Chronic Condition: Experiencing Diabetes - Case Study Example

Running head: Diabetes Chronic condition: Diabetes Introduction Chronic illnesses are common afflictions of the older adults, and among some of the younger adults as well. They are difficult conditions to go through as they can impact significantly on the quality of their lives. This paper shall describe the case of Ronald, a 73 year old male patient who recently underwent partial hip arthroplasty to repair his right hip fracture. He is hypertensive, diabetic (type II), and has gouty arthritis as well. This paper shall specifically discuss the patient’s diabetes. It would first briefly define and describe Type II diabetes then discuss the experience of the patient’s diabetes, and compare this with the typical lived experience of those suffering the same condition. It shall then present an outline of any differences in the perceptions held by the patient and their family members concerning their diabetes compared to that of the general community. Finally, it shall discuss what self-management the patient requires, as well as the discharge plan and community referrals. This case study is being carried out in order to establish clear pathways of disease processes, especially in relation to chronic diseases. Body Diabetes definition/description Diabetes is a chronic disease which is currently affecting about 300 million people around the world. In fact, in 2004, about 3.4 million died from afflictions related to this disease. About 80% of these deaths have been seen in the poorer and middle income states and these deaths are seen to double by the year 2030 (WHO, 2011). According to the World Health Organization (2011), diabetes is a “chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces”. This condition then leads to increased blood sugar or hyperglycaemia which, if uncontrolled, can eventually cause serious damage to the body’s nerves and blood vessels. This disease is classified into type I, which is insulin-dependent diabetes with the body’s inability to produce enough insulin for normal functioning; and to type II diabetes or non-insulin dependent diabetes which is basically the body’s ineffective use of insulin (WHO, 2011). Type II is the more common type of diabetes and is the type which is currently affecting Ronald. And despite the ominous gravity of this disease on the human body, it is however a preventable, if not a curable illness. Experience of the patient, compared with typical lived experience of other patients with this diabetes Ronald was first diagnosed with diabetes at the age of 57. He recalls the initial symptoms which he felt before seeking consult included: excessive thirst, excessive urination, malaise, dizziness, constant hunger, and blurry vision. His visit with his GP who ordered diagnostic tests revealed that he had Type II diabetes, with elevated blood sugar levels three times the normal limit. He was further referred to a specialist who prescribed insulin for three months, and oral medications to reduce blood sugar levels. He was also given anti-hypertensives to manage his elevated blood pressure. He was also prompted to control his diet to promote weight loss and reduced blood sugar levels. Two weeks prior to consult, he slipped on the bathroom floor and broke his right hip. He immediately underwent partial hip arthroplasty to correct the fracture and to regain his mobility. His diabetes has however slowed down the healing process. His biggest difficulty in adhering to his diet and other restriction caused by his diabetes is mostly on his diet. He has admittedly a fondness for sweets and for foods rich in carbohydrates, and he does not like engaging in exercise and other activities. This recent injury upsets him because his wounds usually take long to heal and he worries that his surgical wound might become gangrenous over time. He also has to bring a snack or a candy with him wherever he goes because he cannot have low blood sugar at any point in time. He also has to maintain his blood pressure at normal levels because high blood pressure, as advised to him by his physician may lead to strokes, and to death. The experience of the patient with the patient is very much in keeping with the expected other patients suffering from this condition. Diabetes causes polyuria (excessive urination) and polydipsia (excessive thirst), prompting the patient to feel excessive thirst as well as frequent bouts of urination (Couper and Donaghue, 2007). They would also feel excessive hunger, especially when their blood sugar levels are low. Increase in blood pressure places them in danger of strokes, and uncorrected low blood sugar can lead to coma and then death (WHO, 2011). These patients are often obese or overweight. They also experience tingling of their peripheries. Their wounds often take longer to heal because of high blood sugar which interferes with the normal processes of healing (Department of Health and Ageing, 2011). These patients are required to avoid the extremes of blood sugar levels, meaning – too high and too low blood sugar because this is when the negative symptoms of the disease would manifest. In effect, they need a sugary snack with them at all times, and they cannot skip meals; if possible they have to eat atleast three meals a day, and snacks in between (Department of Health and Ageing, 2011). The portions for these meals also have to be well-managed, with excessive carbohydrates to be avoided at all costs. They also have to comply with the life-long medication regimen in order to maintain their blood sugar within normal levels (Department of Health and Ageing, 2011). Differences in perceptions by the patient concerning diabetes, compared to the general community There are different