Systematic Approach for Managing Patients with Multiple Chronic Disorders

This assignment focuses on the ADPIE process for managing patients with multiple chronic disorders. Learn about the assessment, planning, diagnosis, implementation, and evaluation phases of nursing. Develop a care plan for a patient named Lily Brown who is suffering from diabetes type 2 and other health issues.

Running head: SYSTEMATIC APPROACH
SYSTEMATIC APPROACH
Name of the student:
Name of the university:
Author note:

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Introduction:
Healthcare professionals have to manage patients who suffer from multiple chronic
disorders. Often managing many disorders become difficult for the professionals as the nurses
have to tackle many symptoms altogether for which developing care plans often becomes
difficult (Bryant and Nix 2015). In order to handle such complex cases of patients, often
healthcare researchers advise nursing professionals to follow the ADPIE process. This process
mainly comprises of five phases of nursing which acts as guidelines for the nurses to follow a
systematic procedure and help in managing complex cases successfully (Ackley et al. 2019).
This assignment would be mainly focusing on the procedure of following this ADPIE process is
assessing the different factors that are contributing to poor health of the patient named Lily
Brown. Following that, a care plan would be developed in the appendix section ensuring that
high quality care services are provided to the patient enabling her to live better quality life.
Systematic approach:
ADPIE can be described as the procedure that helps the healthcare professionals to
remember the process as well as the order of the steps that they would need to take for providing
proper care for the service users who they are treating. ADPIE is the acronym that stands for the
assessment, planning, diagnosis as well as the implementation and evaluation of the entire
procedures. Studies are of the opinion that nursing procedures should be functioning following a
systematic guide towards a person centered care that includes 5 sequential steps (Junkin 2018).
The first step is the assessment process that mainly involves critical thinking skills as well as the
data collection of both subjective and objective. Critical thinking skills are an important part of
the assessment and this calls on the need for the concept based curriculum changes. The second

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stage is called the diagnosis stage where nurses undertake the formulation of the diagnosis by the
employment of the clinical judgments that actually assist in the planning and the implementation
of the patient care (Bernard 2018). This would lead to third stage called the planning stage
where the nursing professionals would be setting the goals and the outcomes that are actually
formulated resulting on the direct impact on the patient care. The patient specific goals as well as
the attainment of such aspects help in ensuring a positive outcome. The fourth stage is called the
implementation stage that actually involves actions as well as doing and the actual carrying out
for the nursing interventions that are outlines in the plan of care. The fifth stage is called
evaluation which is stated to positive patient outcome. Nurses need to reassess or evaluate the
interventions that are implemented in order to ensure that the desired outcome is met (Munshi et
al. 2016).
Biographical information:
Mrs. Lily Brown is a 75 year old widow who remains alone in her house and is visited by
her son and daughter in life every weekend. She is suffering from diabetes type 2 for the last two
years and had not been able to manage her blood glucose level successfully. She had been
suffering from high BMI of 34 indicating that she is obese. In the previous few days, her pain of
osteoarthritis had worsened for which she is having huge issues in mobilizing independently. She
had been a associated with NGOs working for orphan children and she had been always
independent throughout her entire life. She used to manage her activities of daily living all by
herself but the present health condition had taken a toll on her and she is leading poor quality
life. She is also facing vision problems which had affected her driving capabilities. She had
suffered a fall in the last week which had concerned her son. The wounds she had developed is
not healing properly and currently, it had become swollen and red. She had been admitted to the

