Client Based Care Case Study: Elderly with Diabetes

Client base fretting Case Study Elderly with Diabetes215479Client Based Cargon StudyIntroductionIn this essay, the author volition explore the maintenance of a single uncomplaining, encountered in clinical pr procedureice, examining the uphold on calibre of negociate, and on the health and wholesome macrocosm of the unmarried, of key verbal expressions of conduct. Case studies allow nurses to suppose on practice, acquire critical elements of shimmy and of clinical decisions made and actions namen, and to examine argonas of dish out in more detail. This essay will explore the business of one tolerant, who shall be called molly, an sometime(a), community dwelling adult with reference 2 diabetes, who was admitted to a medical admissions ward having been found unconscious at her collection plate by neighbours.The essay will examine the aspects of her premeditation that relate to the guidance of her occasion, the assessment and management of her hearty, mis giving and personal of necessity, and the grooming of her future circumspection and actualize carrys. Reference will be made to governmental guidelines and policies, and to interprofessional operative as a fundamental component of meeting patient take in this baptistry.DiscussionDiabetes is a chronic indisposition which is kn declare to impact signifi derrieretly on the health, eudaimonia and prosperity of individuals, of families, and of society as a firm1. More than 1.4 million in the UK are affected by diabetes2. Beca theatrical role of the large impact that this disease has on public health and on the use of NHS and genial fright resources and services, the discussion section of health has published a theme Service good example for diabetes, which not unless sets standards for management and diagnosis of the disease, besides outlines best practice in the light of the la psychometric test available raise on the condition3.There are two types of diabetes, Type 1 and Type 2, both of which are signified by a reignent luxuriously level of circulating alliance glucose, due to a overleap of insulin or a significantly stricken response to insulin, or to a compounding of both occurrenceors4. Type 1 diabetes is due to the insulin-producing cells in the pancreas, called the Beta Cells, dictated in the Islets of Langerhans, failing to produce insulin, because the bodys own repellent system has destroyed them5. Type 2 diabetes is commonly caused by a reduced amount of insulin production by these cells, and by a detail of insulin resistance within the body, wherein the bodys metabolic responses to insulin are not as sensitive6. Type 2 Diabetes is the condition which molly, the patient in this human face study, has been affected by.mollie is a 66 year old cleaning woman who has had Type 2 diabetes for 17 years. She is treated by twice fooling insulin, and, living indiely still in her own home, she is visited once weekly by a district n urse to monitor her glycaemic engage and see her insulin stocks and her general wellbeing. Molly has a BMI of 35, and also has a tale of high store tweet which is controlled by medication. She has her blood pressure checked weekly as well. Molly lives alone, never having married, and has no children. She has an active kindly life, attending a topical anesthetic book group, taking part in a local history and re-enactment society, and volunteering at a community library. She is known by the district nurses to be competent in administering her own insulin and measuring her own blood excoriation, barely she does not always adhere to her regimen and her recommended diet, because it can interfere with her social life.Molly was found unconscious by one of her neighbours at 9 pm, and the ambulance was called. Paramedics attending were told of her history by her neighbour, who waited with her, and suspected either Diabetic diabetic acidosis or hypoglycaemia. Diabetic ketoacidosis i s a condition which can be life- being, and is usually due to a lack of insulin, which agency that the cells of the body are unable to use glucose for energy, and so instead convert fat militia to energy, which can produce ketone bodies which can adversely affect brain function7,8. hypoglycaemia can be caused by an overdose of insulin, or inadequate carbohydrate intake in a person who is taking insulin, or by the patient taking too much exercise, thus using up glucose, or by a combination of theseParamedics found her blood sugar to be 1.1 mmols, and administered glucagon to reverse the hypoglycaemia. She recovered consciousness quickly once her blood sugar improved, still was also given facial oxygen, and had replete(p) observations taken. Molly remained confused after insulin administration. She was taken to the medical admissions unit for a full assessment and, if necessary, in-patient admission and review of her diabetes. According to emergency care principles for the diabe tic patient, the priorities are to fork out the patients life, alleviate their symptoms, prevent semipermanent complications of the disease and their current risk factors, and then to implement care that will help to reduce risk factors for their health, such as hypertension obesity, smoking, and hyperlipidemia, on with providing on-going fosterage and support for self-management of their condition9.In