perceptions of patients and the general population as far as diabetes is concerned. In a paper Troughton, et.al., (2008) the authors discussed that diabetes patients express their need for education and support in relation to their disease. They experienced much uncertainty about their disease and such perception often impacted on their seriousness about their disease and on taking action in relation to diabetic interventions. They also did not have enough knowledge about the physical implications, as well as the management of their disease (Troughton, et.al., 2008). In a study by Pun, et.al. (2008), the authors reviewed the barriers to diabetes self-care stemming from patients’ and healthcare giver’s perspectives. The authors revealed that barriers to self-management mostly come from physical, socioeconomic, environmental, cultural, and psychological barriers. Healthcare givers have an inaccurate perception of diabetes and its impact on the patients, there is a need to correct these perceptions in order to ensure recovery and improved patient outcomes. The general public views diabetes as a relatively mild disease (Matthaei, et.al., 2007). They are also not knowledgeable of the fact that this disease is preventable and that obesity as well as lack of exercise are the major risk factors for this disease. This perception is similar in some ways to patient perceptions of this disease, as was mentioned above; patients often have a less serious perception of this disease and its impact on their lives (Lavernia, 2008). There is a need therefore to change these perceptions about diabetes, to stress upon the general public the seriousness and the gravity of this disease in terms of impact on quality of life and future health implications (Matthaei, et.al., 2007). The public is not educated enough about this disease, viewing the disease as a minor affliction, and therefore, endangering themselves to the risks of this disease. There was also a relationship between a diabetes patient’s perception of self-efficacy and his communication with his GP. The patient believed that when his GP explained more about the disease, then he was more inclined to apply adequate self-management techniques (Matthei, et.al., 2007). This perception is in line with public perceptions of the disease, that with more adequate health education from patients, the more likely that the public would be involved in the prevention of diabetes. Self management education for patient In order to ensure self-management of diabetes, the patient needs to be educated as to the cause and if possible the disease process which relate to his disease (Rose, et.al., 2009). By understanding his disease, it is possible for him to develop a more conscious attitude and to make the necessary adjustments to prevent the exacerbation of his disease (Rose, et.al., 2009). Moreover, the more he knows about his disease, the more likely he is to cooperate with the physician’s orders about his care. The more he would also comply with the physician’s orders in relation to food restrictions, medication intake, as well as other prohibitions or restrictions caused by the onset of the disease. A study by Lowe, et.al., (2008) was also able to establish the importance of diabetes self-management in improving the quality of a patient’s life, as well as in solving diabetes-related issues. Diabetes self-management related to intensive education process about the disease also resulted to patient empowerment, as well as improved quality of life which persisted for a much longer period of time (Lowe, et.al., 2008). The importance of a patient establishing his own diabetes management plan was also seen in the study by Furler, et.al., (2008). This study was able to establish the emotional context of self-management and the benefits of support from health professionals in this context of self-management. The authors were able to point out the importance of establishing an emotional base for self-management of diabetes. The more the person is emotional invested in the self-management process, the more he is able to adapt the treatment religiously into his life. Self-management education also includes teaching the client his appropriate diet. (Dunning and Ward, 2008) This diet must include a low-cholesterol, low carbohydrate, low sodium diet. A patient must be able to recognize the foods he can take, and the food portions for such foods. He must also be able to make adjustments in his diet which would help compensate for a high carbohydrate diet (Dunning and Ward, 2008). In effect, he must be able to easily recognize that if he is at a gathering where he would indulge on food, he must be aware that he may eat cake, but then only a small slice, or that he may eat some bread with jam, but only two slices, and then skip other types of carbohydrates for the rest of the day. These are self-management measures which he can eventually be adept at. The self-management process also includes physical activity and exercise (Alder, et.al., 2009). These activities must be based on his tolerance and must be undertaken after his hip fully heals. These physical activities can improve the burning of extra calories and prevent the build-up of fatty deposits in the arteries. It would therefore help reduce the patient’s weight and improve his general heart and organ functioning (Alder, et.al., 2009). The patient must however take extra precaution in checking his peripheries and other body parts for wounds. Wounds and other injuries must be avoided at all costs for diabetic patients because these wounds take too long to heal (Alder, et.al., 2009). Prolonged wound healing may lead to infection, and later, to gangrene, and inevitably – to amputation. The self-management of diabetes