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healthcare centre by her son stating that she would require healthcare support to overcome the
healthcare issues. She is quite upset on her son as she thinks that her son does not trust her
abilities anymore and she is found to be non-communicative with the nurses.
Biological issues:
Lily is suffering from diabetes type-2. This is a disorder that is characterized by the
increased level of blood glucose level in the body because of the resistance of the cells of the
body towards insulin. Insulin helps the body cells to accept glucose from the blood after meals to
take part in respiration and produce energy for functioning of organs. Insulin resistance
developed by the cells of the body prevents the cells from getting glucose from the blood and
hence they cannot produce energy resulting in failures of different organs in undertaking their
physiological actions within the body (Lawless et al. 2016). Many of the studies have associated
obesity to be one of the most important risk factors that increases the chance of developing
diabetes. When the cells of the body become filled with fat, they cannot respond to insulin and
thereby becomes insulin resistant. Hence, obesity had made Lily more vulnerable to development
of diabetes. Another important aspect is the lack of management of the blood glucose level by
lily which had made her develop many diabetes related complications (Athirarani et al. 2018). It
has been found that complications like glaucoma, diabetic retinopathy and other eye problems
occur due to unmanaged glucose levels in blood. Studies are of the opinion that when blood
glucose levels increase, it can result in damaging the blood vessels in the retina especially in the
light sensitive tissues at the back of the retina causing eye problems. For this reason, Lily has
also developed eye problems (Retornaz et al. 2017). Studies have also associated diabetes type 2
with wound healing. It has been found that high blood glucose level in diabetes can result in
affecting the nerves leading to poor blood circulation thereby making it harder for the blood

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(needed for the skin to repair) in reaching out to areas that are affected by the sores of the
wounds. This can be stated to be the same cause for which Lily’s wounds are not healing.
Moreover, obesity had resulted in increased body weight that had created pressure on her bones
on the knees making her develop osteoarthritis. All these arenas need to be taken into
consideration for developing her care plan (Oh and Moorhead 2019).
Psychological issues:
Lily had always been an independent lady who had till now served a huge number of
charitable organizations helping orphans children find their homes. However, the present days
had been tough for her because of her suffering from a number of chronic ailments. Loss of
independence in regular lives results in development of stress among affected patients which
ultimately becomes a source of emotional turmoil on the patients (Kim and Lee 2016). She had
been suffering from social exclusion because of her inability to drive and meet friends. She is
also having mobility issues for which she also pursues her favorite hobbies like swimming as
well as gardening. Studies have found positive correlations between presence of chronic ailments
and symptoms of depression and anxiety because of her increased suffering as well as loss of
independence to conduct activities of daily lives (Sherifali et al. 2015). Lily had witnessed her
decreased ability of conducting activities of daily lives for which she fears of being dependent on
others and thereby she is seen to remain depressed. She is suffering from loss of self-esteem as
well as loss of self-confidence which had resulted her to withdraw her and for this she is not
found to be communicating with nurses. This situation if not managed might result in
development of major clinical depression in the patient and had to be also taken care by nurses.

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Social issues:
A number of social factors had been found to be associated with the cause of the
occurrence of the different chronic ailments. One of the most important social factors is the lack
of health literacy among the patient named Lily. Health literacy can be described as the degree
that explains the capacity of the individuals in obtaining, processing as well as understanding the
basic health information and the services for making appropriate health decisions (Felton et al.
2017). It had been found that Lily also had not attended higher education which had prevented
her to develop knowledge about importance of proper lifestyle and healthy diet and behaviors. It
has been found that lack of education and health literacy had prevented Lily to undertake proper
strategies for managing her blood glucose levels. She lives sedentary lifestyles and consumes fast
food and take-away foods which are high on calories. Studies have associated these attributes
with obesity and also with diabetes type-2 (Baxter et al. 2016). Another social factor is the lack
of effective income. She has no savings of her own and she also does not want to take any
financial help from her son. Therefore, she is forced to reside on cheap food sources for the
minimum amount of money she had with herself making her rely on take-away foods (Williams
et al. 2015). Hence, economic crisis faced by her is another social factor that is resulting in
development of obesity. Besides, social exclusion suffered by her due to her physical ailments
had resulted in mental instability and emotional turmoil contributing to her suffering.
Environmental issues:
It has been found that she is suffering from mobility issues and is at an increased risk of
fall because of the increased pain from the joints of the knee due to osteoarthritis. She lives all by
herself and she needs to mobiles to conduct her activities of daily living. This might expose her

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to more incidents of fall if not proper interventions are taken (Zhao et al. 2017). Moreover, she is
not able to clean and maintain hygiene because of her issues in completing ADLs. Hence, she
might make her wounds more wounded with the presence of more germs around the house as the
wounds are open. Moreover, the environment in her house is also found to be quite hazardous
when fall-risk assessment was conducted in her house. All such environmental issues must be
taken care of so as to ensure high quality and safe care for the patient
Conclusion:
From the above discussion, it can be seen that with the help of the ADPIE process, the
nursing professional had been able to gather huge amount of data about the patient named Lily
Brown. For ensuring comprehensive assessment of the patient, the nurse tried to gather detailed
information about biological factors, psychological factors, social factors as well as
environmental factors that are resulting in poor quality life of the patient making her suffer from
multiple chronic disorders. After conducting this assessment phase and conducting the nursing
diagnosis, the nursing professionals had developed a care planning process that not only included
intervention planning but had appropriate procedures for evaluation of the success rate as well.
Hence with the ADPIE process, the nurse had been able to develop the best care services that
helped Lily overcome her symptoms.

