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  1. Michael case study

     

     

     

     

     

     

    1. BMI and waist circumference are two method tools used to determine obesity. Discuss the two (2) tools and justify which measurement is the most effective to determine obesity?

    (3 marks)

    1. Review the anatomy and physiology of the three types of diabetes (Type 1, Type 2 and Gestational). Identify the type of diabetes Michael has? Discuss and justify the answer.

    (2 marks)

    1. Review and recall your knowledge of diabetes and the possible adverse complications that may occur. Identify four (4) signs of hyperglycaemia. Discuss one (1) of these signs of hyperglycaemia and justify using anatomy and pathophysiology.

    (4 marks)

    1. Citalopram is a commonly used medication to treat anxiety and depression in adults. Describe the mode of action of this medication for Michael. State (2) administration considerations and (2) side effects of this medication.

    (4 marks)

    1. On review of Michael’s case, identify two (2) allied health professionals you would consider referring Michael to? Provide a detailed rationale for this discipline’s involvement in relation to the case study.

    (6 marks)

    1. From Michael’s physical assessment, there were abnormal findings including his blood glucose level (BGL), blood pressure (BP), temperature and pain. Choose three (3) of these abnormal findings in relation to Michael’s presentation. Discuss and justify with relevant pathophysiology.

    (6 marks)

    1. List and justify the three (3) highest priority nursing problems for Michael.

    (6 marks)

    1. For each priority nursing problem, write one (1) goal of care in SMART format.

    (3 marks)

    1. Based on one goal, state and describe (2) interventions (nursing, collaborative or pharmacological) which would assist to achieve Mr. Dwight’s short-term goal.

     

     

     

     

     

     

     

 

Subject Nursing Pages 8 Style APA

Answer

Question 1

BMI and waist circumference are two method tools used to determine obesity. Discuss the two (2) tools and justify which measurement is the most effective to determine obesity?

The body mass index (BMI) refers to value obtained from height and weight or mass of a person and expressed in kg/m2 which results from height in meters and mass in kilograms. The body mass index attempts to reckon the quantity of tissue mass including bone, fat, and mass in a person after which categorize that individual as overweight, normal weight, underweight, or obese on the basis of the value obtained. An individual with a weight above 30 kg/m2 is considered obese because normal weight ranges between 18.5 kg/m2 to 25 kg/m2. On the other hand, waist circumference refers to the measurement of waist at a midway level usually between the iliac crest and lowest rib (Nuttall, 2015). Measuring waist circumference requires directly placing the tape measure on one’s skin. The two tools are used to determine obesity; however, body mass index is the most effective tool because it provides an assessment of total body fat as well as the risks of developing weight-related disorders (Batsis et al., 2016).

Question 2

Review the anatomy and physiology of the three types of diabetes (Type 1, Type 2 and Gestational). Identify the type of diabetes Michael has? Discuss and justify the answer.

 

There are three types of diabetes including of type 1, type 2, and gestational diabetes. Type 1 diabetes refers to a chronic disorder involving the pancreas producing no insulin or little insulin, and therefore the patient requires supplemental insulin. The immune system erroneously attacks the pancreatic beta cells which produce insulin, therefore, destroying and decreasing the ability of the body to generate adequate insulin as well as regulate the levels of blood glucose (American Diabetes Association, 2014). On the other hand, refers a progressive condition where the body gradually becomes incapable to produce adequate insulin in the pancreas or turn out to be resilient or resistant to the normal effect of insulin. In other words, type 2 diabetes exists where there is insulin deficiency or resistance. Lastly, gestational diabetes occurs or develops during pregnancy and characteristically resolves after child-birth. Moreover, gestational diabetes raises the risks of developing type II diabetes after childbirth. Michael is likely to be suffering from type II diabetes due to symptoms such as obesity, depression, arthritis, diaphoresis, and increased hunger (American Diabetes Association, 2016).

Question 3

Review and recall your knowledge of diabetes and the possible adverse complications that may occur. Identify four (4) signs of hyperglycaemia. Discuss one (1) of these signs of hyperglycaemia and justify using anatomy and pathophysiology.

