Critical Analysis of Case Study 2022

Running Head: CRITICAL ANALYSIS 1
Critical Analysis of Case Study
Name of Student
Name of Professor
Institution Affliation
Date

CRITICAL ANALYSIS 2
Question 1
Biopsychosocial, cultural and spiritual impact on Ted and his family
Biological factors
From the case study, it is clear that Ted has diabetes type 2. Research indicates that there
is a close relationship between genetics and diabetes type 2. The probability of inheriting
diabetes type 2 is very high, and hence there is a real potential that one of Ted family members
had the condition, and that is why it affects him (Jonkman et al., 2016, p. 55-68). Immediately
after the surgery, Ted's blood glucose level is low because he has not eaten for several days, and
hence the body does not have enough energy. The condition will, however, improve once his
health improves, and he can eat and is free of abdominal pain. The other biological factor which
could impact on him after the surgery is that he has hypertension. This is the condition where the
patient has high blood pressure. The pain experienced after the surgery and the stress that the
patient might experience could lead to an increase in his blood pressure.
Psychological
The temporary colostomy might impact on the patient psychologically because it is
associated with stigma in society. Ted might get stressed and stigmatized and feel as if he won't
get well, and this could affect his recovery.
Social
Ted's wife died three years back, and his children live far away from him. Lack of social
support could, therefore, affect Ted after the surgery. However, he has a 78-year-old partner

CRITICAL ANALYSIS 3
called Gwen, who he met at the retirement home, and she could offer much needed social
support.
Spiritual
Spiritual leaders can greatly assist Ted in recovery by helping him to remain positive and
optimistic at the time when he is facing health challenges. This will be a major positive step
towards his recovery.
Question 2
The main priority health problem that Ted is experiencing is colorectal cancer. The case
study indicates that Ted had undergone biopsy and colposcopy, which indicated that he had a
malignant tumor. This is a clear indication that he had colorectal cancer, which eventually
resulted in the operation to remove the cancerous tumor. Colorectal cancer is believed to arise
from two types of precursor polyps through two pathways, which include conventional
adenomas and serrated adenomas, which arise from mutation of the APC genes ( Gessler,
Eriksson & Angenete, 2017, p. 549-556).Once one cancerous cell develops in the large
intestines, it reproduces and divides and hence resulting in the spread of the cancer growth to
other tissues around the area, which was initially affected. Surgery and chemotherapy are,
therefore, one of the main interventions to treat this condition. The genes progress slowly and
eventually end up becoming cancer. Apart from genetic causes of the disease, researchers believe
that environmental factors also contribute to the development of colorectal cancer. Some of the
environmental factors which cause an increased risk of colon cancer include obesity, diet, old
age, African- American race, and inflammatory intestinal conditions (Hof et al., 2016, p. 1055-
1062).

CRITICAL ANALYSIS 4
The other major health concern for Ted is heart failure. Heart failure is a chronic
condition where the heart fails to pump blood around the body properly due to the damage
caused by the muscles of the heart. The heart becomes inefficient due to high blood pressure,
which comes as a result of the increased narrowness of arteries and other blood vessels. The
arteries become narrow due to accumulation of cholesterol and hence meaning that the blood
being pumped from the heart is moving at a higher pressure than usual (Kelly, Reidlinger,
Hoffmann & Campbell, 2016, p. 1693-1702). Due to this reason, the heart adapts and uses more
force to pump the blood, and hence it is overworked. Over time, due to the excess work, the heart
becomes inefficient, and the patient can suffer serious health consequences. Some of the causes
of heart failure include coronary artery disease, high blood pressure, faulty valves of the heart,
cardiomyopathy, myocarditis, and congenital heart defects. Researchers indicate that the risk of
heart failure increases when a person is overweight has diabetes or has suffered a heart attack
previously (Tanner et al., 2016, p. 270-274). The risk of heart failure also increases with age.
From the case study, it is safe to conclude that Ted is suffering from this condition because he is
obese, and diabetes is also a major contributing factor.
The third health priority problem that Ted is experiencing is diabetes type 2. Diabetes
type two is a chronic condition that affects the metabolism of the body. This condition affects the
ability of the body cells to absorb and utilize glucose in the body, which comes from the
consumption of food. Either the body becomes resistant to insulin, or the body does not produce
enough insulin and hence resulting in excess glucose in the bloodstream (Bullard et al., 2019, p.
629-636). Diabetes has long been associated with older adults, but recently, the cases of the
condition among young people have been increasing. The researcher associates the condition
with hereditary genes as well as environmental factors. Some of the factors which increase the