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References:
Ackley, B.J., Ladwig, G.B., Msn, R.N., Makic, M.B.F., Martinez-Kratz, M. and Zanotti, M.,
2019. Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care.
Mosby.
Athirarani, M.R., Sunila, S., Sujathan, S., Sruthi, D.L., Silpa, B.R. and Mathew, T., 2018.
Patient's perceived problem areas with diabetes management. International Journal of Nursing
Care, 6(2), pp.111-114.
Baxter, M., Hudson, R., Mahon, J., Bartlett, C., Samyshkin, Y., Alexiou, D. and Hex, N., 2016.
Estimating the impact of better management of glycaemic control in adults with type 1 and type
2 diabetes on the number of clinical complications and the associated financial benefit. Diabetic
Medicine, 33(11), pp.1575-1581.
Bernard, C., 2018. An Empirical Framework for Nursing Practice. Empirical Nursing: The Art of
Evidence-Based Care, p.231.
Bryant, R. and Nix, D., 2015. Acute and chronic wounds: current management concepts.
Elsevier Health Sciences.
Felton, A.M., McGill, M. and Global Partnership for Effective Diabetes Management, 2017.
Perceptions, attitudes and beliefs among allied healthcare professionals managing people with
Type 2 diabetes: an international cross-sectional survey. International Diabetes Nursing, 14(2-
3), pp.83-89.
Junkin, V., 2018. Improving clinical reasoning skills by implementing the opt model (Doctoral
dissertation, University of Alabama Libraries).

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Kim, S.H. and Lee, A., 2016. Health‐literacy‐sensitive diabetes self‐management interventions: a
systematic review and meta‐analysis. Worldviews on Evidence
‐Based Nursing, 13(4), pp.324-
333.
Lawless, M.E., Kanuch, S.W., Martin, S., Kaiser, D., Blixen, C., Fuentes-Casiano, E., Sajatovic,
M. and Dawson, N.V., 2016. A nursing approach to self-management education for individuals
with mental illness and diabetes. Diabetes Spectrum, 29(1), pp.24-31.
Munshi, M.N., Florez, H., Huang, E.S., Kalyani, R.R., Mupanomunda, M., Pandya, N., Swift,
C.S., Taveira, T.H. and Haas, L.B., 2016. Management of diabetes in long-term care and skilled
nursing facilities: a position statement of the American Diabetes Association. Diabetes
care, 39(2), pp.308-318.
Oh, H. and Moorhead, S., 2019. Validation of the Knowledge and Self-management Nursing
Outcomes Classification for Adults With Diabetes. CIN: Computers, Informatics,
Nursing, 37(4), pp.222-228.
Retornaz, F., Grino, M., Mari, L. and Oliver, C., 2017. Assessment of glycemic control in
nursing home residents with diabetes. The journal of nutrition, health & aging, 21(4), pp.457-
463.
Sherifali, D., Bai, J.W., Kenny, M., Warren, R. and Ali, M.U., 2015. Diabetes self‐management
programmes in older adults: a systematic review and meta‐analysis. Diabetic Medicine, 32(11),
pp.1404-1414.

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Williams, H., Simmons, L.A. and Tanabe, P., 2015. Mindfulness-based stress reduction in
advanced nursing practice: a nonpharmacologic approach to health promotion, chronic disease
management, and symptom control. Journal of Holistic Nursing, 33(3), pp.247-259.
Zhao, F.F., Suhonen, R., Koskinen, S. and Leino‐Kilpi, H., 2017. Theory‐based self‐
management educational interventions on patients with type 2 diabetes: a systematic review and
meta‐analysis of randomized controlled trials. Journal of advanced nursing, 73(4), pp.812-833.

