Case Study: Nursing Care for a Patient with Chronic Conditions

This case study depicts the various forms of care that can be advised to a patient for helping in the development of her chronic conditions. The patient is suffering from unmanaged glucose level, osteoarthritis, obesity, and depression. The nursing intervention is to assess the integrity of the skin and accordingly set interventions to help the patient mitigate the chances of developing infections and wounds. Read on to know more.

Running head: CASE STUDY
CASE STUDY
Name of the student:
Name of the university:
Author note:

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Introduction:
The advancement of modern technology and medicines had helped in increasing the life
expectancy of people. Although people are living longer nowadays, they cannot live better
quality lives and suffer massively (Butcher et al., 2018). Therefore, nursing professionals often
need to care about patients suffering from co-morbid disorders. Such treatments are often
complex as professionals need to care about huge number of aspects of the patient in order to
ensure high quality care. Present day nurses believe in providing holistic care where they ensure
that their treatments cover physical, social, mental and spiritual aspects of the patients
(Abubakari et al., 2016). This assignment would mainly be a case study depicting the various
form of care that can be advised to the patient for helping in the development of her chronic
conditions.
Case study:
I got an opportunity to interview a 65-year-old woman in the community who had
unmanaged glucose level and wanted assistance from healthcare professionals for the skin
infection and the wounds. She had a BMI of 30, which showed that she was obese and she
suffered from osteoarthritis. Moreover, it was also seen that she lives a very poor quality life in
her house as the floor was full of clutters and a layer of dust covered the furniture in her home.
She could not conduct her activities of daily life successfully and therefore she was found to be
in unwashed clothes and had not bathed for three days. She has foods that are delivered to her
home from a nearby fast food center. Her son lives in Canada for work and sends her money for
her maintenance. However, she often feels lonely as she cannot go out and meet her friends that
used to be one of her favorite pastimes. Diabetes had affected her vision. Wounds that have

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developed on her skin and legs make her suffer a lot. Osteoarthritis made her suffer from joint
pain in her limbs and therefore her mobility had been restricted. She also seems to suffer from
depression that she had developed from living alone and the sufferings due to her illness had
affected her emotionally and mentally. She states that she longs for death as she has lost all
hopes of living better quality lives. I was appointed as the community nurse to diagnose her
issues and develop a care plan process.
Assessments and Care priorities:
I interviewed her to know about the different assessments that were conducted in the
community healthcare setting and accordingly I advised her with care priorities that were
identified.
Firstly, it was found by me during the interview that the patient had uncontrolled blood
glucose level. This had posed a huge threat on the organ functioning of the patient making her
more vulnerable to develop complications that remain associated with diabetes. On questioning, I
came to know that the primary healthcare centre in her locality had done three important tests
that helped in successful identification of the symptoms. The patient had then come to know that
she had poorly managed blood glucose levels. These tests are the fasting plasma glucose tests,
oral glucose tests and the random plasma glucose tests. The level of the blood glucose level was
found to be quite higher than the normal and hence the first priority was to manage the blood
glucose level of the patient and make it stable.
Secondly, I also witnessed during the interview that she was facing mobility issues due to
her joint pains because of osteoarthritis.On interviewing, she told me that she had stopped
walking and spent most of her time in her house on her easy chair or on bed. She even could not

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go out for socializing. The different diagnostic tests that were done to identify and confirm the
presence of osteoarthritis is X-rays as well as Magnetic resonance imaging tests also called MRI.
Blood tests as well as joint fluid analysis were also done in order to rule out the chances of the
inflammation of her joints due to other reasons like gout and infection.
Third, on interviewing, it was found that she was obese and her heavy body weight
might be the contributing factors for diabetes as well as arthritis. Researchers are of the opinion
that obesity results in deposition of fats in the cells of the body that in turn makes the cells
resistant to insulin hormone (Sherifali et al., 2015). As the cells become resistant to insulin, the
hormone can no longer make the cells accept the glucose from the blood and hence cannot
participate in respiratory processes. The levels of glucose in the blood increases making the
persons develop diabetes. Again, on the other hand, huge amount of body weight also
contributes to creation of excessive pressure on the joints. Extended period of such pressure
results in wearing and tearing of the cartilage at the joints disrupting the smooth movements of
the limbs (Dunkley et al., 2014). This makes the patient suffer from excessive pain and suffering
when the joints become devoid of cartilage and the bones rub against each other. Therefore,
effective management of the body weight is also important for the patient so that the symptoms
of diabetes and osteoarthritis remain under control.
Risk assessment and subsequent treatment plans:
After the detailed questioning, I developed a clear idea about the patient’s issues. The
person is suffering from huge number of skin infections all over her body as well as wounds in
her legs and feet. Therefore, it was important for the primary healthcare nurses whom the patient
went for help to assess the skin integrity of the patient and accordingly set interventions to help

