Nursing Care Plan for Liam: Managing Type 2 Diabetes and Hypertension

This nursing care plan discusses the management of type 2 diabetes and hypertension for Liam. It includes nursing diagnosis, goals, interventions, and evaluation. Learn how to create a care plan for patients with chronic conditions.

1
Assignment Part-2
Nursing Care Plan

2
Introduction
This assignment is based on the case study of Liam, who have been facing many social
determinants of health that are affecting his physical well-being and quality of life. , Liam has
been living a sedentary lifestyle, eating unhealthy food, smoking a packet of cigarette every
day and drinks alcohol all most every day. Due to his occupational requirements, his work
stress is high, and he has been unable to reduce weight. Due to his unhealthy lifestyle, high
intake of fast food and lack of physical activity, he has been diagnosed with type 2 diabetes
and hypertension. Self-management is considered as the most significant approach for
managing type 2 diabetes, because self-management approach enhances the patient’s
awareness towards the problem, which directly affect their health behaviour and attitude
(Baghbanian, & Tol, 2012). Therefore, Chronic Care Model (CCM) has been identified as the
most appropriate self-management model of care. This paper will discuss the nursing care
plan for Liam including the 3-priority nursing diagnosis and will provide the short-term and
long-term care goals for the patient.

3

4
Nursing Care Plan
Nursing
Assessment
Nursing
Diagnosis
Goals Interventions Rationale (please rewrite the
rationale as per my interventions)
(with in-text references)
Evaluation
First significant
problem that Liam
has gained his
weight due to
regular eating of
fast food meals.
Therefore, his first
need is to reduce
weight. However,
his weakness is that
he could not access
healthy food. His
strength is that he
understands the
significance of
reducing weight for
his health, which
can be a significant
factor for
promoting healthy
habits and healthy
diet.
Imbalanced
nutrition: more
than body
requirements
due to regular
intake of Fast
food meals rich
in fats and
carbohydrates
(Daw, Margolis,
& Wright, 2017).
Short term-
Patient will
identify and try
to control
underlying
factor of
increased
weight such as
over-eating,
stress or self-
neglection, by
1-2 days.
Long term-
Patient will
reduce weight
in between 10
to 15 kgs by
making some
lifestyle and
dietary
For brining changes in
patient diet, first
intervention is to
1. Assess the calorie
intake, time and
content of each
meal
2. Encourage the
client to eat
healthy carbs and
also encourage
the client to avoid
of fatty and high
calorie diet such
as fast food.
3. Emphasize the
client to drink
plenty of fluids
and also reduce
1. Assessing the patient’s current
meal time and content will
inform about the deficits and
deviations from the therapeutic
needs (Sami et al, 2017).
2. Study conducted by Alfadda,
Sallam, & Park, (2019) has also
identified that intake of fatty and
high calorie food can
significantly result in consistent
weight gain and will not allow
patient to manage weight.
3. Reducing the salt intake and
increasing water intake has been
identified in reducing the sugar
level in the body and reducing
saturated fat (Bankir et al,
2017).
4. Study conducted by Villareal et
al (2017) has identified that
aerobics and strength training
helps in reducing body fat.
Within first week,
complete record of the
patient diet will be
prepared.
For achieving the long-
term goal, patient was
encouraged to take
balanced diet, meet
dietician and eat healthy
food. Therefore, in six
months patient’s weight
will be measured and
reduction in weight will
display the efficacy of
intervention.

5
modifications
by 5-6 months.
intake of sodium
in diet.
4. Encourage the
client to take part
in exercises
programs such as
aerobic and
strength training
exercises.
5. Educate the
patient about
importance of
nutritious diet and
required
supplements
through weekly
health education
sessions.
6. Dietician Review
to provide proper
measurements of
intake of calorie
as per client’s
BMI and also to
provide education
of health risks
related to gained
weight (Merakou
et al, 2015).
5. Education also helps in
improving adherence to
treatment plan, and reducing the
intake of alcohol and smoking
cigarettes and sticking to
balanced and nutritional diet
(Dinh et al, 2016)
6. Dietician can significantly help
the patient to inform about the
behavioural health risks that can
result in weight gain
(Baghbanian, & Tol, 2012).