Diabetes has become one of the chronic conditions that most persons suffer from and results in severe complications such as heart attack, cancer, hypertension, and premature death (Nuttall, 2015). It is obstinately characterized by having higher glucose level or sugar in the blood. It arises when either the pancreas fails to produce sufficient insulin or when the body fails to make an effective use of the insulin which it produces. High levels of glucose in the blood result Hyperglycaemia, which ultimately lead to high insulin resistance. Hyperglycaemia is characterized by signs such as headache, fatigue, blurred vision, frequent urination, and increased thirst (American Diabetes Association, 2014). Frequent urination or polyuria occurs when excess glucose or sugar builds up in the blood forcing the kidneys to work actively more to filter as well as absorb the excess glucose. Notably, if the kidneys cannot keep up, the surplus or excess glucose is excreted into the urine triggering more frequent urination that leads to dehydration. One would even urinate more when drinking more fluids to quench the thirst.

Question 4

Citalopram is a commonly used medication to treat anxiety and depression in adults.  Describe the mode of action of this medication for Michael. State (2) administration considerations and (2) side effects of this medication.

 

The mechanism of action of Citalopram in Michael will result from its inhibition of the central nervous system neuronal re-uptake of serotonin. The drug will molecularly target serotonin transporter. It will bind with critically less affinity to norepinephrine, acetylcholine, and histamine receptors (Blier, 2016). Therefore, uptake would be the most vital action for terminating the actions of neurotransmitter and removing them in Michael’s case. Before, administering Citalopram, the healthcare provider must consider a patient’s therapy, for example, whether the patient is receiving IV methylene blue or linezolid . this is because Methylene blue and Linezelid belong to the class of MAOI but citalopram is contraindicated for concomitant use in patients receiving MAOI therapy, due to the risk for serotonin syndrome (Tan et al., 2015).  Additionally, CrCl >= 20mL/min should have no dosage adjustment and the drug ought to be administered as single dose orally of 20mg per day. Nevertheless, the drug has some side effects including dry mouth, nausea, headache, inability to sleep, excessive sweating, drowsiness, and vomiting (Blier, 2016).

Question 5

On review of Michael’s case, identify two (2) allied health professionals you would consider referring Michael to? Provide a detailed rationale for this discipline’s involvement in relation to the case study.

One of the healthcare professional I would refer Michael to is a dietician.  Notably, Michael is diabetic, a condition which can be managed by the type of food the patient eats alongside medication. According to Kushner (2014), Evidence-based research powerfully recommends that diet therapy given by an experienced registered dietitian in the management of diabetes is clinically effective. Another study carried by Kushner (2014), reveals that controlled diabetes is attained by managing medication, diet, and lifestyle effectively which can only be achieved through specialized dietician. On the same note, Michael is also obese, a medical condition which requires the expertise of a dietician to provide a guideline on what and when to eat in a manner that does stress the patient. He states that every time he tries to cut down on his eating he experiences symptoms such as shakiness, increased hunger, and diaphoresis. This means that he has no effective plan to control his eating habit, which is his major cause of obesity.

Another healthcare professional I would consider refereeing Michael to is a psychiatrist. According to this case, Michael is suffering from depression, a mental illness which require healthcare provider who is well trained on matters of mental disorder. Psychiatrists are medical professionals who focus on the diagnosis, management, and treatment of mental illnesses (Kushner, 2014).  Particularly, these health professionals analyze and evaluate patient data to identify nature and the extent of a mental disorder.  Since a psychiatrist is also responsible for the psychological disorders, he/she is the best person to advice Michael to engage in active social and physical activities since being alone is one of the factors which causes too much thinking hence stress and depression. The fact that he does not take anti-depressants calls for a psychiatrist who shall prescribe the correct dosage in case the current ones do not work.

Question 6

From Michael’s physical assessment, there were abnormal findings including his blood glucose level (BGL), blood pressure (BP), temperature and pain. Choose three (3) of these abnormal findings in relation to Michael’s presentation. Discuss and justify with relevant pathophysiology.