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the patient mitigate the chances of developing infections and wounds. While developing the risk
assessment priories, the ACSQHC framework was followed by the nurse to ensure three
important criteria were covered through the risk assessment procedures. The first one was being
consumer-centered care, proper services and care strategies that are driven by information as
well as organized safety where making safety should be the central focus of the healthcare
facilities. Firstly, the nursing intervention is to assess the integrity of the skin and thereby assess
knee and deep tendon reflexes and proprioception (Chapman et al., 2015). The main rationale
for doing this risk assessment is that these assessments help in finding the extent of neuropathy.
Skin as well as the lower extremity pressure joints mainly remains at the greater risk for
ulceration. Secondly, the blood glucose stability also needs to be determined in the risk
assessment step. That main rationale is that unstable blood glucose levels contribute to delay in
the wound healing. Hence, this assessment helps professionals to understand the modifications
they need to ensure in diabetic treatment so that rate of wound healing develops (Finney et al.,
2016). Third, the nursing professional should also assess for the necrotic tissues around the
wound of the client. The main rationale behind this is that necrotic tissues present around the
wound of the diabetic persons signify poor blood flow and for severe cases, amputation becomes
important. To prevent them, this assessment is required. Fourth, the professional also needs to
assess and document the condition of the skin around the wound. The rationale is that it helps in
impending infection as well as evaluating the progress of the necrosis.
Therefore, after interviewing and reviewing all her conditions, I developed a treatment
plan that she could follow. According to the treatment plan, I firstly advised her to use foot
cradle on bed, using space boots on the ulcerated heels, elbow protractors as well as pressure-
relief mattress as they help in prevention on the pressure sensitive points. Secondly, I advised

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herto wash feet of the patient daily with mild soap as well as with warm water and the water
temperature should be checked before immersing feet of the patient in the water. Decreasing
sensations in the fee increases the occurrence of burns and this intervention would help in
handling the issues successfully (Allen et al., 2016). Third, I advised her to inspect the feet for
erythema or the trauma that are mainly considered by experts to be the signs that the skin
requires preventive care. Fourth, I advised her to change the socks and the stockings daily and
they should encourage the patient to wear cotton socks. This helps in prevention of infection due
to moisture. Moreover, white fabrics also help in the easy visualization of the blood or the
textures. Fifth, I advised her to use gentle moisturizers on the feet. Moisturizers help in
lubrication of the dry skin and prevent skin cracking. Sixth, I advised her never to walk barefoot
as this can become a high risk for trauma and might result in ulceration as well as infection (Kao
et al., 2016).
Treatment plan for the identified care priorities:
Diabetes:
It is important for the patient to develop health literacy about diabetes and negative
impacts that are affecting the patient due to uncontrolled blood glucose level. The health literacy
would help her to understand which of her activities are contributing to poor health outcomes
and accordingly she would become careful about it. Firstly, I educated her about the effective
ways of handling the blood glucose monitoring level in a teach-back method. This instrument
helps patients in assessing their blood glucose level successfully and accurately and proper safe
of this device helps patient to become aware before any negative outcomes result on her heath
(Ali et al., 2018). As Martha stays alone, these instruments would help her to understand and

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monitor her health condition and call for help when required. Secondly, I also tried to make her
eduacted about balancing food intake with that of the physical activities. This is extremely
important for prevention of the sudden increase or that of the decrease in the blood glucose levels
of the patient. Third, I also educated her about the ways how anti-diabetic medications work, the
correct timings for taking them, harmful aspects associated with failing to take the medication or
taking the medication twice on health (Briani et al., 2018). This education would make her
careful about being particular to medication intake and prevent her from being exposed to threats
of blood glucose level rising too high or becoming too low. Experts opine that it is important for
the clients to develop understanding of their treatment regimen. This would help in ensuring their
adherence to the treatment and subsequent compliance.
Osteoarthritis:
Researchers are of the opinion that exercise can act as a valuable aid in relieving the pain
of the patient and helps in reduction of the impact of progressive osteoarthritis. Therefore, some
of the common exercises that bring out effective results on the health of the individuals and
mitigate the sufferings of osteoarthritis are the low-impact aerobics, aquatic exercises, strength
training and the neuromuscular education. However, it was seen that the patient named Martha
was reluctant to participate in exercises due to excessive pain. Therefore, I assigned a physical
therapist to the patient (O’Reily et al., 2014).Physical therapists or physiatrists are individuals
who develop a medically supervised therapy plan that align with the capability of the patient and
help the patient to improve her joint movement and reduce pain. I also assigned an occupational
therapist for Martha. An occupational therapist helps in addressing the functional impairment of
the patients and this helps in improvement of the skills required for the activities of daily living.
Martha had to face huge issues with her activities of daily living due to her restricted mobility.