6
-
Liam has been
diagnosed with
Hypertension
evidenced by
sudden chest pain
and recording of
higher readings of
Blood pressure on
hospital
investigations.
There could be
several reasons of
high blood pressure,
such as high
cholesterol diet,
physical inactivity,
smoking and
alcohol intake and
other pathological
conditions.
Altered cardiac
output
Short-term-
Maintain the
Blood pressure
in acceptable
range in 2-3
hours.
Long-term-
Patient will
maintain the
adequate
cardiac output
by making
some dietary
and lifestyle
changes over
the period of
2-4 weeks.
1. Bilaterally
Monitoring and
recording of
patient’s blood
pressure
regularly.
2. Pharmacological
management of
hypertension such
as administration
of beta-blockers
or anti-
hypertensive
drugs as per GP
prescription and
monitor the
effectiveness of
drugs.
3. Cardiopulmonary
assessment
including heart
sounds, breath
sounds, pedal
pulses by weekly
1. Monitoring and recording
patient’s blood pressure is
significant for identifying the
fluctuations in blood pressure.
Regular monitoring can also
help in assessing the patient
condition and managing the risk
of co-morbidities (Gorina,
Limonero, T., & Alvarez, 2018).
2. Jankowska-Polańska et al,
(2016) has identified that
pharmacological treatment is
important for brining immediate
changes in blood pressure.
Regular medication of beta-
blockers or anti-hypertensive
drugs can improve patient’s
condition and can reduce
problem of hypertension within
short time period.
3. According to Stout, et al (2016)
cardiopulmonary assessment and
regular monitoring is significant
for identifying the risk of heart
diseases or pulmonary
deterioration.
4. Assessment of the patient is
The condition of the
patient will be evaluated
with the changes in the
blood pressure and
ability towards activity
tolerance. Patient will be
adhere to treatment and
conduct self-care
activities required for
reducing blood pressure.

7
follow-ups with
cardiologist.
4. Assess and
compare client’s
reports of
extreme fatigue,
sudden weight
gain, feeling of
exertion,
inactivity
intolerance etc.
during weekly
check-ups at GP
clinic.
5. Encourage the
patient to reduce
work stress and
cessation of
alcohol and
smoking and also
suggest the
patient to take
part in health-
related
community
programs.
6. Educate the
patient about at-
important for effective future
care planning and preventing
any sudden deterioration or
health risk (Daskalopoulou ey al,
2015).
5. According to Klatsky, (2015),
smoking and alcohol intake can
affect the patient and increase
the risk of cardiovascular
diseases.
6. Health education is considered
as the significant approach
towards changing individual’s
attitude and health behaviour,
promoting self-care skills and
adhering to treatment regimes
(Breen et al, 2015).

8
home BP
monitoring skills,
be complaint with
medication
regimes and self-
care.
Liam has been
diagnosed with
type-2 Diabetes
Mellitus, due to
higher intake of fast
food, less exercise
and increased work
stress etc.
Unstable blood
glucose level
Short-term-
maintain the
blood glucose
level within an
acceptable
range in
between 2-4
hours.
Long-Term-
Patient will
report of
controlled
blood glucose
level either
with
medication
over 1-2 weeks
or with dietary
precautions
over the period
of 5-6 months.
1. Assess for signs
of
hyperglycaemia
(Rett, &
Hostalek, 2019).
2. Monitor and keep
recording of BGL
before and after
meal daily.
3. Assess patient’s
eating pattern and
lifestyle
behaviours and
suggest patient to
make some
dietary and
lifestyle changes.
4. Encourage the
patient to take
medication (oral
or S/C insulin)
regularly as per
doctor
prescription.
5. Enhancing the
deficient
1. Assessment of the patient
regularly is important in order to
maintain the efficacy of the
pharmacological and non-
pharmacological treatment
options. Assessing the signs and
symptoms are significant for
preventing co-morbidities or risk
of other chronic conditions (such
as cardiovascular disease, foot
ulcers, renal disease, stroke etc)
(Rett, & Hostalek, 2019).
2. Monitoring and keeping the
report of BGL before and after
meal is important for evaluating
the level of blood glucose
(Khan, Masud, & Mamun,
2017).
3. Assessing patient’s eating
pattern is important or
understanding unhealthy
behaviour and for encouraging
patient to make lifestyle changes
(Boehmer et al, 2018).
4. Encouraging patient to take
Patient will become more
conscious towards own
health and will be able to
conduct self-care
activities.

