Question:
Read the Case Study. A 48 year old man has obesity ventilation syndrome, poorly controlled type 2 diabetes and morbid obese.
Many factors can influence the care given to patients with chronic illnesses.
Primary Heath Care nurses need to prioritize care based on patient and clinical needs.
The daily practice of nursing requires that patients are prioritized.
To maximise nursing intervention effectiveness and maximize care activities, you need to be able to combine and collaborate on different aspects of patient care.
This case study illustrates how different principles can be combined to provide care for patients with chronic illnesses.
This case study will require you to analyze the situation, identify care needs, and then discuss two complicated care priorities.
Answer to Question: NRSG366 Partnerships In Chronicity
Care Plan for Chronic Disorder
Introduction
Multiple factors can affect chronic diseases. Each factor should be considered as part of a care plan for someone with chronic illness.
As a primary healthcare nurse, it is essential to prioritise the actual clinical needs and patients’ needs, taking into account both past and present circumstances.
To maximize the effectiveness of nursing interventions, it is essential to collaborate and integrate when prioritizing patients’ needs.
This assignment is about the analysis of the case for a 48-year-old obese patient.
Analyse Of The Case ScenarioConsidering Patient Situation Analysis
Michael Anderson, 48, is the patient in this example. He has type 1 and 2 diabetes.
He was admitted to the hospital because of poorly controlled diabetes.
The key symptoms include diaphoresis (shakiness), increased hunger, high BGL, breathing difficulties and difficulty sleeping.
The patient was initially advised to consume low-energy, high protein foods for weight management. However he never expressed any interest in losing weight.
Medical history has shown that his BP is high, which can increase the risk for other diseases.
According to his social history, he lost his employment and began to gain weight.
His obesity made it difficult for him to find a job. This led to him becoming unsocial and a significant problem in his health.
Identifying Your Care Needs
Collect Cues
Michael’s case analysis revealed that Michael’s primary health concern is obesity. Michael currently has a BMI of 57.09 and is 165kg overweight.
In addition, he has hypertension, BP 180/92.
The other vital signs include HR102 (RR 23), SPO2 95.5% at RT, and SPO2 95.0%.
Michael’s case shows that he has not made any effort to adhere to his weight management care plans.
He is currently being admitted to the medical ward. His symptoms include diaphoresis.
His past medical history revealed that he also had depression and gastro oesophageal diseases reflux disease.
His job was lost and he gained weight. He became isolated.
From 95 kg to 135 kg.
He is embarrassed to leave the house due to his weight.
He lives alone. His family rarely visits him.
He is currently having difficulties with ADLs.
Process Information
Before you can identify the right care for Michael, you need to first identify his needs. Then, prioritize the important aspects of Michael’s medical history. This will help you create a care plan.
It was revealed that he is currently suffering from severe obesity and high blood pressure. This can cause other serious diseases, such as cardiovascular problems. (Gulanick & Myers (2013).
He was first diagnosed with type 2 diabetes in 2009. There is a strong correlation between the two health issues.
However, he did not take any action to reduce his body weight (Gordon, 2014).
His other symptoms, such as.
He also has sleep apnoea. However, it was revealed that he lost his job due to his health and he couldn’t find another job. His children are not allowed to visit him.
These were all factors that contributed to his loneliness, social isolation, and weight gain which made him feel ashamed of going out (Sullivan et. al., 2013).
It is clear that his depression stems from social isolation.
Michael’s two biggest concerns, i.e.
Insulin and obesity are interrelated.
He is taking medication for hypertension, chronic pain, and diabetes.
Discussion of Complex Care Priorities
Identifying the Problem
When reviewing and analysing Michael’s case, several key problems were identified that needed to be addressed.
In this context, Michael’s first major problem is poor weight management.
Type 2 diabetes and hypertension are linked to obesity.
Michael’s social isolation was the second issue. It is a result of unemployment and can lead to depression symptoms.
Michael’s previous health care services have not addressed this issue.
Both of these problems could be managed, and the rest, such as sleep apnoea/gastrointestinal issues, and reduced self-image, can be resolved (Tayloret al. (2015)).Establishing Goals
It is crucial to identify the problem and set goals to achieve the best outcomes.
These are Michael’s goals:For 1st Prioritized Problem:
Promotion of weight loss and diet control for health
Motivation for physical exercise
2nd Prioritized Problem
Assistance from the community to reduce depression
Socialization, self-management, and occupational therapy
It is important to take action
Goals
Actions
Promotion of weight loss and diet control for health
Michael can attend a health promotional session that raises awareness of his overall health.
It would allow him to better understand the importance weight management for severely obese patients (Roth 2015.
He would be more likely to do his best to keep to the diet and activities he has been recommended by his dietician and GP.
Lack of awareness is the primary reason he isn’t following his care plans. If he had a supportive relationship with his GP and dietician, he would likely be more open to the management plan (Martin Rodriguez et al. 2015).
Motivation for physical activity
Motivation is key to making patients feel comfortable during therapeutic procedures.
Michael’s primary goal is to get more physical activity. This will help reduce co-morbidity.
Michael would also receive a health promotion session. A physical therapist would then be assigned to develop a six-month exercise program (Pratt & Brody 2014.
Michael should have a strong therapeutic relationship to help him reach his goals.
