Nursing Professional Practice: Case Study on Type II Diabetes, Osteoporosis and Leg Ulcer

This assignment explores the qualitative and quantitative aspects of important clinical issues of a case study on type II diabetes, osteoporosis and leg ulcer. It discusses the treatment methods and patient education to reduce the impact of these diseases.

Running head: NURSING PROFESSIONAL PRACTICE
NURSING PROFESSIONAL PRACTICE
Name of the Student
Name of the University
Author note

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Introduction
The name of the patient of the case study is Violet, who has been suffering from type II
diabetes, osteoarthritis and ulcer in the lower portion of the left leg. She had been living in the
residential aged care and was waiting for the nursing home bed. Several clinical issues have been
found in the case study. The most important clinical issues are that Violet was suffering from
type II diabetes, osteoarthritis and leg ulcer in the lower portion of the left leg. The patient was
rarely able to walk over long distances and also was using a walking frame. Her daughter was
not getting much time to spend with her. Violet wanted to spend some time with her daughter.
All of the family members were moving through stress as it is seen that that Violet could not
tolerate Mathew. Mathew could not control his temper even while talking with his children. The
clinical issues that are going to be addressed in this assignment are the diseases that they are
suffering from.
Discussion
Violet was living with her daughter Gemma, his husband Mathew and their children Scott
and Lucy. The family was living in a two bed room town house, so they were suffering from
accommodation problem to keep her. Her daughter was working as a registered nurse at night
and so she rarely get time to talk with her mother. As Mathew lost his jobs and used to drink
regularly, Violet could not tolerate him. The most important clinical issues of this study are
diseases from which the patient had been suffering and the stress level of the patient and the
family members. The quantitative research question regarding diabetes is how many and what
are the different treatment methods of type II diabetes, osteoporosis and leg ulcer? The patient
has been suffering from type II diabetes, osteoporosis and leg ulcer. So it is very necessary for

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the Violet to treat all these diseases and appropriate interventions must be followed by the nurses
and doctors to cure her as early as possible. Before proceeding with the treatment, it is important
to properly diagnose the patient. The type II diabetes are usually diagnosed by performing
Glycated hemoglobin (A1C) test. This blood test signifies the average level of blood sugar for
the last two or three months. The normal level of blood sugar is below 5.7 %. The conditions of
the patients are considered to be prediabetics if the value of blood sugar is in between 5.7 to 6.4.
If the value exceeds 6.5 %, the patients are considered to be suffering from type II diabetes
(Heerspink et al., 2016). The other important blood sugar tests are fasting blood sugar test and
oral glucose tolerance test. The patients will not be able to take bay food since the last night and
if the value of the blood glucose level exceeds 126 mg/dL, then the patient has high type II
diabetes (Piero, Nzaro and Njagi 2015). After the diagnoses is over, Violet must be proceeded
with the required treatments. The management of diabetes includes loss of weight, eating health
foods, performing regular exercises, proper administration of diabetes medication or insulin
therapy and regularly checking the blood sugar levels. The nurses and the family members must
check that the patient is taking is more fruits, vegetables and foods with more fibers and less
amount of refined carbohydrates, especially sweets and foods containing saturated fibers. The
most common medicines to reduce diabetes are metformin, sulfonylureas, meglitinides and
thiazolidinedione (Yang et al. 2016). However, mostly metformin is prescribed to the patients
and in serious conditions the patients need insulin therapy. The next important clinical issue is
osteoporosis. The signs of osteoporosis is low bone density mostly in the hip, forearm, spine and
wrist. The fractures are associated with excess pain, decreased mobility, depression and even
premature death. The risk of osteoporosis increases with age, in adults the bones go through
regular process of breaking down and building up, the process is called remodeling (Compston

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et al. 2017). The osteoblast produce bones and when the osteoblast are broken down the minerals
are released into the blood stream. The bisphosphonates help in reducing the loss of bones. These
work by decreasing the activity of osteoclast. This in turn reduces the turnover of bones and also
in removal of old bones. The bone strength and bone density are increased. The name of some
bisphosphonates are Fosamax, Actonel, and Boniva. Reclast is taken intravenously one in a year
or after every two years (Black and Rosen 2016). The parathyroid hormone drugs help in
building the bone back up. The examples such drugs are forteo and tymlos. The patients
suffering from osteoporosis need to inject these drugs regularly after every 18 months or so. The
patients who had been suffering from multiple fractures require these medicines. According to
the doctors, these drugs can cure severe osteoporosis. Patients who takes these medicines, have
significantly low fractures of the bones. The hormone estrogen helps in promoting the production
of bones. The other significant disease that the patient had been suffering from was leg ulcer
(Langdahl, Ferrari and Dempster 2016). The leg ulcer is simply the breakage of the skin of the
leg which allows air and bacteria to grow in the underlying tissue. The treatment of the venous
leg ulcer happens in two ways by controlling the high pressure of the veins of the legs and
treatment of ulcer (Van Gent et al. 2015). The steps of controlling the pressure ulcers in the veins
are elevation of the limb, compressing the bandages and stockings, proper dressings and finally
surgery. Losing of weight, eating fresh fruits, doing proper exercises and reducing smoking are
some of the ways to prevent the occurrence of foot ulcer (Heyer et al. 2017).
The qualitative question in relation to the clinical issues of the case study is what is the
impact of the patient education in reducing type II diabetes, osteoporosis and leg ulcer? The
patient education is one of the effective way to make the patients aware about the disease. The
patient need to know in details about the disease that he had been suffering from. The patient