9
knowledge of the
patient regarding
the disease
process,
treatment and
individual care
(Powers et al,
2017)
6. Referred to
Diabetic educator
to teach the
patient about
BGL monitoring
skills, self-
administration
skills of sub-
cutaneous insulin
and to provide
more education to
control of
Diabetes.
prescribed medication is
important for maintaining the
efficiency of pharmacological
therapies (Bongaerts et al, 2017).
5. Knowledge about personal
health will also help patient to
take support and guidance of
professionals. Studies have
identified that self-management
education and knowledge is very
important for type 2 diabetes
patients (Powers et al, 2017)
6. Self-monitoring and
administration skills will help to
save patient’s time and will also
improve their self-management
capacity (Powers et al, 2017)

10

11
Facilitators and Barriers
Self-management model of care has been identified as the most appropriate approach for
managing the condition of Liam. Studies have identified that this care model is significant in
improving the self-care abilities of the patients (Bonner, Foster, & Spears-Lanoix, 2016).
Diabetes is a chronic illness that can start progressing with fast pace, if not controlled with
appropriate treatment, therapies, self-management approaches and nursing interventions.
Primary care-based approach is therefore, necessary for the patients suffering with type 2
diabetes. Therefore, Bongaerts et al (2017) has identified that self-management model of care
is effective in developing a patient centred care program. This enhance the collaboration of
the various healthcare professionals, who provide coordinated and integrated care to the
patient (Gucciardi et al, 2016).
However, there could some facilitators and barriers that could influence the implementation
of model for type 2 diabetes patients (Bongaerts et al, 2017).
 First facilitator is positive attitude of the patient because it will promote self-care
management, patient education programs (Baghbanian, & Tol, 2012).
 Second is training and education programs for nurses and other professionals because
it will help in improving their skills to deliver high quality care (Boehmer et al, 2018)
 Third is individual ability to make optimal health because making the correct and
healthy choices is important for self-management (Davy et al, 2015).
 Collaborative working skills of health professionals because it helps in delivering
patient centred high quality and integrated care (Bongaerts et al, 2017).
 Individual’s ability to work in partnership with health providers will help in
facilitating better support for the patient (Bonner, Foster & Spears-Lanoix, 2016).
The facilitators can help in enhancing the quality of care and support provided to the patient.
These facilitators are also important for delivering long term care and support.
 The first barrier is patients’ personal values, because personal values and perception
can restrict from adhering to treatment regimens (Baghbanian, & Tol, 2012).
 Second barrier is perception and attitude towards engaging in self-care management,
because the patient may not be enthusiastic towards caring for self (Davy et al, 2015).
 Third barrier is knowledge, skills and experience of health professionals, because the
lack of skills and knowledge or the lack of experience will affect the quality of care
delivery (Gorina, Limonero, & Alvarez, 2018).

12
 Fourth barrier is poor perception of health professionals towards efficacy of self-
management interventions because professionals may consider it time consuming and
that it may not be able to improve patient outcomes (Jankowska-Polańska et al, 2016).
 Fifth barrier is poor skills of the health professionals to deliver collaborated,
coordinated and integrated care, because of lack of training and professional
education may restrict their understanding towards efficacy of delivering patient
centred care. (Boehmer et al, 2018).
These aspects can result in limiting the success of Self-care model and may not provide the
optimal desired benefits.
Conclusion
This assignment focused on analysing and evaluating the case study of Liam. He is a
professional and has been diagnosed with hypertension and type 2 diabetes. This paper
provides a comprehensive nursing care plan for Liam. The main purpose of the nursing care
plan is to assess the most significant health problems that Liam suffers from. With the
support of the Self-Management model of care, the nursing plan has been developed for Liam
focusing on patient-centred, integrated, collaborative and coordinated care. This paper also
discussed the significant facilitators and barriers that could influence the process of care
delivery. However, with a collaborative and integrated care delivery, the limitations can be
overcome and optimal health benefits can be provided to the patient.
References
Alfadda, A. A., Sallam, R. M., & Park, J. (2019). Diet and Nutrition for Body Weight
Management. Journal of Obesity, 2019.

