Case Study: Type 2 Diabetes, Hypertension, and Patient Education

This case study project examines the case of Bill McDonald, a patient diagnosed with type 2 diabetes and hypertension. The study delves into the pathophysiology of type 2 diabetes, explaining the mechanisms of insulin resistance, inadequate insulin secretion, and the role of environmental and genetic factors. It highlights the importance of understanding the disease progression for effective nursing interventions, including the identification of symptoms like pitting oedema and blurred vision. The project explores management approaches for hypertensive diabetic patients, emphasizing the use of ACE inhibitors, lifestyle modifications (such as smoking cessation, dietary changes, and exercise), and regular blood pressure monitoring. Furthermore, it outlines an education plan to support Bill's care and treatment needs, including structured diabetes education, the role of credentialed diabetes educators (CDEs), and the importance of self-management practices. The plan addresses the need for education on lifestyle changes, medication management, blood glucose monitoring, and the recognition of potential complications, with a focus on evidence-based principles to improve patient outcomes and overall health.

Case study Project

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
QUESTION SET A .........................................................................................................................1
Pathophysiology of type 2 diabetes ............................................................................................1
Management approaches for hypertensive diabetic patient ........................................................2
Education Plan for supporting care and treatment needs related to the disease progression ......4
CONCLUSION ...............................................................................................................................5
REFERENCES ...............................................................................................................................6

INTRODUCTION
Chronic diseases are known as the long lasting or the terminal diseases which not only
requires medications but also requires necessary clinical and nursing management approaches.
The chronic diseases such as diabetes are greatly affected by the life style and management
approaches. Thus, education plans which enhances the understanding of treatment and care needs
are considered as important approaches (Powers & et.al., 2017). The report will evaluate the
pathophysiology and nursing management approachers for a diabetic patient in reference to
given case study. It will also provide an educational plan so that support services for the diabetes
can be improved and managed properly.
QUESTION SET A
Pathophysiology of type 2 diabetes
Pathophysiology is defined as the analysis of the physiological changes which appears as
the result of any injury or disease. The study of pathophysiology of diabetes is important as it
enhances the understanding of diseases so that nurses can prepare efficient treatment plans for
the practice. The working and clear knowledge of pathophysiology also assist in discovery of
clinical facts and for developing strong reasoning for the symptoms and medical interventions.
Another aspect which highlights the importance of pathophysiology is that care services can be
improved only if nurses are capable to measure and monitor the disease progression.
Pathophysiological knowledge allows effective partnership between nurses, medical staff and
patients (Hingorani & et.al., 2016). Thus, as per the given case study also, for providing
appropriate medication and the quality of services pathophysiology of type 2 diabetes is
important to know so that better treatment plan can be prepared for Bill McDonald.
The significance of the pathophysiology is also demonstrated in the given case study.
Bill McDonald is diagnosed with type 2 diabetes. The nurses observed that though he does not
have any lesion but in both legs pitting oedema was present. In the diabetic patients it is evident
that foot nerves may get affected and small cuts or lesions are not sensed by the body. Thus, to
prevent infection and other serious complications they must be regularly checked and caution
must be taken. The pathophysiology of pitting oedema and diabetes helped care nurse to identify
that some medications for diabetes can also result in oedema (Bilo & et.al., 2015). However,
there are several other reasons as well for this issue. Hence, pathophysiology provides supportive
conclusions for explaining such changes in the body which can bother patient as well as health
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outcomes. In certain cases for making the diagnosis and treatment interventions health
professionals must understand the underlying causes and background which is not possible
without pathophysiological knowledge. Similarly, Bill also informed that he experience tiredness
in his eyes. The blurred vision and damage to retina are also important changes in the diabetic
patients. Thus, the in-depth knowledge of pathophysiology will assist to take timely steps to
determine the exact rationale for this tiredness and to assure that it is not turning into gradual
blurriness or visionary problems.
Type 2 diabetes (T2D) is also known as adult onset diabetes and is very common among
obese people. It is non-insulin dependent diabetes and is milder than compare to type 1. With
T2D small amount of insulin is produced by the pancreas but either body develops high
resistance for it or produced insulin is insufficient to meet the needs of body. When body
develops insulin resistance then glucose does not enter into cells and accumulates in blood
(McKnight & et.al., 2015). It increases the sugar level and pancreas is required to make more
efforts for producing insulin. This results in strain and gradually pancreas becomes unable to
generate necessary amount of insulin. The progression of T2D can be controlled by weight
management, medications, nutritious diet and physical activities. Thus, T2D is combination of
insulin resistance, inadequate secretion of insulin and inappropriate secretion of glucagon.
