QUT19418: Brennan Michael Case Study - Caring for a Patient with Diabetes, Obesity and Mental Illness - Nursing Assignment Help

Assignment Task:

Assessment on Caring for a patient with Diabetes, Obesity and Mental Illness

Setting the scene

Michael’s holistic assessment by the General Practitioner (GP) today indicates:

Physical:

• 52-year-old male

• Weight 140kg (up from 135kg six months ago)

• Height 176 cm

• BP 160/70; HR 88

• Temp 37.7

• BGL: 9.0mmol

• 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

• HDL: 1.6mmol/L

Previous history:

• 9-year history of diabetes

• Obesity

• Depression

• Hypertension

• Arthritis

Surgical history:

• Trans-urethral resection prostrate

• Cholecystectomy

Medications:

Nurofen, Metformin, Coversyl, Atorvastatin, he is to commence Sertraline today.

Social: 

Michael lives on his own in a small unit after his wife left him 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. He has lost contact with most of his mates since his divorce.

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.

Questions:

Use the Clinical Reasoning Cycle to review the nursing priorities in relation to the care of Michael.

1(a).  The international classification of obesity and overweight is the body mass index (BMI), identify what Michael’s BMI is and his classification for his body weight and obesity. Use a reputable web site to find this information. 

1(b).  Waist circumference and body shape or fat distribution is another assessment consideration for Michael. Identify three (3) associated disease risks for Michael.         

1(c). Having high levels of visceral fat is a health risk. Explain, justifying with relevant pathophysiology why this is so.

1(d). Provide an explanation for Michael about the danger of having visceral fat. You will need to use language that he would understand.                                                     

1(e). State 3 actions that could assist Michael to reduce his visceral fat levels.  

2. Prediabetes is where an individual is at an increased risk for developing type 2 diabetes. Discuss the testing in Australia and values that determines the presence of a pre-diabetic state.

2(a). Name 4 risk factors that are either non-modifiable or modifiable, that increase a patient’s chances of developing diabetes mellitus type 2.             

3. Review and recall your knowledge of diabetes and the possible adverse complications that may occur. Identify six (6) signs and symptoms of hypoglycaemia. Explain the pathophysiology of this sign of hypoglycaemia. 

4. Sertraline is a commonly used medication to treat anxiety and depression in adults Michael is being commenced on this medication by the GP.  Discuss the nursing education you will provide to him. Provide four (4) clear points that he needs to understand to take this medication safely.

5. On review of Michael’s case, you refer Michael to a dietician with expertise in diabetes management. Provide a rationale for this discipline’s involvement in relation to the case study. 

6. Clients like Michael often experience difficulty adhering to a treatment plan for his diabetes, name and describe three (3) evidence -based interventions  that are known to increase adherence and provide brief rationale for each. 

7. Both research and clinical practice strongly suggest that it is important to screen for and treat symptoms of depression in order to optimise diabetes self-care and facilitate both physical and psychological well-being in people with diabetes.

7(a). Identify one (1) screening tool you could  use for measuring depression in Michael and justify why you chose this tool.

7(b). Discuss the importance of screening patients like Michael for depression.                                             

8. On Michael’s physical assessment his blood pressure was 160/70 and he has a history of hypertension. Name and explain two (2) nursing interventions to assist Michael with hypertension control. 

9. Mr Brennan presents with many nursing problems. Reading his case and completing the previous questions for this workbook has required you to read widely on diabetes mellitus type 2. State 2 nursing problems you have identified other than hypertension.

10. Write a goal of care in SMART format for Michael that address your each of your  identified nursing problems (Two (2) SMART goals needed) No reference required for this response.

11. Many patients with diabetes mellitus suffer complications. Choose two (2) of the following and discuss the pathophysiology in relation to a diabetes diagnosis:

11(a). Retinopathy

11(b). Peripheral neuropathy

11(c). Cerebral vascular accident

11(d). Vascular disease

11(e). Increased risk of infection

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