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Hence, I did the allocation of both the therapists because I believed that they would help her to
overcome her pain and live better quality lives (Tate et al., 2016). Some of the other actions that
I also advised her are the application of the moist heat like that hot packs, a bath, sauna or a
shower and this can help in relieving pain. Experts are also of the opinion that another method
like icing the knee is also found to be fruitful as it also shows success in controlling the knee
pain and prevents swelling (Texeira et al., 2015). Other therapies I asked her to follow was the
hydrotherapies or the water therapies as it helps in the decreasing of pain and stiffness. Other is
the relaxation therapy or the meditation therapies that when educated to the patients can help in
dealing with pain and reduction of the muscle tension.
Obesity management:
It is extremely important for patients to control and manage their weights within the
permissible limits to prevent being affected by different chronic ailments, cardio-pulmonary
disorders, cardiovascular disorders, diabetes, osteoarthritis, depression and many others.
Therefore, it is important for nursing professionals to develop intervention for management of
obesity in patients so that the other disorders can be controlled or prevented successfully. One of
the most important criterions that I educated to the patient is effective management of the diet. I
allocated a dietician for the patient who will measure the BMI of the patient and accordingly
develop diet chart for the patient (Moorhead et al., 2018).This will help in ensuring that the
patient takes n nutritious foods and avoids take-away food, which is high on calories. Moreover,
I encouraged her to participate in easy exercises and physical activities that would ensure
prevention of deposition of calories and accordingly reduce the body weight. Besides, avoiding
sedentary lifestyles and being engaged in different fun activities, social works and others would

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also help her to remain active, reduce her depression and provide scopes for engaging with the
society.
Psychosocial effects on the patient:
Throughout the treatment, I had maintained effective communication with the patient and
always involved her in decision-making. Person-centered care advises nurses to allow patients
to become the central position of the care-plan development sessions as this empowers them and
makes them feel respected (Ling et al., 2016). Every decision made by me for Martha was taken
after discussing with her and making her aware of the pros and cons of the treatments. Only after
her informed consent, the treatments were started. The bio-psycho-social model of care was
mainly followed for the treatment of Martha. The model advises professionals to develop
interventions that would not only address the biological determinants of health but also address
the psychological and social aspects of the patient (Gulanik & Myers, 2016). It was seen that the
patient was aged and lived alone in her house. Her loneliness along with the suffering of the
physical ailments had resulted her to suffer from depression and social exclusion. Therefore,
when I devised care plans for successfully treating the physical aspects, she gained confidence
on herself and gradually started to socialize with others by visiting her friends. Motivational
interviewing conducted by me helped her a lot. It helps by making people aware of their negative
thoughts and encourages them to develop motivation to modify their present conditions to their
betterment. One social determinants of health was her poor education and heath literacy. The
professionals also successfully attended it.

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Reflection:
I have tried my best to establish a therapeutic relationship with the patient named Martha.
I had established effective communication with him that was based on empathy and comparison.
When individual patients feel that the professionals are genuinely interested about their health
issues, they feel respected and this helps in developing a strong bond with the professionals. This
bond helps in development of mutual trust and respect with each other. Martha believed on me
completely and therefore. Compliance and adherence also developed. This helped in treating her
successfully. I have followed all the important practice standards as advised by the NMBA.
Thinking critically and analyzing the nursing practices and engaging in therapeutic and
professionals relationships were the two practice guidelines followed by me in a dedicating
manner. Moreover, I also followed the guidelines like developing a plan for nursing practices
and providing safe, appropriate and responsive quality nursing practices.
Conclusion:
From the above discussion, it becomes quite clear that the patient named Martha was
suffering from co-morbid disorders of diabetes, osteoarthritis as well as obesity. She was living a
poor quality life as she was not well educated about her self-management plans and was highly
vulnerable to threatening conditions. Therefore, the care priorities are first developed for the
patient according to the severity of the situation and accordingly, interventions were applied for
Martha. All the interventions helped in developing better quality health for the patient. Martha
was gradually being able to overcome her depression and issues of social exclusion. She was
walking out of the house and meeting with people with the help of the social workers. She was

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living with new hopes for her life and her positivity had effective outcomes on her mental,
physical, and emotional health.

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