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The patient is an 80-year-old man Sherman Yoder, referred to as Red. He lives in a farmhouse with his son Jon and his family. Red was diagnosed with diabetes six months ago and started taking medications, but three weeks ago the doctor changed the treatment to insulin injections.
Soon After Diagnosis
Strengths
The main strength of Red is that he tries to live an active lifestyle in spite of his illness and old age. He shows a moderate degree of independence and carries out most of his daily activities without help. Red does not present any signs of depression and meets with his friends on a weekly basis as planned.
Problems
Red does not adhere to dietary recommendations as set by the doctor. He also lacks family support for his chronic illness, which may impair the quality of life of the patient and may pose risks to health.
Assessment Needs and Tools
The patient mentions a sore on his foot, which needs to be assessed by the nurse. Due to the patients failure to adhere to dietary recommendations, there is also the need to evaluate the Reds overall risk for health complications due to diabetes. Assessment tools that can be used in this case include quarterly A1C testing (ADA, 2014), as well as Qrisk2 cardiovascular risk score and HARP risk calculator (Koumakis, Chiarugi, Lagani, Kouroubali, & Tsamardinos, 2012).
Next Steps
Upon examination of the sore on the patients foot, antibiotic treatment may be needed to prevent infection. Education should be provided to Reds family regarding the support of elderly diabetes patients. Risk assessments should be performed to evaluate the patients risk for complications.
The Time of an Acute Illness
Strengths
The patient indicates strong support from friends, which is a valuable source of encouragement and entertainment for patients living with chronic illnesses. He also presents strong desire to pursue his regular activities.
Problems
The patients overall state is worrying. One of the problems is his lack of appetite, which may indicate a risk for gastroparesis (Lee, 2012). Regular coffee consumption, on the other hand, may lower insulin sensitivity (Shi, Xue, Liang, Zhao, & Zhang, 2016). The patient also complains about high blood sugar despite the lack of meals. The footsore shows signs of infection, as the patient has not been taking antibiotics as prescribed.
Assessment Needs and Tools
The patients low appetite presents a need to assess the patient for other symptoms of gastroparesis, such as bloating and stomach pain (Lee, 2012). There is also the need to examine the sore on the foot for risk of sepsis. Physical examination and symptom assessment should be used for assessing the risks.
Next Steps
The patient should be examined for the risks presented and, if necessary, referred to a doctor for further diagnostics and treatment. Education and advice should be provided to the patient regarding the management of persistent high blood glucose.
Post Hospital Discharge
Admission to hospital for sepsis was an indication of the need to address the patients needs regarding the management of his chronic illness. The patients decision to live on his own, on the other hand, may incur additional risks to health, which is why education and frequent follow-ups are needed.
Assessments
As the patient moves to live on his own, it is necessary to examine his living conditions. Continuous follow-up risk assessments are also needed, as well as scheduled A1C tests and POC testing to identify changes to treatment (ADA, 2014). Evaluation of the patients knowledge of therapeutic needs is also required to determine whether or not the patient is capable of effective diabetes self-management (ADA, 2014).
Risks and Benefits
The patients choice to live on his own is understandable, although it does raise certain concerns. For instance, the patient may not be able to have quick access to help if required. Also, Red will now be responsible for controlling his diet and treatment, which he may not be effective in due to his old age. One of the main benefits, however, is the lack of pressure from the patients son, who is frequently irritated about Reds illness and the need for support.
Needs
The core need of the patient, both at this time and in the future, is to ensure adherence to diet and treatment. Another need is for Red to maintain close connections with friends to prevent loneliness. Due to the new living arrangements, there may also be a need for more frequent follow-up visits to ensure positive condition and address any health concerns.
Communication Strategies
Continuous communication with the interprofessional team should be maintained to circulate relevant information and ensure adequate care. Communication with Red should be focused on education regarding treatment and assessment scheme required to manage and monitor the condition. The patients family should be approached to address Reds need for medical and social support. The patients son should receive necessary information for medical emergencies and care.
Conclusion
The patient shows adequate management of his chronic illness, although there are still risks related to non-adherence to treatment and diet. The patients family may become a major source of support and help to raise the quality of Reds life as long as they receive enough education on the patients needs and are willing to help. Overall, if the communication strategies prove to be successful, the patient can manage the disease successfully and avoid serious medical risks, as well as social exclusion.
References
American Diabetic Association (ADA). (2014). Executive summary: Standards of medical care in diabetes 2014. Diabetes Care, 37(1), s5-s13.
Koumakis, L., Chiarugi, F., Lagani, V., Kouroubali, A., & Tsamardinos, I. (2012). Risk assessment models for diabetes complications: A survey of available online tools. International Conference on Wireless Mobile Communication and Healthcare, 2011(83), 46-53.
Lee, L. A. (2012). Gastroparesis.
Shi, X., Xue, W., Liang, S., Zhao, J., & Zhang, X. (2016). Acute caffeine ingestion reduces insulin sensitivity in healthy subjects: A systematic review and meta-analysis. Nutrition Journal, 15(1), 103-109.
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