Clinical Case Conference Report: Mr. Smith's Ulcer and Diabetes

This clinical case conference report focuses on Mr. Smith, a 72-year-old male with a history of T2DM, hypertension, and hypocholesterolemia, who presents with a chronic ulcer. The report delves into Mr. Smith's medical condition, including relevant anatomy, physiology, and the pathophysiology of his conditions, specifically focusing on the development of the ulcer and its relationship to his diabetes and hypertension. The discussion includes an analysis of the ankle-brachial index and the impact of his lifestyle choices, such as smoking and alcohol consumption, on his health. The report also outlines nursing management strategies, incorporating both BAR-based and systems approaches, and highlights the role of an inter-disciplinary team in providing holistic care. The report explores pharmacological treatments and emphasizes the importance of patient compliance and lifestyle modifications for improved health outcomes, considering the implications of his obesity and other related health issues.

CLINICAL CASE
CONFERENCE
REPORT

Contents
INTRODUCTION...........................................................................................................................1
DISCUSSION..................................................................................................................................1
Understanding of patient’s medical condition including relevant anatomy and physiology and
in depth pathophysiology.............................................................................................................1
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

INTRODUCTION
A clinical case basically lists the clinical criteria in which a person’s illness is included as a
case in outbreak investigation. Present report has laid emphasis on the case study of Mr. Smith
who is a 72 years old male patient. Service user has been retired from bank job and is a chain
smoker. He is also being engaged in consuming alcohol. It has also been analyzed in case study
that service user lives with his wife alone in their house. They also have two children who visits
them occasionally, Patient has been diagnosed with problem of T2DM and hypocholesterolemia.
It has also been analyzed that the patient is been suffering from chronic ulcer from past two
months. Present report will lay emphasis on patient’s medical conditions including relevant
anatomy, physiology and pathophysiology. It will also include nursing management using based
approach and system approach. Ankle Branchial Index will also be shown in report.
DISCUSSION
Understanding of patient’s medical condition including relevant anatomy and physiology and in
depth pathophysiology
From the case study it has been analysed that MR. Smith has bene diagnosed with various
problem like he is facing the problem of ulcer from past two months. Patient is being admitted to
primary health care unit because of ulcer. Because of this disease he is also facing severe pain in
leg. It has also been analysed in case study that from past two months Mr. Smith is also not been
aware of the pain in leg because of sensation. He has a history of T2DM, Hypertension and
hypocholesterolemia. It has also been interpreted in case study that Mr. Smith is also suffering
from diabetes. He has no control over his diabetes (Guest and et.al., (2018).
Anatomy and Physiology: Anatomy can be defined as the study in which the human form
is being analysed and observed. It is the examination of living being. It has been analysed that
MR. Smith is facing problem of ulcer. This disease is partially being formed by the gastric acid.
Patient going through this disease can also face problem of bleeding. Every understanding of
functional anatomy however is based on the meticulous and often painstaking basic
morphological work of others. Anatomy in diabetic service users, is that blood sugar level of
individual increases. Mr. Smith might face situation where the supply of oxygen in his body is
not sufficient. He can also face situation of hypoxia.
The physiology can be described for service user facing ulcer in leg as where the blood
vessels in skin is being narrowed down. In this situation service user is not able to feel the
1

sensation that is being arising in leg. They can feel intense amount of pain and also it can hamper
the health condition of service user. It also reduces patient’s quality of life. In venous ulcers
wounds on leg are being created. The major reason for occurring of ulcers in leg can be because
of hypertension. It has been analyzed that MR. Smith has the history of suffering from
hypertension.
Pathophysiology: From the case study it has been revealed that Mr. Smith is suffering from
problem of ulcer. He is facing this problem from past two months. This can be because of the
reason that arterial blood flow can be reduced in human body. Disease can occur to those service
users who are diabetic (Raffetto and et.al., (2016). Diabetic patients are at more risk of facing
problem of ulcer. Also from the case study it has been interpreted that Mr. Smith has also the
history of facing hypertension which is main reason for developing of ulcer in leg. Common
signs and symptoms that can be seen by service user that is Mr. Smith is that he can have open
sores in leg. Patient can also have the pain in affected are. They can also face the feeling of
sensation in his leg which can reduce service user’s ability to move. Heaviness in leg can also be
occurred.
Mr. Smith can also notice that skin of leg in which ulcer has occurred is darken. The reason
for occurring of leg ulcer can also be enlarged veins. This disease can reduce the quality of life
of Mr. Smith. By this he is also prone to all other diseases. It has also been analyzed that because
of ulcer in leg service user also have chronic wound that is 6*4 cm and 0.4 cm deep. The wound
is deep and also it is very easy for it to become infected. This can be because of dirt and germs.
Peripheral neuropathy can be the reason for occurring of ulcer in leg (Wrigh and et.al., (2018).
In peripheral neuropathy service user can feel numbness in their feet and hand. It can be
diagnosed when patient is undergoing blood test, nerve biopsy and skin biopsy. Main cause of
peripheral neuropathy is type 2 diabetes. Injuries and explosion to germs and bacteria can also
cause problem of peripheral neuropathy in Mr. Smith. Treatment can include physical and
surgical therapy. It can increase nerve pressure that can cause chronic pain in the feet and hand.
The ankle Brachial index of Mr. Smith was slightly imbalanced. It was analyzed from case
study that ABI in right leg was 1.0 and in left leg is 1.40 (Leung and et.al., (2017). It can be
considered at slight normal but Mr. Smith must take care as This can increase the risk of
cardiovascular disease. Patient becomes more prone to heart attack and other heart disease.
2

