Case Study: Diabetes, Social Isolation, and Care Plan

This case study focuses on a 57-year-old woman, Alice Jones, admitted to the hospital with type 2 diabetes, hypertension, and a fractured leg. The case study explores the impact of diabetes and social isolation on her well-being, including depression and poor eating habits. It identifies her needs based on Maslow's hierarchy, emphasizing safety, love, and belonging. The study outlines SMART goals for nursing interventions, such as reducing blood glucose levels and managing depression. The role of nurses includes promoting social interaction, providing education on medication adherence, and encouraging physical activity. The case study highlights the importance of collaborative goal setting and comprehensive care to improve patient outcomes. The patient's condition includes diabetes, hypertension, and social isolation, and the nursing interventions are planned to improve her overall health.

Running head: CASE STUDY ON DIABETES
Case Study on Diabetes
Name of the Student
Name of the University
Author Note

CASE STUDY ON DIABETES
Case Study
Alice Jones is a 57-year-old woman who is admitted recently to the local hospital by
the neighbours in an unconscious condition. She was found in the garden area by one of her
neighbours and as per the information of the neighbour, Alice is living in that house for last
30 years and she has two daughters and one son. However, she is living alone as hers son is
living 5 km away from her house. Her daughters are living in another country. After
admission to the ward, hospital authorities had informed her son and after 2 hours her son
reached to the hospital. During this time, Alice regained her consciousness and doctors
assessed the patients for finding the vital signs of the patients. On assessing the patients, it
was reported by the nurses and the doctors that the patients had the problem of hypertension
and her blood pressure was represented as 156/ 100. Her breathing rate was almost 20
breaths/ min. At room temperature, her oxygen saturation rate was approximately 90% (SpO2
= 90%). Her son reported that she has been suffering from diabetes type 2 mellitus for the last
10 years. She is under treatment for this condition. However, her son is not aware of the
hypertension condition. She lost her husband 2 years ago and during that, she was in deep
trauma and stopped all type of social interaction. She went outside of her house rarely. The
person who admitted her to the hospital also confirmed that fact. As she had a fall, doctors
performed an x-ray and it was found that she had a fracture in her right leg and she had a
severe pain. She had a pain score of 7/10. After she had consciousness, the care providers
asked the patient about her condition and Alice informed that since the death of her husband,
she became a regular smoker. Approximately she smoked 6-7 cigarettes per day. When,
assessing the blood sugar level of the patient, it was reported that the blood glucose level of
the patient was approximately 13.3 mmol/L. For managing this hyperglycaemic condition,
Alice was prescribed to take metformin in a regular basis. Therefore, Alice confirmed that
from last two days, she was skipping her medicine and no one was there to bring her the

CASE STUDY ON DIABETES
medicine and as she was not able to go outside; she skipped her medicine. However, the
doctors and the nurses faced difficulties during the assessment process as she was not able to
express her thoughts in a well manner due to poor communication skills. Along with this, she
also reported that she felt lonely at her house after death of her husband and that was the
reason she isolated herself from the society and did not want to interact with anyone around
her. She also experienced about loss of appetite a few days ago and a few days ago she also
experienced senseless in her house for a few moments of time.
Impact on the Well Being of the Individual
The effect of diabetes type 2 mellitus among the patients is characterized by the
negative effect on the patients. It is reported that, the negative affective disorders and
psychological distress incidents are very common among the patients with diabetes type 2
mellitus patients. Along with this, it is also reported in various studies that, the incidents of
clinical depression are also very common among the patients having diabetes mellitus type 2
(Sweileh et al.,2014). In this case study, it can be observed that, the patients had the problem
of diabetes type 2 mellitus and since the death of her husband; she was feeling depressed and
withdrew herself from all kind of social interaction. Along with this, in multiple studies, it is
reported that, lack of proper social interaction can hamper the quality of life of the individual
as well and thereby causing the gradual degradation of the psychological and physiological
state of the patients (Schwarzbach et al., 2014). While discussing the negative impact of
diabetes type 2 mellitus among the patients, it is stated that, the psychological syndromes
such as depression and anxiety have been consistently associated with poor outcomes in
patients with T2D. Along with this, in other studies, it was stated that, complications
associated with the diabetes type 2 mellitus is closely associated with the poor eating habits,
fear of having hypoglycaemia among the patients (Sweileh et al.,2014). The present case
study also depicted about the depression and poor eating behaviours among the patient. The