CRITICAL ANALYSIS 5
risk of diabetes type 2 include obesity, age, distribution of fat in the body, family history of the
disease, race as well as lack of physical activity. Diabetes type 2 results in severe complications
such as damage to the nerves, amputation due to diabetic foot ulcers, kidney diseases, and slow
healing of wounds (Hoffmann et al., 2016, p. 510-518.). This condition is not curable but can be
managed, and a person can live for long, even after being diagnosed with the condition.
Question three
Goals
 Facilitate the quick recovery from the surgery
 Control blood glucose level
 Reduce body weight by 7%
 Achieve lifestyle changes to prevent the disease from progressing further
 Improve personal care to achieve better patient outcomes
Interventions
Education-Ted needs to be educated to enhance his recovery from the surgery.
Education is very critical for Ted since it will provide him with an opportunity to learn how to
care for himself so that he can recover quickly (Claes, Buys, Budts, Smart & Cornelissen,
2017, p. 244-256). He will be taught how to handle the surgical wound to avoid infection and
how to handle the temporary colostomy to prevent complications. Education interventions will
help Ted to understand how he should use the medication administered to him. Research also
indicates that patient education plays a major role in improving patient outcomes for patients
who have type 2 diabetes (Miller, 2017, p. 10-13). During the education sections, he will be
taught how to monitor his blood glucose level. He will also be taught the factors that could

CRITICAL ANALYSIS 6
increase the risk of the BGL rising or of blood pressure rising. Education improves self-care and
hence improving patient outcomes as well as reducing mortality.
Pharmacological intervention- Research indicates that pharmacological treatment of
patients with diabetes type two and cardiovascular diseases such as heart failure is highly
effective in reducing the symptoms of the diseases. According to Day (2019), pharmacological
treatment is very crucial in achieving blood glucose level, and hence it is essential for patients
with diabetes type two. The most commonly used medication is Metformin, but patients can be
prescribed other medications based on the safety and the unique needs of the patients.
Pharmacological interventions for heart failure, combined with a change in lifestyle, also reduces
the complications associated with the disease (Marczynski et al.,2016, p. 801-812). Research has
also shown that it decreases mortality rates and frequency of hospitalization and hence will be
very helpful in treating Ted.
Dietary intervention-Diet has been identified as one of the factor that greatly contribute
to diabetes type 2, heart failure, and gout, which are some of the health problems that Ted is
experiencing. The kind of diet consumed by an individual determines how healthy they are.
Patients suffering from chronic conditions such as diabetes type 2 and cardiovascular disease
should stick to the prescribed diet. Some of the foods which are not good for Ted due to his
condition include carbonated drinks, excess carbohydrates, excess proteins, food with excess fats
as well as sugars. He should concentrate on vegetables, low-fat diet, and low carbohydrates.
Healthy eating contributes greatly to weight loss and will be very helpful for Ted to overcome
his obesity and will generally lead to favorable health. Reduction in body weight has been
identified as being very important in avoiding heart complications such as high blood pressure
and minimizing the risk of heart failure (Gillis et al., 2018, p. 91-410).

CRITICAL ANALYSIS 7
Exercise-Regular exercise routine has been established as being critical in the treatment
of cardiovascular diseases as well as diabetes type two. Exercises help in reducing the blood
cholesterol level and hence helps in reducing the thickness of the arteries and hence making it
possible for blood to flow more freely and reduce blood pressure (Byrne, Caulfield & De Vito,
2017, p. 717-733). Exercises have also been determined to improve the flow of blood, and the
performance of the heart and hence helps in avoiding future complications as a result of the
condition. Exercise also helps in managing diabetes type2 since it makes it possible for the body
to utilize excess glucose in the body and hence stabilizing the patients' blood glucose level.
Insulin therapy-Insulin treatment is used to achieve the goal of glycaemic control,
especially among older patients who are more than 70 years old. Research has ascertained that
the use of long-acting insulin in elderly patients with type 2 diabetes is effective in stabilizing
HbA1c without the risk of hypoglycemia (Davies et al., 2018, p. 2461-2498). Insulin is,
therefore, a very viable option to assist Ted in treating diabetes type two conditions, especially if
the lifestyle interventions are not very effective in controlling his blood glucose level.
Question 4
Systemic therapy drugs
Systemic therapy is the use of medicine to destroy cancer cells either before an operation
or after the operation. These drugs will be appropriate for Ted because they will help to kill the
cancerous cells that could have been left after the surgery. This medication is given through the
bloodstream so that it can reach cancer cells throughout the body. Nurses administer the drugs
either orally or via an intravenous tube. The three types of systemic therapy include
chemotherapy, targeted therapy, and immunotherapy. The drugs destroy the cancer cells by
preventing them from multiplying and hence helping to bring cancer to an end ( Chatterjee,

CRITICAL ANALYSIS 8
Davies & Khunti, 2018, p. 13-24). The side effect of this class of medication includes vomiting,
nausea, diarrhea, and mouth sores. To overcome the side effects, the nurse can either lower the
dose or the treatment section can be postponed.
Analgesics
Analgesics are a class of medication that is used to reduce pain for patients who have just
undergone an operation. The nurse can use several analgesics to manage the pain that Ted is
undergoing. Some of the medications that can be used include opioids, local anesthetics,
NSAIDs, and psychoactive drugs (Gustafsson et al., 2019, p. 659-695). The nurse, however, has
to consider the drugs that will be safe, given that he has CVD and has type two diabetes, and
hence the pain medication given must not result in adverse effects. Some of the side effects of
analgesics include stomach upset, confusion, dry mouth, nausea, and sleepiness. Nurses need to
adhere to given management guidelines to ensure that the patient does not suffer from the
negative effects of the medication.

