Health Care Case Study Analysis: Chronic Illness and Patient Care

This essay provides a detailed analysis of a case study involving Manny, a 42-year-old man with type 1 diabetes who underwent a forefoot amputation due to poor wound healing. The essay delves into the pathophysiology of type 1 diabetes and its connection to peripheral neuropathy, which led to the amputation and wound healing complications. It examines relevant diagnostic and ongoing tests, including fasting plasma glucose, HbA1c, and blood glucose monitoring. Two potential problems associated with the condition, namely diabetic foot complications and an increased risk of stroke, are identified. The essay also explores developmental and health literacy considerations, emphasizing the importance of cultural sensitivity in patient education and care. Three nursing priorities are highlighted: reducing the risk of infection, minimizing impaired tissue perfusion, and controlling blood sugar levels. The conclusion summarizes the key aspects of the case, emphasizing the importance of both pharmacological and non-pharmacological interventions in promoting patient recovery.

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Health care
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Part A: Written case analysis essay
Introduction:
The main purpose of the essay is to analyze the case study of Manny, a 42 year
old man with type 1 diabetes who had his forefoot amputated. The presenting condition
for the client is poor wound healing post his forefoot amputation and the chronic
condition is history of type 1 diabetes. The essay will discuss about the pathophysiology
of this chronic condition and the presenting issue and explain about relevant diagnostic
and ongoing test linked to the patient’s condition. The essay will evaluate two potential
problems for patient and identify three nursing care priorities for the management of the
chronic and presenting condition. All health literacy and cultural consideration will be
discussed in the context of planning care for the patient too.
Symptom, anatomy, pathophysiology of the chronic and presenting condition:
This essay is focused on the case study of Manny whose presenting condition of
poor wound healing post forefoot amputation is seen because of Type 1 diabetes (T1D).
T1D is a chronic disease associated with clinical presentation of polydipsia (increase in
thirst), polyphagia (increased hunger) and polyuria (increased urination) along with
hyperglycemia. These symptoms are the diagnostic hallmarks in children and
adolescents. In case of adults, the common symptoms include feeling thirsty, fatigue,
loss of weight, blurred vision, urinating frequently and difficulty in breathing (Atkinson,
Eisenbarth & Michels, 2014). It is a condition that can be diagnosed at any age,
however the peak in presentation is mostly seen between 5-7 years of age (Kahanovitz,
Sluss & Russell, 2017). The main pathophysiology behind T1D is the alterations in the
immune producing hormone leading to autoimmune destruction of the insulin producing
beta cells. Another explanation is that in patient with this disease, pancreas lack insulin
producing cells and remaining beta cells are incapable of generating adequate amount
of insulin (Atkinson, Eisenbarth & Michels, 2014).. Thus, the body is not able to
produce adequate insulin to meet the overall needs. The main anatomic structure
affected by the condition is the insulin producing beta cells in the pancreas and the

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physiological mechanism behind it is the destruction of the beta cells. Insulin deficiency
and hyperglycemia leads to poor transport of glucose from the bloodstream into the
tissues, increase in glucose levels in the blood and urine and fluid losses (Kahanovitz,
Sluss & Russell, 2017).
Moreover, the presenting condition of foot amputation and poor wound healing is
seen in patients like Manny because of a condition called peripheral neuropathy. It
mainly involves narrowing of the blood vessels leading to poor flow of blood to the legs
and feet. This increases the potential for foot ulceration which ultimately progress to
gangrene and amputation. The risk of amputation increases by 1.7 fold in patients with
somatic neuropathy (Juster-Switlyk & Smith, 2016). Peripheral neuropathy is also
associated with impaired wound healing of poor nutrient and oxygen transfer to the cells
after stiffening of the blood vessels. Lack of oxygen is the cause behind poor repair of
wounds as well as necrosis and amputation (Vinik et al., 2013). Thus, T1D, amputation
and poor wound healing are all linked to high blood glucose level and narrowing of the
blood vessels due to T1D. Because of the above pathophysiology and increase in blood
glucose level, Manny had to amputate his foot and he was struggling with wound
healing issues too.
Diagnostic and ongoing tests for the condition:
There are several diagnostic criteria for identifying T1D in patients. The first
diagnostic test is the fasting plasma glucose (FPG) test that helps to confirm diabetes
when FPG level is more than 126 mg/dl. More recently, the HbA1c test has been added
in the diagnostic criteria of diabetes too. It is a marker for chronic glycemia and this is
ruled when the haemoglobin level is 6.5% or higher in two separate test. Compared to
FPG, the main advantage of HbA1c test is that it can be done without fasting allowing
for easier screening of patients. Moreover, the second advantage is that HbA1c test had
greater analytical stability and less day-to-day variance compared to FPG test.
However, one limitation of the HbA1c test is that it gives misleading results in patient
with anemia. In such condition, there is a need for conducting laboratory HbA1c assays
to diagnose T1D (Kahanovitz, Sluss & Russell, 2017). Other ongoing test that is
regularly required for patients like Manny include frequent blood sugar monitoring using