The first abnormal finding in Michael’s assessment is blood glucose level (BGL) which is 9mmol/L. Blood glucose levels rise either because there is an insufficient amount of insulin in the body or the body cannot use insulin well. Normally, the pancreas releases insulin after a meal so that the cells of the body can utilize glucose for fuel (). According to the standards, a person whose BGL is less than 5.6mmol/L is considered normal. A person whose BGL ranges from 5.9 to 6.9mmol/L is considered prediabetes (American Diabetes Association, 2016). However, anything above 7.0mm/L is considered diabetic. Michael has a BGL of 9mmml/L, which is considered abnormal and indicates that he is suffering from a serious level of diabetes.

The second abnormal finding in Michele’s assessment is blood pressure. Blood pressure is a measure of two pressures known as the diastolic and the systolic. The systolic pressure is the pressure blood exerts on the arterial walls as the heart contracts to pump and distribute blood to the peripheral organs and tissues. The diastolic pressure is residual pressure exerted on the arteries as the heart relaxes between beats (). Found to be 160/70mmHg Michael’s blood pressure is beyond normal and considered risky for his health. According to American Diabetes Association (2016), blood pressure can be defined by the pressure at which it passes through the artery. There are several causes of high blood pressure in Michael’s case. First, he has been diagnosed with hypertension, which itself is high blood pressure. Secondly, high blood pressure is common in people with who are overweight. Another factor is lack physical activity since most of the times he is indoors.

Michael has abnormal weight against his height. This has resulted to obesity which is measured by BMI. An individual with a weight above 30 kg/m2 is considered obese because normal weight ranges between 18.5 kg/m2 to 25 kg/m2. High BMI has been brought by poor physical activities and poor diet.

Question 7

List and justify the three (3) highest priority nursing problems for Michael

The first priority is hyperglycemia, a condition caused by high blood sugar level.  Michael has abnormal blood sugar level of 9mmol/L, when actually the normal ranges should be should be between 3.9 and 7.1 mmol/L. (LaChapelle et al, 2015). This puts his health at risk since he is likely be affected by kidney damage failure, never damage a condition now as neuropathy, diabetic retinopathy which can lead to blindness (Nuttall, 2015).

The second priority is management of pain in his knees and legs. Although the pain is still at 4/10 it is likely to increase which can put the patient in agony. On the same note, pain is among factors which subject the client to stress hence depression. Therefore, it should be addressed as soon as possible (Nuttall, 2015). The psychological side effects of living with chronic pain can be as debilitating as the pain itself.

High blood pressure or hypertension. Blood pressure od Michael has reached 160/70 mmHg when the normal should be between 120/80-140/90 (SPRINT Research Group, 2015). It increases the risk of a heart attack or stroke. High blood pressure can also cause heart and kidney disease, and is closely linked to some forms of dementia (SPRINT Research Group, 2015).

Question 8

  1. For each priority nursing problem, write one (1) goal of care in SMART format.

S

Michael’s blood pressure will lower to be within the normal range, to prevent other health complications such as stroke or plaque buildup (Nuttall, 2015).

M

Michael’s blood pressure to be in at least higher normal range. Under 140/90mmhg (Nuttall, 2015)

A

To achieve normal blood pressure within days

R

To make sure Michael has all the education necessary to maintain the normal blood pressure for the rest of his life.

T

Michael’s blood pressure will be within normal range within days.

 

S

Lowering Michael’s blood sugar levels to normal range, to prevent other health complications such related to hyperglycaemia, by giving him insulin if necessary and providing education about diabetes (LaChapelle et al, 2015).

M

Michael’s blood sugar levels to be within normal limits.

A

Lower his blood sugar levels within normal limits within hours

R

To make sure Michael will know how to maintain the normal blood sugar levels

T

His sugar levels will be down within hours

 

S

Managing his pain which is probably caused by either recurring hyperglycemia or arthritis. This will be achieved by managing his sugar levels and medication if necessary (Rothrock, 2018)

M

Michael’s pain to be manageable for him

A

Take away his pain as soon as possible

R

To provide education about pain and management, obesity and hyperglycaemia as well as arthritis

T

Pain score will be 0/10 within minutes/hours

 

 

Question 9

  1. Based on one goal, state and describe (2) interventions (nursing, collaborative or pharmacological) which would assist to achieve Mr. Dwight’s short-term goal.

