–12 school program focused on the needs of children with ASD.
Stagnitti, K. (2016). Play therapy for school-age children with high-functioning autism. In A. A. Drewes and C. E. Schaefer (Eds.), Play therapy in middle cildhood (pp. 237–255). American Psychological Association. https://doi.org/10.1037/14776-013 Diabetes Self-Management Education Assignment Paper
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Stagnitti discussed how the Learn to Play program fosters the social and personal development of children who have high functioning autism. The program is designed as a series of play sessions carried out over time, each session aiming to help children with high functioning autism learn to engage in complex play activities with their therapist and on their own. The program is beneficial for children who are 1- to 8-years old if they are already communicating with others both nonverbally and verbally. Through this program, the therapist works with autistic children by initiating play activities, helping children direct their attention to the activity, eventually helping them begin to initiate play on their own by moving past the play narrative created by the therapist and adding new, logical steps in the play scenario themselves. The underlying rationale for the program is that there is a link between the ability of children with autism to create imaginary play scenarios that are increasingly more complex and the development of emotional well-being and social skills in these children. Study results from the program have shown that the program is successful: Children have developed personal and social skills of several increment levels in a short time. While Stagnitti provided evidence that the Learn to Play program was successful, she also acknowledged that more research was needed to fully understand the long-term benefits of the program. Diabetes Self-Management Education Assignment Paper
Stagnitti offered an insightful overview of the program; however, her discussion was focused on children identified as having high-functioning autism, and, therefore, it is not clear if and how this program works for those not identified as high-functioning. Additionally, Stagnitti noted that the program is already initiated in some schools but did not provide discussion on whether there were differences or similarities in the success of this program in that setting.
Although Stagnitti’s overview of the Learn to Play program was helpful for understanding the possibility for this program to be a supplementary addition in the K–12 school system, more research is needed to understand exactly how the program might be implemented, the benefits of implementation, and the drawbacks. Without this additional information, it would be difficult for a researcher to use Stigmitti’s research as a basis for changes in other programs. However, it does provide useful context and ideas that researchers can use to develop additional research programs. Diabetes Self-Management Education Assignment Paper
Wimpory, D. C., & Nash, S. (1999). Musical interaction therapy–Therapeutic play for children with autism. Child Language and Teaching Therapy, 15(1), 17–28. https://doi.org/10.1177/026565909901500103
Wimpory and Nash provided a case study for implementing music interaction therapy as part of play therapy aimed at cultivating communication skills in infants with ASD. The researchers based their argument on films taken of play-based therapy sessions that introduced music interaction therapy. To assess the success of music play, Wimpory and Nash filmed the follow-up play-based interaction between the parent and the child. The follow-up interactions revealed that 20 months after the introduction of music play, the patient developed prolonged playful interaction with both the psychologist and the parent. The follow-up films also revealed that children initiated spontaneously pretend play during these later sessions. After the introduction of music, the patient began to develop appropriate language skills. Diabetes Self-Management Education Assignment Paper
Since the publication date for this case study is 1999, the results are dated. Although this technique is useful, emerging research in the field has undoubtedly changed in the time since the article was published. Wimpory and Nash wrote this article for a specific audience, including psychologists and researchers working with infants diagnosed with ASD. This focus also means that other researchers beyond these fields may not find the researcher’s findings applicable.
This research is useful to those looking for background information on the implementation of music into play-based therapy in infants with ASD. Wimpory and Nash presented a basis for this technique and outlined its initial development. Thus, this case study can be useful in further trials when paired with more recent research. Diabetes Self-Management Education Assignment Paper