13
Azadbakht, L., Fard, N. R. P., Karimi, M., Baghaei, M. H., Surkan, P. J., Rahimi, M., ... &
Willett, W. C. (2011). Effects of the Dietary Approaches to Stop Hypertension
(DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a
randomized crossover clinical trial. Diabetes care, 34(1), 55-57.
Baghbanian, A., & Tol, A. (2012). The introduction of self-management in type 2 diabetes
care: A narrative review. Journal of education and health promotion, 1.
Bankir, L., Perucca, J., Norsk, P., Bouby, N., & Damgaard, M. (2017). Relationship between
sodium intake and water intake: The false and the true. Annals of Nutrition and
Metabolism, 70(Suppl. 1), 51-61.
Boehmer, K. R., Dabrh, A. M. A., Gionfriddo, M. R., Erwin, P., & Montori, V. M. (2018).
Does the chronic care model meet the emerging needs of people living with
multimorbidity? A systematic review and thematic synthesis. PloS one, 13(2),
e0190852.
Bongaerts, B. W., Müssig, K., Wens, J., Lang, C., Schwarz, P., Roden, M., & Rathmann, W.
(2017). Effectiveness of chronic care models for the management of type 2 diabetes
mellitus in Europe: a systematic review and meta-analysis. BMJ open, 7(3), e013076.
Bonner, T., Foster, M., & Spears-Lanoix, E. (2016). Type 2 diabetes–related foot care
knowledge and foot self-care practice interventions in the United States: a systematic
review of the literature. Diabetic foot & ankle, 7(1), 29758.
Breen, C., Ryan, M., Gibney, M. J., & O'Shea, D. (2015). Diabetes-related nutrition
knowledge and dietary intake among adults with type 2 diabetes. British Journal of
Nutrition, 114(3), 439-447.
Daskalopoulou, S. S., Rabi, D. M., Zarnke, K. B., Dasgupta, K., Nerenberg, K., Cloutier,
L., ... & McKay, D. W. (2015). The 2015 Canadian Hypertension Education Program
recommendations for blood pressure measurement, diagnosis, assessment of risk,
prevention, and treatment of hypertension. Canadian Journal of Cardiology, 31(5),
549-568.
Davy, C., Bleasel, J., Liu, H., Tchan, M., Ponniah, S., & Brown, A. (2015). Factors
influencing the implementation of chronic care models: A systematic literature
review. BMC family practice, 16(1), 102.

14
Daw, J., Margolis, R., & Wright, L. (2017). Emerging adulthood, emergent health lifestyles:
Sociodemographic determinants of trajectories of smoking, binge drinking, obesity,
and sedentary behavior. Journal of health and social behavior, 58(2), 181-197.
Dinh, T. T. H., Bonner, A., Clark, R., Ramsbotham, J., & Hines, S. (2016). The effectiveness
of the teach-back method on adherence and self-management in health education for
people with chronic disease: a systematic review. JBI database of systematic reviews
and implementation reports, 14(1), 210-247.
Gorina, M., Limonero, J. T., & Alvarez, M. (2018). Effectiveness of primary healthcare
educational interventions undertaken by nurses to improve chronic disease
management in patients with diabetes mellitus, hypertension and
hypercholesterolemia: A systematic review. International journal of nursing studies.
Gucciardi, E., Espin, S., Morganti, A., & Dorado, L. (2016). Exploring interprofessional
collaboration during the integration of diabetes teams into primary care. BMC family
practice, 17(1), 12.
Jankowska-Polańska, B., Blicharska, K., Uchmanowicz, I., & Morisky, D. E. (2016). The
influence of illness acceptance on the adherence to pharmacological and non-
pharmacological therapy in patients with hypertension. European Journal of
Cardiovascular Nursing, 15(7), 559-568.
Khan, T., Masud, M. A., & Mamun, K. A. (2017, December). Methods to predict blood
glucose level for type 2 diabetes patients. In 2017 IEEE Region 10 Humanitarian
Technology Conference (R10-HTC) (pp. 392-395). IEEE.
Klatsky, A. L. (2015). Alcohol and cardiovascular diseases: where do we stand
today?. Journal of internal medicine, 278(3), 238-250.
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., ... &
Vivian, E. (2017). Diabetes self-management education and support in type 2
diabetes: a joint position statement of the American Diabetes Association, the
American Association of Diabetes Educators, and the Academy of Nutrition and
Dietetics. The Diabetes Educator, 43(1), 40-53.

15
Rett, K., & Hostalek, U. (2019). Understanding prediabetes: definition, prevalence, burden
and treatment options for an emerging disease. Current Medical Research and
Opinion, (just-accepted), 1-1.
Sami, W., Ansari, T., Butt, N. S., & Ab Hamid, M. R. (2017). Effect of diet on type 2
diabetes mellitus: A review. International journal of health sciences, 11(2), 65.
Stout, K. K., Broberg, C. S., Book, W. M., Cecchin, F., Chen, J. M., Dimopoulos, K., ... &
Kuvin, J. T. (2016). Chronic heart failure in congenital heart disease: a scientific
statement from the American Heart Association. Circulation, 133(8), 770-801.
Villareal, D. T., Aguirre, L., Gurney, A. B., Waters, D. L., Sinacore, D. R., Colombo, E., ... &
Qualls, C. (2017). Aerobic or resistance exercise, or both, in dieting obese older
adults. New England Journal of Medicine, 376(20), 1943-1955.