Along with the genetic reason environment factors are also critical elements for the onset
of type 2 diabetes. This has been also observed in the case of Bill. The patient has family history
of diabetes. His mother had diabetes and thus there were higher risks of patient for suffering with
the disease. The environment factors such as life style changes, smoking and drinking can also
cause T2D. The excessive consumption of alcohol decreases the sensitivity of human body
towards insulin (Care, 2019). The heavy drinking and smoking for prolong period also causes
chronic pancreatitis which can worsen the diabetes. Bill has been chain smoker and drinker for
around 35 years which gave the strong pathological concept for the development of T2D which
is also known as adulthood diabetes which occurs due to unhealthy life style.
Management approaches for hypertensive diabetic patient
Type 2 diabetes is closely associated with the adulthood and the life style practices. Thus,
hypertension and life style related factors can significantly affect its onset and progression. The
integration of hypertension and T2D is very lethal and can increase the vulnerabilities of stroke
and diabetes. This combination can also encourage kidney diseases and issues related to blood
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vessels of eyes. Thus, it is very important to understand the management practices for the
hypertension in diabetes. The poor management of hypertension accelerates the progression of
vascular complexities of diabetes. The use of nursing management practices to control the
aggressive blood pressure brings improvement in the health outcome of the diabetic patient. The
antihypertensive regimens optimises the non-pharmacological interventions (Garber & et.al.,
2015). As a result adverse impact of medications and imbalance in glucose control level. Thus,
health care service providers providing care services to the diabetic patients can employ
management practices for controlling the blood pressure and critical implications of diabetes.
According to (Hingorani & et.al., (2016) it has been observed that the rise in blood
pressure in hypertensive diabetic patient can worsen the condition of the patient. Bill McDonald
has very high blood pressure. The observed readings are 170/100 mm Hg. High BP can cause
damage to the blood vessels and when it teams up with diabetes life threatening conditions such
as stroke, cardiac arrest or heart attack can occur. The management practices such as controlled
diet, regular exercises can lower the cholesterol and blood pressure. Similarly, stress
management techniques like relaxation and task prioritisation is also preferred clinical approach
used for the patients of hypertensive diabetes.
The regular blood pressure monitoring is an essential part of the diabetes management
plan. The first therapy which can be used for managing hypertension in Bill is the use of
angiotensin converting enzyme (ACE) inhibitors. ACE are used as antihypertensive agents for
the patients of diabetes. Along with BP, ACE inhibitors also delay the kidney diseases associated
with diabetes. Apart from these pharmacological therapies such as Thiazide diuretics,
Angiotensin receptor blocker, beta and calcium channel blockers are used as antihypertensive
agents (Shaikh., 2017). Management of hypertensive diabetes also emphasis on modifying
lifestyles and to continue those changes throughout the treatment procedure.
For instance after diagnosis of T2D Bill skipped his habit of smoking and drinking and
always used to follow the sedentary life style. It is necessary that he continues this life style
regularly. The BP of Bill is greater than 140-90 mm Hg, thus he requires pharmacologic therapy
as well along with the life style changes. Health professionals also recommend to periodically
check the blood pressure so that it can be managed within normal range. In the last two years Bill
has reduced weight from 156 to 1230 Kg. In addition, with the weight reduction, hypertension
management strategies also focus on regulating protein, alcohol and sodium (Choudhary & et.al.,
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2015). For the management of sugar level Bill must also change its diet plans and fat free foods
must be included primarily in his diet. This will help to manage cholesterol and fat. For reducing
both types of vascular complications in hypertensive diabetes patients multi-fraction
management approach can also be preferred for the managing both BP and hyperglycemia. The
blood pressure targets must be set up for Bill so that life style changes, pharmacological changes
can help to achieve those targets. Counselling and blood pressure management at home are the
best strategies for the quality health outcomes (Beck and et.al., 2017).
Education Plan for supporting care and treatment needs related to the disease progression
Life style changes and management practices plays equivalent role in improving health
outcomes of diabetic patients as played by effective medications. Thus, Australian government
and health care organisations formulates various learning programs and diabetic educators which
motivates and support people in their care needs. Such educational plan helps individuals to
assess and manage the disease progression so that nurses can develop better interventions.
Hence, for encouraging the role of patients in care services and diabetes management such
education plan are very important and integral part of the diabetes care.
The significance of the education plan can be demonstrated through various instances.
For instance the drinking habits and healthy diet is significant factor in regulating the
complications of diabetes (Tools & eLearning, 2019). Thus, it is very essential that Bill is
educated with the importance off sedentary life style. Similarly, being patient of hypertensive
diabetes it is also necessary for Bill to control and check his blood pressures regularly. For this
purpose educating Bill regarding his condition, treatment procedures and possible future
outcomes can help him to better bring changes as per his sociocultural needs.