CASE STUDY ON DIABETES
patient Alice Jones, reported that, she had loss of appetite and depression. Along with this,
her neighbours also reported that she isolated herself from the society as well and it is one of
the symptoms of the depression among the patients. Along with this, the problem of
hypertension among the patients also can restrict the patients from any type of physical
exercise and thus promotes the inactivity and social isolation among the patients as well
(Holt, De Groot & Golden, 2014). According to the study of Colberg et al. (2016), it is
reported that, hypertension can cause restriction of the physical movements of the patients as
they may have the problems of breath shortness due to high blood pressure. Although, the
primary assessment of Alice did not show any kind of breathing issues in spite of having
hypertension among the patients. In another study, it was reported that, the cases of diabetes
type 2 mellitus is associated with two time higher risks of developing depression and thereby
hampers the quality of life of the patients. In other studies, it is also found that, patients with
diabetes type 2 mellitus may suffer from various diabetes specific emotional distress
conditions and it is associated with the poor exercise practice, functional impairment,
inadequate glycaemic control (Gonzalez et al., 2015). In this case study, only the last
parameter is applicable as due to the diabetes mellitus type 2 condition, the patient is unable
to manage her diabetes condition and thereby she had a high level of blood glucose levels that
is approximately 13.3 mmol/ L.
Needs of the Individual
From the above discussion it is observed that, social isolation, diabetes mellitus type
2, hypertension, depression are the main problems of the patient. According to the Maslow’s
theory there 5 stages of hierarchy and as per this theory the primary needs of an individual is
the physiological need. The second need of this hierarchy is the safety needs of the
individual. In the third step of the hierarchy the need of the individual is characterized by the
belonging and the love needs. In the fourth step of the Maslow’s need of hierarchy

CASE STUDY ON DIABETES
individuals’ need is associated with the self-esteem needs and in the last of hierarchy, an
individual can achieve the concept of self-actualization (Cherry, 2014). As per the case study,
it is reported that Alice had her own house and she had no insecurity issues regarding the
food and water. Therefore, she had needs of safety and security of herself as she lived alone
in her house. Her Son and daughters lived away from her and so, she was deprived in terms
of security and safety. While analysing the love needs of the individual, it is reported that due
to social isolation, Alice has no friends and she avoids to go outside. So, it can be stated that,
Alice has the needs of love and belongingness. Not only this, but she also has no support
from her family members and so she also needed the support from her family members as
well. In the next stage of Maslow’s theory describes the concept of self-esteem that is the
feeling of prestige and accomplishment (Cherry, 2014). Whenever an individual has already
gained all the needs of the previous stages, only then the individual can think about the nest
stages of the Maslow’s hierarchical stage. In this case of Alice Jones, it is reported that, Alice
only has achieved the first stage of Maslow’s Hierarchy of Needs. So, as per the theory, Alice
will try to gain the next stage of the hierarchy that is safety needs and after achieving that
needs, Alice will try to achieve the next need that is the need of love and belongingness.
Goals of the Needs
After identifying the needs of this patient, the nursing personnel must identify the
goals of the specified needs of the patient. According to the study of Lancaster et al. (2015),
it is reported that, the setting of goals for gaining the needs of the individual is very crucial
for achieving the selected goal. Recent studies showed that, collaborative goal setting is very
crucial for the nurses and for the health care providers for gaining the needs of the patients. In
this study, it is reported that, the collaborative goal setting in the treatment process of the
nurses will cause better adherence of the nurses and the patient to the treatment process and
thereby results in better patient outcome. In another study it is reported that, the maintenance

CASE STUDY ON DIABETES
of daily goal work sheet will help to improve the patient outcome (Hepp et al., 2015). In this
regard, the use of SMART goal strategy will be very effective. All the goals set by the nurses
and the doctors engaged in the treatment process of the particular patient must be SMART
goal that is specific, measurable, achievable, relevant and time-based goals. As a part of the
SMART goals, the nursing personnel must identify the specific goals that are reduction of
blood glucose level and reducing the depression issue of the patient. The measurable goals of
the case must include the reduction of blood glucose level by 2-3 mmol/L within 24-48 hours
and simultaneously the reduction of the high blood pressure of the patient is another crucial
issue in case of Alice. While analysing the achievable goals, it can be stated that, the nursing
personnel should identify the achievable goal. In this case, the achievable goals will be the
reduction of the blood glucose level to 12mmol/L within 2 days of admission. While
discussing about the relevancy of the goals, it can be said that all the goals are relevant and
achievable as well. Apart from that, the managing of the depression issue of the patient, a
relevant time frame must be set as managing the depression is not a short time process and
for reducing the blood glucose level within the normal range the nurse must set a timeline of
6 months and within this time frame blood glucose level should be controlled.
Role of Nurses
While, discussing the role of the nursing personnel, it can be said that the nurse
should promote the patients to join any community club so that social interaction can be
enhanced and this intervention by the nursing personnel will also help to reduce the issue of
depression among the patients (Kupferberg, Bicks, & Hasler, 2016). Along with this, the
nurse should employ a social worker who will also help the person to reduce the loneliness.
For addressing the issue of loneliness, the nurse must train the patient about the importance of
insulin medication so that the patient can sincerely take medicines to manage the diabetes
(Grimaldi et al., 2016). In this case, it is reported that, the patient had skipped her medicines

CASE STUDY ON DIABETES
and thus it can be stated that, this intervention will be helpful for Alice. Along with this, the
nurse should assist the patient in walking as a part of the physical activity program and it will
help the patient to manage the glucose utilization of the body as burning of more glucose will
also help to reduce the blood glucose level of the body. In this case study, it was reported
that, the patient had issues regarding the poor physical activity and thus the nurse can help the
patient in a short distance walking in the hospital premises (LeFevre, 2014). Apart from that,
the nurse should motivate the patient to take part in the physical activity program and make
them understand Alice about the importance of this intervention.

CASE STUDY ON DIABETES
References
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