Mollys case, the team up evaluated her condition, because although the initial diagnosis was hypoglycaemia, adumbrateed by her self- stateed history of missing meals that day and being rattling busy, the differential diagnosis was diabetic ketoacidosis, which can be precipitated by physical or biological stress, including changes in endocrine function or other diseases, such as myocardial infarction10. Molly is pale as well, a finding suggestive of hypoglycaemia, along with her elevated blood pressure and dilated pupils11. As Molly was conscious, her Glasgow Coma Score was 13, and she had responded well to glucagon, according to naturalised diabetic protocols, she needed to be stabilised and undergo a digress of investigations to determine either other disease or factors precipitating her condition12. assembly line pressure, temperature, pulse and respiration rate were monitored recorded via continuous telemetry, and an ECG was carried out, which rule out myocardial infarction. Molly had blood sent for Full inventory Count, Liver Function Tests, Urea and Electrolytes and Glucose, as well as insulin levels, prothrombin time, clotting factors13. Prothrombin Time and Clotting Factors may also be tested, due to the risk of disseminated intravascular coagulation. Bloods were also sent to test HbA1c Fructosamine Urinary white excretion Creatinine / urea Proteinurea and Plasma lipid profile14. Urine was dipped with reagent strips to test for glucose, protein (suggestive of kidney problems) and ketones.Because of her presentation, Molly was put on a contin uous IV selection of insulin, titrated hourly using a syringe driver against blood glucose, with an selection of 5% glucose running in a different IV port. IV fluid therapy, and fluid balance, were also monitored closely15. Diabetes can cause kidney damage and impaired urinary function, so supervise kidney function was an eventful part of care16. formerly Molly was stabilised, ongoing care related to support her health and wellbeing, and minimising complications of her diabetes, became an beta part of care. Diabetes is a significant public health issue, because it is not only associated with the social disease of obesity, but also because as a overturn it is associated with a number of serious health implications17. These complications include macrovascular complications, including atherosclerosis and cardiovascular disease18, 19, 20 diabetic retinopathy and sight loss due to vascular damage which weakens the walls of the blood vessels in the eyes, causing microaneurysms and lea kage of protein into the retina, vascular damage and scar wind 21, peripheral neuropathy, peripheral vascular disease and gastrointestinal dysfunction, gomerular damage, and kidney failure22. The impact of this disease on public health relates to the fact that many peck of operative(a)s age are diabetic, and because the condition is chronic as well as serious, with acute exacerbations and so many complications, it presents a serious drain on health and social care resources. Therefore, it is imperative that individuals with diabetes are identified as early as possible, and are educated and support in straightforward self-management, and provided with ongoing care to maintain good glycaemic control23.Mollys side as an older adult is also a public health issue, because older adults constitute the largest patient group in the UK, and the ones which consume the biggest proportionality of healthcare services24. However, it was also burning(prenominal) to avoid stereotyping Molly as an older person, and making assumptions about her needs and her health. Although she was obese and hypertensive, and had Type 2 diabetes, she was very active and had a very grave social life, and was usually independent and self-caring. It was important to consider the social support that she had, and to ensure that she was aware of any services or support she might be able to glide path if she felt it necessary. However, some members of the multidisciplinary team, in particular, some of the medical staff, did appear to act in a way that suggested they were stereotyping Molly based on these factors (age, weight, health) and were discussing her case without really making clear reference to her as a whole person. This nothingnesss on to the need to evaluate the multidisciplinary input in Mollys case, and the select of the interprofessional functionals that took place, which is discussed below.As can be seen from the list above, diabetes can affect the individual and the body in labyrinthine ways, and so overtops an holistic approach to care25. Care should also be based on raise based, collaboratively agreed care pathways26, as suggested by the NSF for diabetes27. Molly may need a comprehensive review of her management and her lifestyle, the patterns of care and the ongoing monitoring of her condition28. The National Institute for clinical Excellence recommends a patient-centred approach to ongoing patient study and management, and also suggests a number of options for patients who might require different forms of insulin administration, such as continuous sub-cutaneous insulin29, 30. This, however, was not suitable for Molly, because it is usually for muckle with Type 1 diabetes.wellness promotion and education is an important part of Mollys care at this point, which is