Bill must be provided with the structured diabetic patient education. It can be provided
either in group or as individually. As per the framework of Diabetes Australia vast range of
resources are available which can be helpful for educating Bill. The health professionals can
educate Bill regarding self management practices. It will help him to achieve the self managed
goals like understanding the condition, collaboration with the healthcare team and to bring
necessary changes to health behaviour and environment (Diabetes Self-Management Education
and Credentialed Diabetes Educators, 2019). This type of education is person centred and
provides more effective outcomes. For this purpose credentialed diabetes educators (CDE) can
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interact with Bill and can help him to gain necessary knowledge regarding his health status and
other aspects of diabetes management.
Credentialed programs are supported by Australian diabetes educators association
(ADEA). The CDE evaluates the cognitive, physical as well as psychological assessment of
diabetic patient (Khunti & et.al., 2016). Such educators will help Bill to develop plans related to
his goals of loosing weight, managing blood pressures and routine plan for the physical workout
or exercises. The educators will also educate Bill that how his behavioural changes and improved
clinical behaviours can assist in managing the complications. This education is based on the
evidence based principles. For instance in situation when Bill may experience fatigue or changes
in blood pressure then he must check and seek for the help of doctor so that insulin level in his
body can be monitored and controlled.
Under CDE education program Bill will be given education for choosing appropriate
food, medications, blood glucose monitoring, lifestyle choices and diabetes management. Within
this education plan educators must also inform and teach Bill that how he can manage or
overcome the situation of sick days or fluctuating glucose levels. The diabetes have serious
chronic complications which must be identified at their onset so that conditions can be
controlled. For example the visionary issues, oedema, hypertension are associated with the
diabetes (Garber & et.al., 2015). Thus, Bill must be informed about these as well so that on
observing basic symptoms he may consult doctors on time and does not get panic on their sudden
occurrence. This education plan will also consider the psychological factors into considerations
so that Bill can self evaluate his health outcomes and with the support of healthcare professionals
he can manage his diabetes and hypertension. Bill can also become part of the National diabetes
service Scheme (NDSS) of Australia government which gives all necessary assistance to the
diabetic patients. It raises the understanding of people so that they can self manage their diabetic
condition. This services are accessible at free of cost and gives complete assistance for the
diabetes.
CONCLUSION
It has been analysed that quality of care services and nursing interventions cannot be
improved by only medication management. Especially in case of chronic care health care
professionals must provide adequate knowledge to the patients so that they can adopt a life style
which supports their disease management. It can be concluded from the study that adoption of
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health life style and support of credentialed diabetes educators can bring significant
improvements in quality of care services and diabetes management. From the above discussion it
is also concluded that understanding and regular monitoring of the pathophysiology can also help
care service providers to analyse the clinical complications on time and to take necessary
interventions.
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REFERENCES
Books and Journals
Beck, R. W. and et.al., (2017). Effect of continuous glucose monitoring on glycemic control in
adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical
trial. Jama. 317(4). 371-378.
Bilo, H., & et.al., (2015). Clinical Practice Guideline on management of patients with diabetes
and chronic kidney disease stage 3b or higher (eGFR< 45 mL/min). Nephrology Dialysis
Transplantation. 30(suppl_2). ii1-ii142.
Care, D. (2019). Standards of Medical Care in Diabetes 2019. Diabetes Care, 42, S81.
Choudhary, P. & et.al., (2015). Evidence-informed clinical practice recommendations for
treatment of type 1 diabetes complicated by problematic hypoglycemia. Diabetes
Care. 38(6). 1016-1029.
Garber, A. J. & et.al., (2015). AACE/ACE comprehensive diabetes management algorithm
2015. Endocrine Practice. 21(4). 438-447.
Hingorani, A. & et.al., (2016). The management of diabetic foot: a clinical practice guideline by
the Society for Vascular Surgery in collaboration with the American Podiatric Medical
Association and the Society for Vascular Medicine. Journal of vascular surgery. 63(2).
3S-21S.
Khunti, K. & et.al., (2016). Clinical inertia with regard to intensifying therapy in people with
type 2 diabetes treated with basal insulin. Diabetes, Obesity and Metabolism. 18(4). 401-
409.
McKnight, J. A. & et.al., (2015). Glycaemic control of Type 1 diabetes in clinical practice early
in the 21st century: an international comparison. Diabetic Medicine. 32(8). 1036-1050.
Powers, M. A. & et.al., (2017). Diabetes self-management education and support in type 2
diabetes: a joint position statement of the American Diabetes Association, the American
Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The
Diabetes Educator. 43(1). 40-53.
Online
Diabetes Self-Management Education and Credentialed Diabetes Educators. 2019. [Online].
Accessed through <https://www.adea.com.au/about-us/our-people/diabetes-self-
management-education-and-credentialled-diabetes-educators/>
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Shaikh., A., 2017. A practical approach to hypertension management in Diabetes. [Online].
Accessed through <https://link.springer.com/article/10.1007/s13300-017-0310-3>
Tools & eLearning. 2019. [Online]. Accessed through
<https://www.diabetesaustralia.com.au/tools-e-learning>
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