There are two interventions which nurses can use to reduce knee pain.  The first is to play with temperature. For the first 48 to 72 hours after a knee pain, a cold pack can be used to ease swelling and numb the pain (Rothrock, 2018). A plastic bag of ice or frozen peas works well. Use it for 15 to 20 minutes three or four times a day lot of junk foods such as snacks. The second intervention is use of drugs.  Taking drugs for high blood pressure and high cholesterol will slow down the knee pain the patient is currently undergoing (Rothrock, 2018).

 

Question 10

Provide and justify two (2) methods of how you would evaluate the outcomes.

One of the outcome evaluation is physical examination. Just like before, Michael was subjected to physical examination where certain symptoms were observed and noted down and led to pronouncement that he was suffering from certain condition or diseases for example, obesity.  On the same note, during evaluation same physical examination should be carried out to determine if he still suffering from such diseases. This could include measuring blood pressure, blood sugar level, and the extent of pain (Rothrock, 2018).

Another form of evaluating the outcome is through the interview. This is done between healthcare provider and the patient. Before the intervention, the patient was complaining of several issues such fatigue, blurred vision, tearfulness, and inability to take his antidepressant. After intervention, these feelings and symptoms should be absent or reduce. If they reduce or removed totally then the outcome is positive; however, if such symptoms persist then the outcome is negative (Oermann & Gaberson, 2016).

Question 11

Identify and discuss two (2) mental health illness risks for Michael with links to relevant literature.

One of mental health illness risks for Michael is Post-Traumatic Stress Disorder (PTSD). Originally known as Shell Shock, PTSD is an anxiety related mental disorder which usually occur after stressful situation. According to the study conducted by Martins (2015), about 10 percent of the population develop PTSD at some points in their life in the United States.  The author reveals that among the ten percent, majority are people who have undergone through certain diseases and disorders such as obesity and hypertension which have exposed to some level of stress. In this case, Michael has under stress as a result of various diseases and conditions such as obesity. Therefore, he is at risk of PTSD.

Another mental health illness risks for Michael is depression. According to Corrigan (2014), main causes of depression include poor nutrition, stress, lack physical health, and genetics. The above mentioned factors have been identified from Michael. Poor nutrition has led to obesity. He is indoors and does not engage in physical activities. His condition also stresses him. Thus he is at risk of developing depression.

Question 12

Review Standard 3 of the NSQHS. Michael is at higher risk of healthcare associated infections (HAI’s) and diabetic foot ulcers.  Explain why he is a greater risk of and one (1) nursing intervention that could be implemented to reduce this risk? Justify your answer.

HAIs are infections that patients get while receiving treatment for medical or surgical conditions. Obesity, like multiple trauma, is associated with an inflammatory condition that leads to an immunodeficient state which puts Michael at high risks of acquiring HAIs.  According to the study conducted by Rothrock, (2018), obese patients are thus thought to be at higher risk of infection compared to patients of normal body mass. Despite this risk, studies to date have not defined obesity as an independent risk factor for infection in trauma patients.  The nursing procedure that could prevent HAIs in the case of Michael is observation of hygiene. According to National Safety and Quality Health Service (NSQHS) Standards, healthcare providers should ensure devices and site of operation are clean and free from any infections. Also surgical procedure set by NSQHS should be followed.

 

 

 

References

American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes care37(Supplement 1), S81-S90.

American Diabetes Association. (2016). Standards of medical care in diabetes—2016 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association34(1), 3.

Blier, P. (2016). Neurobiology of depression and mechanism of action of depression treatments. J Clin Psychiatry77, e319.

Corrigan, P. W. (2014). The stigma of disease and disability: Understanding causes and overcoming injustices. American Psychological Association.

Kushner, R. F. (2014). Weight loss strategies for treatment of obesity. Progress in cardiovascular diseases56(4), 465-472.

Martins, I. J. (2015). Nutritional and genotoxic stress contributes to diabetes and neurodegenerative diseases such as Parkinson’s and Alzheimer’s diseases.

Nuttall, F. Q. (2015). Body mass index: obesity, BMI, and health: a critical review. Nutrition today50(3), 117.

Peck, J. L. (2014). Social media in nursing education: responsible integration for meaningful use. Journal of Nursing Education53(3), 164-169.

Rothrock, J. C. (2018). Alexander’s Care of the Patient in Surgery-E-Book. Elsevier Health Sciences.

 

 

 

 

 

 

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