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glucose monitoring devices. The report Health Quality Ontario (2018) justifies frequent
blood glucose monitoring as effective in maintaining targeted glucose range and
administering appropriate amount of insulin via injection or pumps.
In case of the presenting condition of foot amputation due to peripheral
neuropathy, the diagnostic test that can help to detect this problem includes blood test,
imaging test, nerve function tests and nerve biopsy. The role of blood test in the
diagnosis is that it enables detecting vitamin deficiencies and abnormal immune
function. Moreover, nerve function test like electromyography records electrical activity
in muscles to find out any nerve damage. Yang et al. (2018) argues that some
diagnostic test for a patient involves complete blood count test, complete metabolic
profile, fasting blood glucose and erythrocytes. This may be followed by antimyelin
associated glycoprotein antibodies to detect sensorimotor neuropathies. The test
specific for patients with peripheral neuropathy also involves Vitamin B 12 test, thyroid
stimulating hormone level and erythrocyte sedimentation test.
Two potential problems associated with the condition:
Manny has been suffering from T1D. Two potential problems associated with the
condition involve risk of diabetes foot complications and risk of heart disease. According
to Jain, Diab and Diab (2016), foot complication is a serious complication that is seen in
about 15% of the patient with diabetes. The common characteristics of diabetic foot
complications seen in patient include wet gangrene, abscess, cellulitis, osteomyelitis
and necrotizing fasciitis. Similar issue was found for Manny and the foot problems
progressed to an advanced stage due to which his forefoot had to be amputated.
According to Chen, Ovbiagele and Feng (2016), stroke is one of the potential problem
for patients too. Various microvascular and macrovascular change results in greater risk
of stroke occurrence. For patients who suffer from uncontrolled diabetes, the risk of
ischemic and hemorrhagic stroke is the highest. Considering this evidence, it can be
said that Manny may be at risk of stroke in the long term too.
Developmental and health literacy considerations for the problem:

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As per Manny’s confession, he has confessed that in times of stress, he has
erratic blood glucose control. To provide health related education to Manny, it will be
necessary to consider cultural values of patient. The significance of health literacy is
that it promotes behavioural skills and effective self-management behaviour in patient
by learning more about the disease and its management. Health literacy efforts can be
successful by being culturally sensitive and collecting knowledge related to cultural
values, beliefs, customs and languages. This would help to plan diet chart and lifestyle
management programs as per cultural preference of Manny. Moreover, it would also
help to understand the level of openness and interpersonal interaction needed with the
patient. The five attributes that can influence communication style include language,
cultural norms and values, cultural beliefs, cultural body language and stereotypes
(Caballero, 2018). These considerations would help in improving self-care, self-efficacy
and empowerment. While deciding to educate patient about diabetes, it is necessary to
consider the developmental stage of patient. Manny is 42 year old and he is free from
any developmental issues that is seen in children and adolescent patient. However, the
transtheoretical model of behavioural change can be used to assess his readiness for
change and prepare him to act on a new health behaviour (Tseng et al., 2017).
Three nursing management priorities for the condition:
As Manny is suffering from poor wound healing issues post amputation, three
nursing priorities will be important include reducing risk of infection, minimize impaired
tissue perfusion and control blood sugar level. To reduce risk of infection, it will be
necessary to administer antibiotics and prophylaxis to Manny. Some antibiotic that can
be given includes amoxicillin or clindamycin. It can help control complications occurring
due to infection. The antibiotic therapy may be prolonged if soft tissue infection is not
reduced (Rossel et al., 2019). To control any risk of tissue perfusion, it will be necessary
to regularly perform neurovascular assessment of patient and monitor dressing for
drainage. Regular dressing change will be necessary too. Moreover, dietary counselling
session should be arranged with Manny so that she learns about the importance of diet
in controlling her blood sugar level and promoting wound healing process. Protein
should be included in the diet too as it is required for wound healing in all stage of the

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wound healing process such as fibroblast proliferation, collagen formation, angiogenesis
and immune function (Sajid et al., 2018).
Conclusion
To summarise, the essay discussed about the pathophysiology and symptoms of
T1D and foot amputation due to peripheral neuropathy and linked it to the case scenario
of Manny. It gave insight into relevant diagnostic test that helps in diagnosing the
chronic disease and peripheral neuropathy issues in individuals affected with T1D. Two
potential problem identified in such patients were foot amputation and high risk of stroke
in the long term. Based on the analysis of Manny’s immediate health need, both
pharmacological and non-pharmacological nursing intervention was considered
important to treat and promote recovery of patient

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References:
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The
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Caballero, A. E. (2018). The “A to Z” of managing type 2 diabetes in culturally diverse
populations. Frontiers in endocrinology, 9, 479.doi: 10.3389/fendo.2018.00479
Chen, R., Ovbiagele, B., & Feng, W. (2016). Diabetes and stroke: epidemiology,
pathophysiology, pharmaceuticals and outcomes. The American journal of the
medical sciences, 351(4), 380-386.doi: 10.1016/j.amjms.2016.01.011
Health Quality Ontario. (2018). Continuous monitoring of glucose for type 1 diabetes: a
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Tseng, H. M., Liao, S. F., Wen, Y. P., & Chuang, Y. J. (2017). Stages of change
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