related to the fact that her current hospital admission is due to mismanagement of her condition herself. It was important to determine what factors about her lifestyle and behavio urs had led to the lapse and the serious hypoglycaemia. ongoing care, health promotion and education concern multi-professional collaboration and integration of care into a complex, detailed care plan. The aim was to provide Molly with the information, support and guidance that would allow her to view her diabetes management as a means of achieving a better quality of life, rather than viewing her diabetes as something which interfered with her quality of life. It was also important to view Molly in terms of supporting her to continue with her normal social activities. search shows that making changes in lifestyle, and providing good, impressive health education, helps to contribute to reducing rates of diabetic complications31.However, the kind of health education and support used is important, because different approaches have different levels of effectiveness. most research examines the differences betwixt health education that tries to persuade patients to be lamblike with regimes and activities designed by health professionals, approaches which are usually generic, and health education that is client-centred32. Client centred approaches are usually more effective, as they are individualised. Research shows very clearly that patients with diabetes need to understand their disease fully, and be supported and empowered to make the lifestyle and behavioural changes that will enhance their wellbeing whilst enabling them to control their condition33. In this case, a diabetic nurse medical specialist was involved with Mollys case, and a plan for health education and support drawn up, with clear guidelines and a tailored plan for managing her social life well-nigh her diabetes. Diabetes UK recommends a structured, tailored education programme for people with the condition34.Interprofessional and multidisciplinary working is a fundamental component of care for a patient with diabetes like Molly35. This means that diabetic patients should experience seamless care, addressing all needs, with access to all the professionals necessary to support her care36. Specialist involvement, including diabetic nurse specialists, was a feature of this care, and helped with a client centred focus37. The literature suggests that it is important for a drive professional to take charge38, but in Mollys case, her lead nurse was not present for the majority of her inpatient stay, and on that point was a lack of effective coordination of the complex number of professionals involved.In relation to multidisciplinary, interprofessional working Molly was referred to ophthalmic services for a check-up, to ensure that there was no diabetic retinopathy or glaucoma. She was referred to a dietician to support her in managing her dietetical intake. She was also referred to a social thespian. Diabetic specialist doctors were involved, and a report was sent to the diabetic nurse at her local surgery, as well as to her GP. Molly ended up staying in hospital, howeve r, on a medical ward, for two weeks, even though her condition was stabilised rapidly, and she experient no further complications. In this case, interprofessional working was not effective, because although the said referrals were made, or were recorded to have been made, Molly was not seen by the dietician or a social worker for over a week, and only when she began to threaten to take a discharge against medical advice did the dietician and social worker arrive and get involved. The doctors in charge of Mollys case however appeared to make judgements about plans for discharge and ongoing care without involving the care for team and without considering some aspects of her social situation and Mollys own preferences and wishes.It is apparent, from this case, that while Mollys immediate medical needs were met, the interprofessional working element of her ongoing care failed in some way. There are a complex range of professionals and support workers who provide healthcare39. Because of this complexity, interprofessional education has call on part of healthcare education programmes40. Interprofessional working is supposed to help with the readiness of true patient-centred care, and the highest quality of care41. However, experience in this case, and some of the literature, cites ongoing problems with interprofessional working in a number of contexts. Some of this is to do with the professional boundaries and hegemonies which persist in healthcare professions, which continue to be defended rigorously by severally(prenominal) profession42. Some literature shows that elitism, professional isolationism and professional defensiveness can have detrimental effects on health professionals themselves as well as on the quality of care delivery43. Yet there is ample government guidance, in particular from the Department of health, which aims to improve service provision, and the NSF for Older People44, identifies the most important elements of care and service provi sion which must be improved upon. measure 2 of the NSF, Person-Centred Care, requires that health and care services are designed around the needs of the older patient (and their carers)45. However, this kind of