Nursing Management in Geriatric Ward

Running head: NURSING MANAGEMENT IN GERIATRIC WARD
NURSING MANAGEMENT IN GERIATRIC WARD
Name of the student:
Name of the university:
Author note:

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NURSING MANAGEMENT IN GERIATRIC WARD
1. Introduction:
Diabetes is found to be one of the most common but complex disorder that had
affected huge number of people in the nation and had become a concerning health burden on
the nation. It has been found to be particularly high among aged individuals resulting in poor
quality life with higher levels of both physical and mental sufferings (Zheng et al., 2018). The
Australian Bureau of Statistics had conducted the National Health Survey in 2014-2015 and
had found that 1 in 6 people of the age 65 and over have diabetes. This accounts for about
574000 people over the age of 65 being affected by diabetes (Bigali & Lodovici, 2019).
Studies are of the opinion that diabetes rate is seen to increase with age and it has been found
that the highest number of prevalence is found to be about 19.4% in the people who are aged
85 and over (Meshkani & Vakli, 2016). This assignment would also describe the case study
of a patient named George who is suffering from diabetes as well as to complex
complications and accordingly their pathophysiology; anatomy and physiology of the
complications would be discussed. Following this, management plan would be proposed.
2. Patient history:
Mr. George Brown is an 82-year-old man who had recently suffered from a fall and
had been admitted to the ward by his family members. Preliminary analysis showed that he
has many wounds on his arms and knees, which were not healing properly resulting in
redness and swelling. It has been also found that he has severe foot ulcers, which seemed not
have been attended to by any professionals. On assessing the various diagnostic data from the
tests conducted, it was found that he had high blood glucose level of 165mg/Dl along with
hypertension of 145/89 mmHG (Cederberg et al., 2015). The patient had been suffering from
diabetic neuropathy along with vision problems as well. His family members stated that the
patient faces issues in his eyes where he can no longer see things properly and this had made

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him stop driving or mobilising further. His BMI was 37. The family members complain that
Mr. George is suffering intensely and often claims that he needs to die to overcome his
suffering (Goldstein et al., 2016). Even he believes that medications are of little use in such
condition and had stopped taking medications as well. He had faced more than three falls,
which had resulted in bruises, and wounds that do not heal. He had lost his hope of living and
he had totally withdrawn himself from the society. The family members requested healthcare
professionals to help them save the patient from such crisis.
3. Anatomy, physiology and pathophysiology:
3.1. Pathophysiology of diabetes type 2:
The patient is seen to have high level of glucose in the blood for about 165mg/Dl
when the normal blood glucose level prevails between 120 to 126 mg/Dl. The increased level
of blood glucose level can be attributed to the lack of proper management of the symptoms of
diabetes type 2. Impairment of the insulin secretion as well as insulin resistance jointly plays
a significant role in the development of the symptoms of diabetes (Schwartz et al., 2017).
Under normal condition, the beta cells of the Islets of Langerhans located in the regions
within the pancreas of every human being secrete the hormone called insulin. This hormone
mainly helps the cells of the body to accept glucose present in the blood and undertake the
procedures of cellular respiration enabling the production of energy. The organs to carry on
their physiological activities use this energy and thereby it helps the organ systems to
function effectively. Type 2 diabetes can be characterised by the combination of that of the
peripheral insulin resistance as well as because of the inadequate insulin secretion by the beta
cells of the pancreas. Salvotelli et al. (2015) is of the opinion that insulin resistance can be
attributed for the elevated levels of free fatty acids as well as pro-inflammatory cytokines.
This is mainly seen to result in the decrease of the transportation of the glucose into the

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muscle cells as well as also leads to an elevation of the hepatic glucose formation along with
the increase of the breakdown of the fat. Recent attention had been focused about the
involvement of adipocyte-derived bioactive substances (adipokines) making researchers
believe that they take an active part in insulin resistance. Zaccardi et al. (2016) has found
TNF-, leptin, resistin, and free fatty acids to be associated with increases resistance of insulin.
It has been found that George is having a BMI of 37 that shows that he is suffering from
obesity due to increased fat accumulation in the body. Hence, it can be related why George
had become more prone to develop diabetes type 2. Asmat et al. (2016) had given another
version of the pathophysiology where the authors have taken the consideration of the role of
excess glucagon as they believe that such roles cannot be underestimated in development of
type-2 diabetes. They have described the disorder as the islet paracinopathy where the
reciprocal relationship existing in between that of the glucagon-secreting alpha cell as well as
that of the insulin-secreting beta cell is found to get lost (Domingueti et al., 2016). This can
be stated to be the reason of hyperglucagonemia and consequently hyperglycemia.
However, insulin resistance cannot alone result in the development of type 2 diabetes.
A study by Sharma et al. (2016) had shown the use of findings from glucagon test, computed
tomography (CT) scan and fecal elastase-1 measurements. The authors have found that
reduction in the pancreatic volume had been found in individuals with 15-year history of
diabetes. This can thereby explain the rationale of associated with exocrine deficiency found
in people with prolonged diabetes. Baxter et al. (2016) is of the opinion that beta cell
dysfunction can be one of the major contributors which is believed to be developed earlier in
the pathologic procedures and may not inevitably follow the stage of insulin resistance. This
dysfunction might result in the prevention of insulin production successfully in individuals
with type-2 diabetes. To be more specific, it has been found that impaired insulin production
progresses in ways where it results in glucose toxicity and lipo-toxicity. When such