Michael would be encouraged to incorporate traditional methods of relaxation, such as yoga or meditation, into his routine.
Assistance from the community to reduce depression
Michael’s wellbeing is dependent upon community and social supports. Michael’s obesity has contributed to his depression.
Cognitive behavioural therapy is one of the best ways to reduce depression symptoms. Therefore integration of CBT into Michael’s treatment plan would benefit his well-being and reduce depression and stress related symptoms.
CBT sessions will help him build positive relationships, demonstrate empathy and support, and teach him how to cope with type 2 diabetes and obesity.
To reduce stress, he would be encouraged to use relaxation techniques like yoga, meditation, and even acupuncture.
Self-management, socialization and occupational therapy
Michael lives alone and has a low self-image. This is why he feels isolated.
To help him overcome his negative self-image and to rebuild his self-image through counselling, empathy, support, and counselling, community support programs had to be organized.
Weber & Kelley 2013, 2013: He would be motivated by social programs. Referrals for obesity club, as well as other social programs, could be made available to him to make him more social, meet new people, and rebuild his self image.
A changed self-image would encourage him to regain self management skills, and complete his ALDs.
Additionally, he will receive support socially to find the right job for him. This will improve his socialization as well as reduce depression.
Evaluation
Michael requires significant support to fulfill his personal and professional goals.
Prioritizing Michael’s most pressing problems and providing the necessary support has helped to establish the goals for his care plan.
For example, each goal is specific to a particular domain. It can be measured by Michael’s continuous progress in his health, weight reduction, and improved self image. This can be accomplished through collaborative activities among health professionals and other allied health workers such as a dietician or physical therapist. These goals are time-specific since they would be achieved within a given timeframe (Zinman, 2015).
Reflection
As a primary health care nurse and responsible in the care of Michael, I realized that priority care must be given to patients’ key needs. This will help avoid medical or ethical problems as well as ensure the best possible patient health.
As a primary nurse, I have to be compassionate, dignified, and respectful when communicating with Michael, who suffers from a chronic disease.
Finally, I believe that motivation and support are essential to a holistic and patient-oriented approach to healthcare. This can make it easier for patients to adopt the care methods and maximize therapeutic effects.
I believe partnership is the key to providing high-quality health care services through effective communication.
Conclusion
This assignment focused on the case study of a severely obese patient who also has other health problems.
As key nursing activities, we discussed how to identify the main problems and prioritize them in order to establish appropriate goals for care interventions.
Refer to Reference ListGordon, M. (2014).
Manual of nursing diagnosis. Jones & Bartlett Publishers.Gulanick, M., & Myers, J. L. (2013).
Nursing care plans: nursing diagnosis. Elsevier Health Sciences.Martin-Rodriguez, E., Guillen-Grima, F., Marti, A., & Brugos-Larumbe, A. (2015).
The APNA study.
Obesity research clinical practice, 9(5).Pratt, L. A., & Brody, D. J. (2014).
2005-2010. Depression and obesity among the US adult household population. Women, 20, 39.Roth, C. L. (2015).
Hypothalamic obese in craniopharyngioma victims: impaired energy homeostasis correlated with extent of hypothalamic dysfunction and its implications for obesity intervention.
Journal of clinicalmedicine, 4(9) 1774-1797.Sullivan, M. D., Katon, W. J., Lovato, L. C., Miller, M. E., Murray, A. M., Horowitz, K. R., … & Johnson, J. (2013).
Association of depression and accelerated cognitive loss in type 2 diabetes patients, ACCORD MIND trial. JAMA psychiatry, 70(10), 1041-1047.Swift, D. L., Johannsen, N. M., Lavie, C. J., Earnest, C. P., & Church, T. S. (2014).
Exercise and physical exercise are key to weight loss and maintenance.
Progress in cardiovascular diseases, 56(4). 441-447.Taylor, R. W., Cox, A., Knight, L., Brown, D. A., Meredith-Jones, K., Haszard, J. J., … & Williams, S. M. (2015).
A randomized trial of a family-based obesity intervention. Pediatrics, 136(2), 281-289.Weber, J. R., & Kelley, J. H. (2013).
Assessment of health in nursing. Lippincott Williams & Wilkins.Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., … & Broedl, U. C. (2015).
Heart disease, mortality, and empagliflozin in type 2 diabetes.
New England Journal of Medicine. 373(22), 2117-2128.BibliographyMarmorstein, N. R., Iacono, W. G., & Legrand, L. (2014).
Reciprocal risks: Obesity in adolescence.
International journal of obese, 38(7). 906-911.Papadavid, E., Vlami, K., Dalamaga, M., Giatrakou, S., Theodoropoulos, K., Gyftopoulos, S., … & Rigopoulos, D. (2013).
Study of sleep apnea and its comorbidity among obese psoriasis patient: Cross?sectional.
Do metabolic parameters and psoriasis characteristics have a role in this?
Journal of the European Academy of Dermatology and Venereology. 27(7): 820-826.Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016).
Fundamentals of Nursing. Elsevier Health Sciences.Wadden, T. A., Volger, S., Sarwer, D. B., Vetter, M. L., Tsai, A. G., Berkowitz, R. I., … & Chittams, J. (2011).
Two-year randomized trial of obesity treatment within primary care.
New England Journal of Medicine (365(21), 1969-1979.