Answer

 Chronic Care: Mr. James Store Case Study

Risk Factors

            Risk factors for type II diabetes include a combination of lifestyle and genetic. For Mr. James Storey, the risk factors can be identified as chronic diseases such as hypertension, routine use of alcohol, smoking, obesity, advanced age, sedentary lifestyle, family history of cardiovascular disease and type II diabetes, high cholesterol levels, and high-fat diet. These are risk factors because they make it impossible to maintain healthy blood sugar and blood pressure levels. With age comes less more inactivity, weight gain, and muscle mass loss which predisposes one to type 2 diabetes. James at 66 years is at risk of contracting the disease. His inactivity levels after closing his business because it was causing him stress and had developed feelings of tiredness also poses a risk. Although he rarely eats sugar, James takes in high carbohydrate foods such as pasta and bread and too many fresh fruits as snacks. Drinking beer also increases the number of processed carbohydrates taken while smoking raises the patient’s oxidative stress and consequently chances of type 2 diabetes. Uncontrolled hypertension is also a predisposing factor to type-2 diabetes in this case (Tsimihodimos et al., 2018).

Assessment Priorities

            A comprehensive assessment of Mr. James should include the initial and follow up evaluations, comorbid conditions management, psychosocial assessment, and patient engagement through the assessment process (American Diabetes Association (ADA), 2018). The assessment components should be prioritized depending on the available time and resources to offer information that will ensure the patients get optimal healthcare support. Laboratory tests and physical examinations should also be administered to guide on routine immunizations and assess the patient’s psychosocial health, nutrition, and self-management behaviors for hypertension and type 2 diabetes. Consideration should also be given to the assessment of sleep duration and pattern (Australian Health Ministers’ Advisory Council, 2017). Follow-up visits should be scheduled after 2 months for Mr. James because he has indicated non-adherence to medication intake and home diabetes monitoring until he is stable and able to maintain a healthy lifestyle. Assessment of the amount of education received should be conducted to determine whether the patient needs more self-management advice and training. Modifiable risk factors should be assessed and addressed (American Diabetes Association (ADA), 2018). For Mr. James, modifiable risk factors involve identification of smoking status and how it can be stopped, exercise, and how it can be incorporated in his life, dietary patterns, and how they can be modified to improve glycaemic control, and alcohol intake and how to stop.

Self-Management Priorities

            Self-management stimulates patients and provides to utilize a collaborative approach to problem identification, priority setting, goal setting, and treatment plan creation to resolve issues as they arise (Carpenter et al., 2019). The major aim of diabetes self-management is to keep glucose levels close to the optimal range of 4-6mmol/L to prevent both long term and short term complications. One of the self-management activities for Mr. James is eating well. This will facilitate proper management of the glucose levels in the blood and the patient’s body weight. Self-management will also include regular monitoring tests on how the treatment is adhered to facilitate blood glucose level management and help determine when a treatment adjustment is required (Klinkner et al., 2017). Exercising is also required to increase the efficiency of insulin, reduce heart disease risk, and lower the patient’s blood pressure (Tsimihodimos et al., 2018). Mr. James should also be enrolled in smoking and alcohol drinking therapy training to aid in stopping their use. Emphasis should be laid on proper medication intake to increase their effectiveness in managing the blood glucose levels (Carpenter et al., 2019). Since Mr. James has indicated weak adherence to medication, he should be linked to a local support group.

SMART Goal

            I will eat 50 grams of healthy carbohydrates per meal and engage in 30 minutes of brisk walking per day split into two mornings and evening 15-minute sets to lose I pound per week and 10 pounds over a 3 months duration.

            One of the most optimal methods of diabetes management is reducing body weight and fat index (Klinkner et al., 2017). This is achieved through a combination of a low carbohydrate diet and increased physical exercise. A low carbohydrate diet reduces the amount of stored sugar and hence reduces the blood sugar levels responsible for type 2 diabetes. Physical exercise, on the other hand, helps in burning excess body fats which are predisposing factors for type 2 diabetes. Therefore, the SMART goal was selected because it gives the required amount of carbohydrates and physical exercise needed to achieve the 1 pound loss of body fat per day. This will also strengthen Mr. James physically to eliminate comorbidities resulting from type 2 diabetes complications and incidences of cardiovascular diseases registered in the family history.

Impact of Goal Setting

            Patient engagement in goal setting creates a holistic plan in the management of their health (Klinkner et al., 2017). When the patient is involved in setting the self-management goals, they are inclined to be more active (Australian Health Ministers’ Advisory Council, 2017). Besides, patient likelihood to follow a plan increases when they know there is an important goal to achieve (Van Smoorenburg et al., 2019). For instance, for Mr. James, reducing the amount of carbohydrate and engaging in physical activity would mean avoiding comorbidities, eliminating cardiovascular disease risk, and reopening his business.

            Patient engagement in goal setting also ensures they are par with the healthcare professionals (Van Smoorenburg et al., 2019). For instance, Mr. James believes that a healthy diet means the elimination of refined sugar while for type 2 diabetes it includes a reduction of carbohydrate intake. Therefore, engaging the patient in goal setting enables them to understand the meaning of each element contained therein to adhere to the intended care plan (Klinkner et al., 2017).

Engagement also creates accountability (Australian Health Ministers’ Advisory Council, 2017). Measurable goals with a deadline encourage the patient to participate in the care plan (Klinkner et al., 2017). For instance, dividing the physical wellness exercises into two parts will enable Mr. James to avoid feeling overburdened. Besides, regular monitoring of weight loss after every week will facilitate tracking of the progress which he can do as an individual or part of a support group comprising of like-minded individuals.