needs-based care then demands. an corporate approach to service provision regardless of professional or organisational boundaries, which is delivered by clinical governance, underpinned by professional self regulation and lifelong reading .46In Mollys case, the fundamental role of the nurse in providing leadership and coordination for her care was not acknowledged or supported. Some researchers suggest that this can be due to medical hegemony47. Current approaches to offsetting such essential hierarchical thinking are very much focused on initial education of healthcare professionals, overcoming historical professional boundaries48, 49, 50. The research shows that there is a difference between multiprofessional working, which does not transcend the traditional hierarchies and boundaries , and inter-professional working, which is reinforced on the desire to share care, support each other, and value each others expertise51. Government drivers continue to underpin strategies for better, joined up working.52,53.The failures which occurred in Mollys care were clearly linked to poor communication between the healthcare professionals, a lack of joined up working, and a lack of recognition, perhaps, of the importance of the social aspects of Mollys case, and the health-education aspects, based on her individual needs. On reflection, the author believes that had there been better, collaborative working, then none of these needs would have been overlooked and they would have been dealt with more speedily. But another aspect of her care that could be improved upon was related to her own involvement in her case. Molly was not fully involved in her case discussions and in the medical decisions made about her care. While this can be a product of the medical hegemo ny mentioned before54, it constitutes a serious oversight and is not in line with governmental guidance55. Research shows that the patient voice is the most important one in terms of collaborative care planning and management56.decisivenessThis case study has identified the case of Molly (a pseudonym), an older patient with Type 2 diabetes who received good quality clinical care in meeting her acute care needs and managing her medical condition and its potential consequences, but for whom interprofessional working failed in relation to ongoing care and multi-discinplinary involvement. Diabetes is a significant public health issue, and a range of governmental guidance and research evidence informs care for patients with the condition. The public health issues asphyxiate the serious morbidity and mortality associated with diabetes, and the fact that good management and glycaemic control can minimise these complications. In this case, the patients needs were prioritised medically, but interprofessional communication broke down. While the appropriate referrals were made, proper joined up working did not take place. Similarly, Molly was not fully involved in her case, and should have been.Diabetes is a serious, chronic condition, and one which requires patient-centred assessment, identification of needs, and management. alone those involved should adhere to the available guidelines and commit to effective interprofessional working.ReferencesAllen, D., Lyne, P. Griffiths, L. (2002) Studying complex caring interfaces key issues arising from a study of multi-agency rehabilitative care for people who have suffered a stroke. daybook of clinical Nursing 11 297-305.Anthony, S., Odgers, T. Kelly, W. (2004) Health promotion and health education about diabetes mellitus. daybook of the Royal high society for the Promotion of Health. 124 (2) 70-3Banks, s. Janke, K. (1998) growing and implementing interprofessional learning in a faculty of health professions. Journal o f Allied Health. 27 (3) 132-136.Billingsley, R. 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Journal of Integrated Care Pathways 7 (2) 75-79.Turina, M., Christ-Crain, M. Polk, H.C. (2006) Diabetes and hyperglycemia strict glycaemic control. Critical Care Medicine 34 (9) 291-300.Watkins, P.J. (2003) ABC of Diabetes (Fifth edition). capital of the United Kingdom BMJ Publishing Group.1Footnotes1 Department of Health (2002)2 Hilton, L. Digner, M. (2006) p 89.3 Department of Health (2002).4 Department of H ealth (2002).5 Watkins, P.J. (2003).6 Watkins (ibid)7 DoH (ibid)8 Hankin, L.(2005) p 67.9 Watkins (ibid).10 Turina, M., Christ-Crain, M. Polk, H.C. (2006) p 291.11 Guthrie, R.A. Guthrie, D.W. (2004) p 113.12 Edge, J.A., Swift, P.G.F., Anderson, W. Turner, B. (2005) p 10005.13 Hankin (ibid)14 Reinauer, H. (2002)15 Guthrie (ibid)16 Guthrie (ibid)17 DoH (2002) Department of Health, (2001).18 Guthrie (ibid)19 Bloomgarden, Z.T. (2006)20 Soedmah-Muthu, S.S., Fuller, J.H., Mulner, H.E. et al (2006)21 Guthrie (ibid)22 DoH (2002).23 DoH (2002)24 Department of Health, (2001)25 Collis, S. (2005)26 Pollom, R.K. Pollom, R.D. (2004)27 OBrien, S.V. Hardy, K.J. (2003)28 Snow, T. (2006)29 NICE (2003)30 Diabetes UK (2006)31 Anthony, S., Odgers, T. Kelly, W. (2004)32 Skinner, T.C., Cradocl, S., Arundel, F. Graham, W. (2003)33 Antony (ibid)34 Diabetes UK (2006)35 DoH (2002)36 Keene, J., Swift, L., Bailey, S. Janacek, G. (2001)37 Keen, H. (2005)38 Scott, A (2006)39 Masterson, A. (2002)40 Pollard , K.C., Miers, M.E. Gilchrist, M. (2004)41 Kenny, G. (2002)42 Colyer, H.M. (2004)43 Price (ibid)