Case study has also revealed that Mr. Smith was non-compliant of diabetes. It means that
service user has been diagnosed with diabetes but never given proper advice on what diet they
need to follow. Also it means that medical advice is not being followed by Mr. Smith. Non-
compliant diabetes only occurs to those patients whose Hb1AC of more than 7%. Patient is
suffering from type two diabetes and chronic ulcer because of which he also had wound in his
leg. It has been analyzed that because of diabetes there might occur chances that the wound
might not be healed. Slow healing of cuts and wounds can be first sign and symptom which can
be noticed by Mr. smith that he is suffering from diabetes. In order to overcome from this disease
patient must be involve in taking proper diet and must engage in exercising regularly. Type 2
Diabetes can also be faced by patient because of old age. Elderly individuals are more at risk of
suffering from problem of type two diabetes. Patients who are suffering from type 2 diabetes also
can have issue in foot. This can reduce quality of service users. It can hamper their health
condition. Type 2 diabetes can also occur in Mr. Smith because of the continuous consumption
of alcohol and smoking of cigars. Service users can also face problem of blurred vision because
of type two diabetes. This can deteriorate their outcome of health. It can reduce their quality of
life. Diabetes can also be the reason of peripheral neuropathy occurring in Mr. Smith (Green and
et.al., 2018.
Case study has also analyzed that Mr. Smith also have a history of hypertension. The main
reason for occurring of this disease can be when patient diet is not being normal. Family history
of high blood pressure can also be reason for occurrence of this disease. Diabetes is also one of
the main reason for occurring of hypertension. In this service user that is MR. Smith can face
problem of chronic headache, fatigue and confusion. There might occur chances that patient is
going through problem of vision after this. So Mr. Smith needs to make sure that they have
proper diet and also they intake less salt in their diet. This practice when followed by them can
enhance their health outcome. It can also improve quality of life of Mr. Smith. He can also face
problem of fatigue by this. Also case study has revealed that Mr. Smith has 175 cm height and
weight of patient is 105 kg. It means service user is overweighed that is one of the reason that he
is going through problem of hypertension. Also service user is more at risk of heart attack and
other severe diseases. Body mass index of Mr. Smith is 34 that means he is obese. The main
reason for Mr. Smith being obese is physical in activity. Also he is consuming alcohol and
3

smoking cigars. Other psychological problem like being depressed can also be reason of being
obese.
Case study also revealed that Mr. Smith is also suffering form problem of
hypocholesterolemia. The small bumps that can be seen in patient can be because of the health
disease like hypocholesterolemia. It can lead patient at risk of heart attack and also they can face
problem like peripheral artery disease. Service user can also face problem including pain in left
side of chest. Mr. Smith can also face problem related to dizziness, slurred speech. Also they can
a face pain their lower feet. This disease can decrease quality of life of patient. It can hamper
their health aspects.
Nursing management: BAR based approach can be used by health care professionals and
nurses when Mr. Smith is being admitted to primary health care unit. In this nurses must be
involved in efficient communication so that they can effectively analyse all problems that is
being faced by patient. It can be described as an evidence based communication practice which
can be used so that service user’s satisfaction can be increased with care provided to them. This
approach can be used to reduce barriers that can be faced by health care professionals while
providing care to service users.
Systems approach- Nurses can also be involved in making use of systems approach. In this
health care professional will involve in providing holistic care to Mr. Smith. In this nurses will
be involved in letting patient know about the early signs and symptoms so that patient can detect
problems even before they grow (De Franchis, (2015). This can support the service users in
enhancing quality of life. In this nurses can foster relationship with service user so that they can
promote and health-wellbeing of service users. Also nurses can engage in providing Mr. Smith
with emotional support as he is living alone with his wife and his children visits him
occasionally. This will help health care professional in making health condition of service user
better.
Role of inter-disciplinary team: Primary health care unit in order to provide acute care to
Mr. Smith going through problem of ulcer from past two months can involve multi-disciplinary
team. In this there are number of people like nurses. Physicians, neurologist, dietician, health
care professional, psychiatrist are engaged in improving the health outcome of service users.
They will make use of evidence based practice so that patients condition can be improved. In this
the team can make use of person-centred practice. In this approach the health care professional
4