CRITICAL ANALYSIS 9
References
Bullard, T., Ji, M., An, R., Trinh, L., Mackenzie, M., & Mullen, S. P. (2019). A systematic
review and meta-analysis of adherence to physical activity interventions among three
chronic conditions: cancer, cardiovascular disease, and diabetes. BMC public health,
19(1), 636.
Byrne, H., Caulfield, B., & De Vito, G. (2017). Effects of Self-directed Exercise Programmes on
Individuals with Type 2 Diabetes Mellitus: A Systematic Review Evaluating Their Effect
on HbA 1c and Other Metabolic Outcomes, Physical Characteristics, Cardiorespiratory
Fitness, and Functional Outcomes. Sports Medicine, 47(4), 717-733.
Chatterjee, S., Davies, M., & Khunti, K. (2018). Pharmaceutical interventions for diabetes
prevention in patients at risk. American Journal of Cardiovascular Drugs, 18(1), 13-24.
Claes, J., Buys, R., Budts, W., Smart, N., & Cornelissen, V. A. (2017). Longer-term effects of
home-based exercise interventions on exercise capacity and physical activity in coronary
artery disease patients: a systematic review and meta-analysis. European journal of
preventive cardiology, 24(3), 244-256.
Davies, M. J., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., ... &
Buse, J. B. (2018). Management of hyperglycemia in type 2 diabetes, 2018. A consensus
report by the American Diabetes Association (ADA) and the European Association for
the Study of Diabetes (EASD). Diabetologia, 61(12), 2461-2498.
Day, C. (2019). Glucose-lowering drugs and cardiovascular risk: how recent outcome trials have
informed practice. Acute pain, 10, 00.

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Gessler, B., Eriksson, O., & Angenete, E. (2017). Diagnosis, treatment, and consequences of
anastomotic leakage in colorectal surgery. International Journal of colorectal disease,
32(4), 549-556.
Gillis, C., Buhler, K., Bresee, L., Carli, F., Gramlich, L., Culos-Reed, N., ... & Fenton, T. R.
(2018). Effects of nutritional prehabilitation, with and without exercise, on outcomes of
patients who undergo colorectal surgery: a systematic review and meta-analysis.
Gastroenterology, 155(2), 391-410.
Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., ... & de
Boer, H. D. (2019). Guidelines for perioperative care in elective colorectal surgery:
Enhanced Recovery After Surgery (ERAS®) society recommendations: 2018. World
journal of surgery, 43(3), 659-695.
Hof, J., Wertenbroek, M. W. J. L. A. E., Peeters, P. M. J. G., Widder, J., Sieders, E., & De Jong,
K. P. (2016). Outcomes after resection and radiofrequency ablation for recurrence after
treatment of colorectal liver metastases. British Journal of Surgery, 103(8), 1055-1062.
Hoffmann, T. C., Maher, C. G., Briffa, T., Sherrington, C., Bennell, K., Alison, J., ... & Glasziou,
P. P. (2016). Prescribing exercise interventions for patients with chronic conditions.
Cmaj, 188(7), 510-518.
Jonkman, N. H., Westland, H., Trappenburg, J. C., Groenwold, R. H., Bischoff, E. W.,
Bourbeau, J., ... & Gallefoss, F. (2016). Characteristics of effective self-management
interventions in patients with COPD: individual patient data meta-analysis. European
respiratory journal, 48(1), 55-68.

CRITICAL ANALYSIS 11
Kelly, J. T., Reidlinger, D. P., Hoffmann, T. C., & Campbell, K. L. (2016). Telehealth methods
to deliver dietary interventions in adults with chronic disease: a systematic review and
meta-analysis. The American journal of clinical nutrition, 104(6), 1693-1702.
Marczynski, M. A., Cortellazzi, K. L., Barberato-Filho, S., Motta, R. H. L., Vieira, A. E. F.,
Quilici, M. T. V., & Bergamaschi, C. D. C. (2016). Unsatisfactory glycemic control in
type 2 diabetes mellitus patients: predictive factors and negative clinical outcomes with
the use of antidiabetic drugs. Brazilian Journal of Pharmaceutical Sciences, 52(4), 801-
812.
Miller, E. M. (2017). Individualizing treatment with SGLT-2 inhibitor therapy in type 2 diabetes
mellitus. Journal of Family Practice, 66(2), S13-S13.
Tanner, J., Kiernan, M., Hilliam, R., Davey, S., Collins, E., Wood, T., ... & Leaper, D. (2016).
Effectiveness of a care bundle to reduce surgical site infections in patients having open
colorectal surgery. The Annals of The Royal College of Surgeons of England, 98(4), 270-
274.