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have to be familiar with the causes and the treatment of the diseases. Age, hypertension, past
medical record are the important reasons of the diabetes (Ríos, Francini and Schinella 2015). The
patient of the case study is an aged person and also she was moving through some mental
traumas. All these led her to suffer from diabetes. The patient must also know about the several
methods of diagnoses require to test diabetes. The changes in the diet and the lifestyle are the
most important in curing diseases. The diet of the patient should include more vegetables and
fruits and reduced amount of fatty foods. Some people need to take insulin to reduce the blood
sugar level (Lan et al. 2015). If a patient do not undergo proper treatments, then high chances are
there for the disease to get complicated. The level of blood sugar can get reduced and the patient
may suffer from hypoglycemia which is very dangerous as the patient may feel dizzy, weak and
shaky. The patient may feel sleepy, confused or hungry and in such conditions, the patient can be
served with fruit juices, milk, honey or hard candies. The patient must take care of herself by
taking the prescribed medicines in proper time, completing doing the physical examination at
least once in a year. The patient should protect her skin from getting dry, cuts or redness,
regularly check the blood sugar level. The nurse who are taking care of violet should let her
know about the prevention and treatment of osteoporosis. The nurse should inform the patient
about the importance of inclusion of calcium and vitamin D in the diet. Violet must include 2000
mg of calcium per day to improve the conditions of the bone. As she is an aged persons she
needs to include 20 mg of vitamin D per day in the diet (Perricone 2015). If any patient is
involved in drinking alcohol and smoking, it has to be reduced. Violet must also know the ways
to prevent leg ulcer. For managing the leg ulcer, he person need to maintain healthy weight,
avoid crossing of legs, limiting the intake of salts (Mooij and Huisman 2016). She should avoid
wearing the tight fitted clothes and maintain good skin hygiene.

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Conclusion
This assignment has explored the qualitative and quantitative aspects about the important
clinical issues that the patient had been suffering from. The qualitative and the quantitative
questions were discussed with proper literatures. After going through the discussion it can be
concluded that patient of the case study nee proper treatment method which she was deprived
from. In the case study nothing such was mentioned about the treatment procedures that the
patient had undergone. Proper treatment procedures need to be followed by Violet to get cured
early.

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References
Black, D.M. and Rosen, C.J., 2016. Postmenopausal osteoporosis. New England Journal of
Medicine, 374(3), pp.254-262.
Compston, J., Cooper, A., Cooper, C., Gittoes, N., Gregson, C., Harvey, N., Hope, S., Kanis,
J.A., McCloskey, E.V., Poole, K.E. and Reid, D.M., 2017. UK clinical guideline for the
prevention and treatment of osteoporosis. Archives of osteoporosis, 12(1), p.43.
Heerspink, H.J., Perkins, B.A., Fitchett, D.H., Husain, M. and Cherney, D.Z., 2016. Sodium
glucose cotransporter 2 inhibitors in the treatment of diabetes mellitus: cardiovascular and
kidney effects, potential mechanisms, and clinical applications. Circulation, 134(10), pp.752-
772.
Heyer, K., Protz, K., Glaeske, G. and Augustin, M., 2017. Epidemiology and use of compression
treatment in venous leg ulcers: nationwide claims data analysis in Germany. International
wound journal, 14(2), pp.338-343.
Lan, J., Zhao, Y., Dong, F., Yan, Z., Zheng, W., Fan, J. and Sun, G., 2015. Meta-analysis of the
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hypertension. Journal of ethnopharmacology, 161, pp.69-81.
Langdahl, B., Ferrari, S. and Dempster, D.W., 2016. Bone modeling and remodeling: potential as
therapeutic targets for the treatment of osteoporosis. Therapeutic advances in musculoskeletal
disease, 8(6), pp.225-235.
Mooij, M.C. and Huisman, L.C., 2016. Chronic leg ulcer: does a patient always get a correct
diagnosis and adequate treatment?. Phlebology, 31(1_suppl), pp.68-73.

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Perricone, N.V., Transdermal Biotechnology Inc, 2015. Compositions and methods for treatment
of osteoporosis and other indications. U.S. Patent 9,198,931.
Piero, M.N., Nzaro, G.M. and Njagi, J.M., 2015. Diabetes mellitus-a devastating metabolic
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