will involve patients in all aspects of care that is being provided to them. Also nurses will be
engaged in providing comprehensive person-centred care. Nurses can also involve in giving
them holistic and person-centred care. Also multi-disciplinary team will be engage in making
patient know about the signs and symptoms that can give rise to a particular disease. Team also
need to make use of evidence based practice so that they can be involved in enhancing health
outcome of patient who has been suffering from chronic disease like ulcer in leg.
Pharmacological treatment: When being admitted to primary health care unit nurses can
provide them with drug like Trental that can be effective in solving problem of wound which is
not healing in Mr. Smith. To heal the wound health care professional can also put a zinc paste
bandage that is containing calamine, coal tar so that the wound can be closed. It can be because
of the blood vessel is also stretching in old male. Beta-blockers can also be given to
hypertension. This medicine can help service user in keeping a control over its hypertension. It
can make arteries to improve flow of blood. It can open up veins of MR. smith that can assist
continuous flow of blood. Nurses must make sure that Beta-Blocker is being taken by Mr. Smith
after he has taken food. Propranolol can also be given by health care professional in night.
Nurses must make patient know about that this medicine that it can cause sleeping problems. It
must be taken at night after having meal. This must be communicated by health care professional
to their patient. This pharmaceutical medicine will help them in improving outcome of health of
individual. These medicines can increase the amount of dizziness.
Non-Pharmacological treatment: Non-pharmacological treatment can support Mr. Smith
in reducing effect of anti-hypertensive medication. In this multi-disciplinary team like dietician,
physician, nurses can motivate Mr. Smith to engage in exercising and taking proper diet
(Basavanagowdappa and et.al., (2016). This will support patient in having a control over the
problem of non-compliant diabetes. Also health care professional must involve in making service
user understand that he must no take more stress, so that their health outcome can be improved.
Health care professional also must engage in motivating patient and letting them know about the
benefits of exercising and involving in activities like aerobics, yoga and other.
Education needs of patient- Nurses must be engage in educating Mr. Smith about the
healthy eating habits. They must make sure that service user has proper knowledge of the
strategies related to weight loss. They must have skills so that their diabetes can be self-
managed. This will help them in monitoring blood glucose level. Also nurses must make sure
5

that patient develop skills to manage diabetes with self. Also Mr. Smith must have knowledge
that smoking cigars and consuming alcohol can increase the problem of ulcer. So Mr. Smith
must be motivated to reduce the consumption of alcohol. It can help him in enhancing outcome
of health. It will also improve quality of life of service users. Also health care professional must
make sure that the family member of service user is also educated on the disease which are being
faced by patient. It will help them in improving health care condition of patients.
CONCLUSION
From the above study, it has been summarised that Mr. Smith has been diagnosed with
various diseases. This has hamper the health condition of patient. It has also been analysed that
service user is being suffering from various health disease like hypertension, cholesterol. Also he
has been facing a chronic disease that is ulcer in leg. In this patient has been diagnosed with a
wound which is really deep. It has also been analysed that Beta blocker is being given by health
care professional to Mr. Smith. This pharmaceutical drug has helped them in enhancing their
health outcome.
6

REFERENCES
Books and Journals
Basavanagowdappa, H., Basavanagowdappa, N., Ravikumar, Y. S., Kulkarni, P., & Devegowda,
D. (2016). Magnitude of resistant hypertension and impact of aldosterone to renin ratio in
resistant hypertension. Journal of Cardiovascular Disease Research. 7(4).133-138.
De Franchis, R. (2015). Expanding consensus in portal hypertension: Report of the Baveno VI
Consensus Workshop: Stratifying risk and individualizing care for portal
hypertension. Journal of hepatology.63(3). 743-752.
Green, J., Jester, R., McKinley, R. and Pooler, A., 2018. Chronic venous leg ulcer care: Putting
the patient at the heart of leg ulcer care. Part 1: exploring the consultation. British journal
of community nursing. 23(Sup3). pp.S30-S38.
Green, J., Jester, R., McKinley, R. and Pooler, A., 2018. Chronic venous leg ulcer care: Putting
the patient at the heart of leg ulcer care Part 2: Development and evaluation of the
consultation template. British journal of community nursing.23(Sup6). pp.S20-S30.
Guest, J. F., Fuller, G. W., & Vowden, P. (2018). Venous leg ulcer management in clinical
practice in the UK: costs and outcomes. International wound journal, 15(1), 29-37.
Jinnai, S., Suenaga, A., Murata, M., Chiba, T., Kohda, F., Kiryu, H. and Furue, M., 2017. Two
cases of leg ulcer caused by bevacizumab. Nishinihon Journal of
Dermatology. 79(5).pp.468-472.
Leung, A. A., Daskalopoulou, S. S., Dasgupta, K., McBrien, K., Butalia, S., Zarnke, K. B., ... &
Gelfer, M. (2017). Hypertension Canada's 2017 guidelines for diagnosis, risk assessment,
7

prevention, and treatment of hypertension in adults. Canadian Journal of
Cardiology, 33(5), 557-576.
Raffetto, J. D., Eberhardt, R. T., Dean, S. M., Ligi, D., & Mannello, F. (2016). Pharmacologic
treatment to improve venous leg ulcer healing. Journal of Vascular Surgery: Venous and
Lymphatic Disorders.4(3).371-374.
Wright, J. M., Musini, V. M., & Gill, R. (2018). First‐line drugs for hypertension. Cochrane
Database of systematic reviews.(4).
8

9