Clinical Process Case Study: Marcel's Diabetes Self-Management Plan

This case study focuses on Marcel, a 70-year-old retired sugar cane farmer with type 2 diabetes, obesity, and a history of smoking. The assignment analyzes Marcel's condition, including his family history, lifestyle, and lab findings, highlighting the impact of his sedentary lifestyle and medication regime. The report details the nursing interventions, emphasizing patient education, holistic care, and the importance of a multidisciplinary team approach. It addresses Marcel's needs, priorities, and self-medication management, including the need for psychological support, diet management, and blood sugar monitoring. The conclusion underscores the significance of understanding both the physical and psychological needs of the patient, the importance of self-management, and the role of a multidisciplinary team in optimizing patient outcomes. The assignment references several research papers and guidelines to support the recommendations.

Running head: CLINICAL PROCESS CASE STUDY
CLINICAL PROCESS CASE STUDY
Name of the Student:
Name of the University:
Authors note:

1CLINICAL PROCESS CASE STUDY
Introduction
The given case study, is about Marcel who is a 70 year old sugar cane farmer,
originally from Spain. However, now he is retired, and sold his farm. There can be
observable family history of hypertension along with type 1 and type 2 diabetes.
Furthermore, Marcel is obese and before retiring he was a heavy smoker. According to
Australian Government-Australian Institute of Health and Welfare (2019), excess obesity
could lead to complications of several other metabolic complications and chronic conditions.
There is contribution of 5% in terms of burden of disease due to obesity and overweight.
Collection of Information
There can be observable family history of hypertension along with type 1 and type 2
diabetes. Evidently diabetes as well as hypertension are strongly related with genetics and
inheritance, and can be possibly passed down from one generation to other (Groop & Pociot,
2014). Type 2 diabetes, or hyperglycaemia has been reported due to development of
increased insulin due which the pancreatic beta cells no longer could produce the insulin
required for the glucose metabolism. Furthermore, he has reported of getting fatigued and
tired, and getting up for toilet every night. In the given case study it can be understood that
Marcel has a sedentary lifestyle, as he has retired and proper diet is not established.
Background Information about Marcel
The lab findings suggest that Marcel has diabetes which is type 2. It has to be
understood that there are long term effects in case of this type of disorder and diabetes can
further complex the situation if right medication management is not adopted. There is an
impact of sedentary lifestyle, increased risk diabetes and therefore lifestyle plays an
important part in managing the treatment as well as maintaining the body weight (Rockette-
Wagner et al., 2015). In the given case study report it could be also identified Mr. Marcel has

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suffered few episodes of hypoglycaemia while going out with his friends and stiffness or loss
of sensation in hands and legs.
Understanding Marcel’s Needs and priorities
Going by the psychosocial attributes of health and patient consideration it could be
understood that, Marcel felt embarrassed to express the reasons for hypoglycaemic episodes.
He expressed that he would feel embarrassed if he falls and, therefore, he disclosed that he
wanted keep the sugar level higher. Furthermore, he had difficulty while reading, and there
had been organised a meeting with an optometrist. It is important to understand the
psychological, emotional, hesitation needs and fears he might be having. Therefore, not just
with medication but incorporation of all the aspects of mind and body has to be assessed.
Marcel’s medication regime and self-Medication management
The establishment of Goals have to be alignment with patient informed consent,
monitoring of the patient’s health, along with incorporation of proper diet. According to
(Chew, Shariff-Ghazali & Fernandez, 2014), the people who have diabetes do not only need
medicinal arrangement or support but also psychological support throughout their life, from
the time the disease has been diagnosed. Hence, patient education is an important aspect for
establishing self-medication management as well as nursing intervention (Tannenbaum et. al,
2014). There are different metabolic conditions established with diabetes which can include
neurological effects, diabetic nephropathy as well as possible retinopathy. When it comes to
diabetes, medication of self-management is an important factor, as there are situations that
would require individual efforts. The knowledge of normal blood sugar level, and there
should be proper management of diet as well. According to National Diabetes Service
Scheme, (2019) there is a proper diabetic food plan for diabetic patient across Australia that
should be followed.

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Nursing Intervention (Patient education and Holistic Approach)
It is important to go forward, for holistic approach and proper family setting. A good
multidisciplinary team is important as it could maximise the care for the diabetes
management (Ofori, & Unachukwu, 2014). Patient education, proper maintenance of diet,
and checking of blood sugar levels individually. Marcel can be referred to primary care
physician for any medication advice medication management, Diabetes nurse specialist,
certified diabetes educator, for any confrontations or hesitations Marcel has or wants to
know, and dietician.
Priorities of medication self-management for Marcel
It is important to have a proper diet, as maintaining proper diet is an important part of
life long diabetes management. The physical exercise of brisk walking of Marcel along with
his dog will keep him over all manage his weight. There is constant episodes of
hyperglycaemia despite the medication management and proper lifestyle changes. The
persistent diarrhoea, has been referred to the usage of 500 mg metformin BD, and Marcel has
chosen insulin. However, proper instruction include, intake of meals and insulin shot is
important.
Conclusion
From the above discussion, I have come to the conclusion that diagnosis of diabetes
and its metabolic complications can have varied impact on the patient , therefore, it is
necessary to understand not only the physical but also the psychological needs and aspects of
the patient. Furthermore, a multidisciplinary team approach has to be assessed, and
accordingly the treatment and outcomes have to be followed.

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References
Australian Government-Australian Institute of Health and Welfare. (2019). Overweight and
Obesity. Available at:
https://www.aihw.gov.au/reports-data/behaviours-risk-factors/overweight-obesity/
overview
Chew, B. H., Shariff-Ghazali, S., & Fernandez, A. (2014). Psychological aspects of diabetes
care: Effecting behavioral change in patients. World journal of diabetes, 5(6), 796–
808. doi:10.4239/wjd.v5.i6.796
Groop, L., & Pociot, F. (2014). Genetics of diabetes–are we missing the genes or the
disease?. Molecular and cellular endocrinology, 382(1), 726-739.
http://dx.doi.org/10.1016/j.mce.2013.04.002
National Diabetes Service Scheme. (2019). Food choices for people with diabetes. Available
at : https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/c0fbfd3a-
6a48-46d3-9feb-295a0235ecc4.pdf
Ofori, S. N., & Unachukwu, C. N. (2014). Holistic approach to prevention and management
of type 2 diabetes mellitus in a family setting. Diabetes, metabolic syndrome and
obesity : targets and therapy, 7, 159–168. doi:10.2147/DMSO.S62320
Rockette-Wagner, B., Edelstein, S., Venditti, E. M., Reddy, D., Bray, G. A., Carrion-
Petersen, M. L., ... & Montez, M. G. (2015). The impact of lifestyle intervention on
sedentary time in individuals at high risk of diabetes. Diabetologia, 58(6), 1198-1202.
https://doi.org/10.1007/s00125-015-3565-0
Tannenbaum, C., Martin, P., Tamblyn, R., Benedetti, A., & Ahmed, S. (2014). Reduction of
inappropriate benzodiazepine prescriptions among older adults through direct patient

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education: the EMPOWER cluster randomized trial. JAMA internal medicine, 174(6),
890-898. doi: 10.1001/jamainternmed.2014.949