Chronic Endocrine Disease Management

This paper focuses on the nursing case management of chronic endocrine diseases like diabetes using clinical reasoning cycle and multidisciplinary approaches. It discusses the priorities, interventions, and outcome evaluation for effective disease management.

Running head: CHRONIC ENDOCRINE DISEASE MANAGEMENT
CHRONIC ENDOCRINE DISEASE MANAGEMENT
Name of the Student:
Name of the University:
Author note:

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Introduction
The following paper will focus extensively on the nursing case management of Marcel
using clinical reasoning cycle (CRC) as well as nursing quality practices of multidisciplinary
approaches, patient centered care and collaborative inter-disciplinary care.
Discussion
Priorities
Considering Marcel’s present disease severity nursing emphasis on patient’s medication
management along with education on skills of self management form the primary nursing care
priorities. It can be observed that Marcel’s diabetic condition has progressed and is resulting in
his symptoms of diabetic retinopathy (difficulty to read insulin values) and diabetic neuropathy
(loss of sensation in toes). Hence, the nurse may be required to administer timely and
appropriately dosed medications in Marcel and also design a strict plan of medication. A key
contributor of diabetes symptom escalation, is the lack of engagement in appropriate
pharmacological interventions – hence, necessitating nursing prioritization (Schwartz et al.,
2017).
Additionally, a key factor contributing to prevention of metabolic symptom severity is
patient knowledge acquisition on skills of self-management (Coppola et al., 2016). Hence, the
nurse must prioritize Marcel’s improvement of self management skills by educating him on BGL
self-monitoring, medication administration and encouraging Marcel’s participation in healthy
diet consumption and exercise performance. A multidisciplinary approach and patient education

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has been proven to be beneficial for patient empowerment and management of diabetes (Conca
et al., 2018).
Interventions and Rationale
The first priority involves ensuring adequate management of his medications. In order to
control hyperglycemic symptoms, adherence to a medication plan in adequate times and dosages
has been proven to be beneficial (Butt et al., 2016). Hence, the nurse can discuss with Marcel,
using patient centered approach, on his appropriate timing and food consumption schedule and
hence, accordingly, using inter-professional care, take help from a diabetologist to create a
specific medication plan. Adherence to a specific medication plan, has been known to not only
make it convenient for the patient to manage his medications but also ensures prevention of
metabolic severity in the future (Mayberry et al., 2015). Hence, Marcel’s present emergence of
retinopathy, neuropathy and hyperglycemic symptoms requiring strict pharmacological
adherence form the rationale for this intervention.
Marcel prefers fast glucose monitoring and attempts to maintain higher BGL levels to
prevent reoccurrence of hyperglycemia - which clearly highlights his unawareness on the
dangers of hyperosmolar hyperglycemic state and inaccuracies of fast glucose monitoring. A
diabetic education plan results in improved patient awareness and self-management. Hence, the
nurse must educate Marcel, using patient centered care on the need to learn self-monitoring of
BGL, the accuracies of finger prick testing and importance of maintaining healthy BGL to
further improve Marcel’s knowledge and his sense of confidence for disease management (Dube
et al., 2015). Marcel’s lack of awareness on accurate BGL monitoring strategies and BGL
maintenance resulting in HHS complications, form the rationale. Additionally, using
multidisciplinary collaboration with a diabetologist, optometrist, nutritionist and fitness expert,

3CHRONIC ENDOCRINE DISEASE MANAGEMENT
the nurse must ensure that Marcel’s adheres to balanced diet consumption, adequate exercise,
appropriate footwear and visual inspection. Associations between multidisciplinary and positive
health outcomes along with Marcel’s emergence of retinopathy and neuropathy symptoms form
the rationale for these interventions (Pal et al., 2018).
Outcome Evaluation
Patient engagement in timely medication administration, balanced diet intake and
performance of moderate physical activity, will lead positive outcomes of achieving healthy
standards of body mass index and BGL (Cole, 2015). Hence, to evaluate the same, the nurse can
perform routine glucose and anthropometric monitoring in the form of blood tests and weighing
scale measures (Dei Cas et al., 2015). Dedicated engagement to multidisciplinary care as well as
patient education strategies has been implicated to lead to outcomes of increased patient health
literacy and perceptions of feeling controlled and empowered in self-management of disease
(Buggy & Moore, 2017). Hence, to evaluate this outcome, the nurse can discuss with Marcel,
with the help of patient centered care, his opinions, feelings and experience before and after care
plan administration. With the aid of these outcomes, the nurse will gain in insights on the
strengths and limitations of the implemented care plan and hence, improvise accordingly to
execute necessary changes and improvements in the future.
Clinical Reasoning Cycle
The first step of step of patient consideration involves thoroughly investigating the
presence case details of the patient (Levett-Jones, Courtney-Pratt & Govind, 2019). Hence to
apply the same, the nurse must consider and understand Marcel’s present details of chronic
diabetes condition and previous engagement as a farmer along with existing disease symptoms.
The next step of cue collection involves nursing collection of relevant patient data and

4CHRONIC ENDOCRINE DISEASE MANAGEMENT
administration of appropriate assessment tools (Levett-Jones, Courtney-Pratt & Govind, 2019).
Hence to apply the same, the nurse must collect details on Marcel’s previous career or health
conditions and performs assessments to gain insights on his blood glucose and BMI levels
(Oliveira et al., 2016). The CRC steps of identification of information processes aids the nurse in
the careful associating evidence based research with the patient’s care and establish links
between patient’s condition and possible disease processes (Levett-Jones, Courtney-Pratt &
Govind, 2019). Hence, with the application of this step, the nurse will be able to process that
Marcel’s sedentary lifestyle post retirement has contributed to his present hyperglycemic diabetic
conditions (Pham & Ziegert, 2016). The CRC steps of identification of patient issues and goal
establishment include nursing evaluation of possible health issues in the patient for care
prioritization (Levett-Jones, Courtney-Pratt & Govind, 2019). Hence, applying the same, the
nurse can identify that Marcel’s skills of self-management and medication adherence are
inadequate and hence prioritize the same in the care plan. The CRC step of taking action
involves nursing implementation of care plan (Levett-Jones, Courtney-Pratt & Govind, 2019).
Hence, the nurse must formulate patient centered medication plan for Marcel and ensure
multidisciplinary treatment and education (Pham & Ziegert, 2016). The Final CRC processes of
evaluation and reflection, include nursing follow up and mindfulness on the results and possible
improvements of the care plan (Levett-Jones, Courtney-Pratt & Govind, 2019). Hence to
evaluate Marcel, the nurse must collect relevant blood and BMI reports and reflect her own
performance as well as discuss with Marcel to obtain feedback (Oliveira et al., 2016).

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Conclusion
Hence, it can be concluded that, nursing execution of CRC steps along with
implementation of practices which are patient centered and multidisciplinary in nature can aid in
management of chronic endocrine diseases like diabetes. Additional, patient education is needed
to ensure empowerment and enhancement of health literacy and self-management skills.

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