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Appendix:
date Nursing problem
or issue
Nursing intervention Aim of the
intervention
evaluation signatur
e
XX
X
The patient is at a
higher risk of fall
because she is
suffering from
mobility issues;
she is suffering
from pain due to
osteoarthritis
The patient would be
allocated a physiotherapist
who wound applies therapies
to help her get over the pain
of osteoarthritis. The
physiotherapy would be first
undertaking non-
pharmacological treatment
like exercise programs,
counseling on weight loss as
well as education. He can
also advice acetaminophen
medication but should
monitor for side effects.
In order to reduce
the risk of fall, the nurse
should first use the Fall Risk
Assessment tool called the
FRAT tool which is the
standard tool used for the
assessing the fall risk of the
patient. Following this, the
nurse should also undertake
the environmental analysis of
the house where Lily lives to
make modifications that
would lessen the chances of
her fall. Removing clutters
from the floor, attaching
bathroom rails, hand rails,
bed rails are also important.
Advising the patient to wear
non-skid shoes and replace
light furniture with heavy
furniture would reduce
chances of toppling over.
The goal of
the therapy
would be to
reduce the
suffering of
the patient
by
controlling
the pain,
swelling of
the joints
and
improving
the quality
of life
The nurse
should use the
pain
measurement
scale and
assess her pain
from the
values of 1 to
10. This would
help the nurse
to know
whether her
pain had been
managed or
not by the
physiotherapist
. The FRAT
tool should be
also used for
evaluation to
see whether
the chances of
her falls had
reduced or not.
XXX
XX
X
The patient is also
seen to suffer from
high blood
glucose level
It is extremely
important for the nurse to
educate Lily about the proper
management techniques of
The main
aim of the
intervention
is to manage
Lily should be
advised to
participate in
screening
XXX

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which needs to be
maintained in
order to help the
patient manage her
diabetes
blood glucose level as Lily is
found to have low health
literacy. At first, she should
be educating her about risk
factors of diabetes and
explain the various ways by
which she can manage the
blood glucose level. She
should be educating the
patient about the importance
of maintaining a proper body
weight through appropriate
diet and exercises to manage
obesity and hence to manage
diabetes. Accordingly she
would allocate a dietician to
develop her diet chart and
educate her not to eat fast
foods. She would also
develop an exercise regimen
for Lily which she can follow
to manage her weight.
Another important
aspect would be medication
management. Lily often
forgets to take medications
and even does not understand
that why she takes such
medications. Hence, the
nurse should teach her about
the actions of each of
medication and how each of
the medication would help in
managing her blood glucose
level. She would talk in
details about use of
metformin and insulin
therapy and would also
allocate foxed timing and
dose of the medication. The
nurse can accordingly set
reminders or alarms for her
so that she can take them at
the right time
Another important
nursing intervention would
be helping the patient learn
about the ways of handling
glucometer and the way to
the blood
glucose level
of the patient
and help her
develop
health
literacy and
enable her to
develop self-
management
symptoms.
programs and
take part in
glucose testing
of various
types like
fasting glucose
test, HbA1c
tests and others
to find out
whether the
blood glucose
level is within
the range or
not

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take measurement through
the glucometer. The nurse
would use the teach-back
method for the patient.
Studies opine that teach back
methods are best for helping
patient develop skills of
tackling instruments and help
nurses to identify the
presence of any gaps in
learning of the student.
Glucometer would be
helping the patient in
developing an idea about the
blood glucose level in the
current stage and identify
whether she is within the
limit or she is in the danger
zone
XX
X
The patient is
found to be in the
initial stage of
depression mainly
because of los of
independence over
her activities of
daily living and
also of the
tremendous
suffering she is
going through
The nurse would be working
in collaboration with a
psychotherapists and initiate
a talk therapy like that of
cognitive behavioral therapy.
This therapy mainly helps in
replacing the negative
thoughts of the patient with
the positive thoughts and
also promotes positive
feelings helping patients to
develop self coping and self
management abilities. This
would help her overcome her
psychological turmoil as well
The main
goals are to
help the
patient
overcome
depressed
feelings and
enable her to
regain self-
management
skills and
self coping
abilities.
Depression
measurement
tools and
mental status
examination
tool would be
used for
assessing her
depression
level
XXX