is also very much related to appropriate medication intake (Jordan and Osborne, 2007). The patient has to be properly educated as to the importance of each medication he is taking, including their functions, and proper dosage. The importance of these maintenance medications cannot be emphasized enough to the patient who has to understand that his diabetes medications are for life (Jordan and Osborne, 2007). Therefore, he cannot unilaterally decide to stop taking his medications without properly consulting his physician and without the necessary substitutes for such medications. He must also have a ready supply of these drugs as well as emergency medications for increased high blood pressure and increased blood sugar. Discharge Plan The discharge plan for this patient includes increased mobility, fully healed wound site, and partial mobility with the assistance of a walker. It also includes blood sugar levels within the accepted levels for diabetic patients (Dunning, 2009). No symptoms of dizziness must be seen, and the patient must be properly informed about his medications, including when and how often these are to be taken. He must also be able to express what symptoms of infection, bleeding, and elevated blood sugar levels he needs to watch out for and immediately refer to his physician. The discharge plan must also include a clear understanding of his prescribed diet, as well as physical activities which he can carry out on his own (Dunning, 2009). The patient must also be aware of the importance of follow-up visits with his physician. These visits would help ensure that his symptoms are well managed and would not exacerbate during his rehabilitation and recovery. A referral to the community health centre is also important for the patient because his blood sugar levels, as well as the healing of his hips would have to be monitored (Dunning, 2009). The community health centre can also assist him with his daily activities, including his cooking and cleaning. A social worker can also assist him in his other activities, including buying groceries, socialization, and emotional support. Conclusion The above discussion specifically discusses the case or Ronald, who is a diabetic. Diabetes is one of the most common chronic diseases. It often manifests with extreme thirst, extreme hunger, frequent urination, malaise, dizziness, peripheral neuropathy, long-healing wounds, and blurring visions – symptoms that the patient can all feel prior to consult. This disease can lead to serious consequences if unmanaged and has been known to cause serious deterioration of the quality o patient’s lives. The perceptions of patients and the general public about the disease are more or less similar, with patients not taking the disease seriously and the community perceiving this disease to be a mild affliction. Such perceptions need to be corrected in order to ensure that adequate prevention measures for the public are in place. Self-management measures include education in relation to proper diet and exercise, as well as the proper intake of medications. It also includes targeting the emotional context of the disease, ensuring that the health professionals appreciate the emotional issues which the patient is going through and making adjustments in the treatment based on such issues. Works Cited Alder, B., Abraham, C., & Teijlingen, E. (2009). Psychology and Sociology Applied to Medicine. New South Wales: Elsevier Health Sciences. Couper, J. & Donaghue, K. (2007). ISPAD Clinical Practice Consensus Guidelines 2006–2007: Phases of diabetes. Pediatric Diabetes, volume 8: pp. 44–47. Department of Health and Ageing. (2011). Diabetes. Retrieved 28 August 2011 from http://www.health.gov.au/internet/main/publishing.nsf/Content/pq-diabetes Dunning, T. & Ward, G. (2008). Managing Clinical Problems in Diabetes. New South Wales: John Wiley and Sons. Dunning, T. (2009). Care of People with Diabetes: A Manual of Nursing Practice. Sydney: Wiley-Blackwell. Furler, J., Walker, C., Blackberry, I., Dunning, T., Sulaiman, N., & Dunbar, J. (2008). The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes. BMC Health Services Research, volume 8: p. 214. Jordan, J. & Osborne, R. (2007). Chronic disease self-management education programs: challenges ahead. eMJA Rapid Online Publication. Retrieved 27 August 2011 from http://www.mja.com.au/public/issues/186_01_010107/jor10642_fm.pdf Lavernia, F. (2008). Treating Hyperglycemia and Diabetes With Insulin Therapy: Transition From Inpatient to Outpatient Care. Medscape J Med., volume 10(9): p. 216. Lowe, J., Linjawi, S., Mensch, M., James, K. & Attia, J. (2008). Waiting for diabetes: Perceptions of people with pre-diabetes: A qualitative study. Diabetes Research and Clinical Practice, volume 80(3), pp. 439-443. Matthaei, S., Munro, N., & Zinman, B. (2007). Raising diabetes awareness in the public domain. International Journal of Clinical Practice, volume 61(157), pp. 31–37. Pun, S., Coates, V., & Benzie, I. (2009). Barriers to the self-care of type 2 diabetes from both patients’ and providers’ perspectives: literature review. Journal of Nursing and Healthcare of Chronic Illness, volume 1(1), pp. 4–19. Rose, V., Harris, M., Hoc, M., & Upali, W. (2009). A better model of diabetes self-management? Interactions between GP communication and patient self-efficacy in self-monitoring of blood glucose. Patient Education and Counseling, volume 77(2), pp. 260-265. Troughton, J., Jarvis, J., Skinner, C., Robertson, N., Khuntic, K., & Davies, M. (2008). Patient Education and Counseling. Diabetes Research and Clinical Practice, volume 72(1), pp. 88-93. World Health Organization (2011). Diabetes. Retrieved 28 August 2011 from http://www.who.int/mediacentre/factsheets/fs312/en/index.html Read More