Comprehensive Diabetes Case Study: Holistic Patient Management

This case study presents a 61-year-old patient, Clara Mitchell, admitted after a fall due to hypoglycemia, complicated by poorly managed diabetes. The analysis reveals issues with medication adherence, lack of health literacy, and slow-healing wounds due to uncontrolled blood glucose levels. The patient experiences symptoms such as dizziness, fatigue, blurry vision, and excessive thirst. The recommended management plan involves educating the patient about diabetes, proper insulin administration techniques, blood sugar level monitoring, and lifestyle adjustments. Nursing interventions focus on improving health literacy, ensuring timely medication, and managing wounds to prevent infections, ultimately aiming to enhance the patient's quality of life. Desklib provides access to similar case studies and resources for students.

Running head: DIABETES
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Introduction:
Diabetes is a form of disorder that mainly results in the rise of the blood glucose resulting in
failure of different other organs. The cells become unable to get appropriate amount of glucose from the
blood that is extremely necessary for the production of energy by the process of respiration. This is
mainly because the insulin, which is a hormone significant for the helping, the cells to take in glucose
decreases in amount or the cells become resistant to the acceptance of glucose from the blood. As a result,
the cells fail to produce energy that affects the working mechanisms of many organs (Butcher et al.,
2018). This may result in life threatening situations for the individuals who are suffering from the
disorder. Therefore, it becomes extremely important for the healthcare professionals to develop
interventions that would help the patients to overcome such situations and thereby lead better quality life.
Researchers are of the opinion that proper lifestyle interventions as well as effective following of
medications and its management may help in proper care of the patient and ensure safe life (Marques et
al. 2017). It is also important to educate the patients in ways by which they become aware of their
disorders and develops proper ideas about how to maintain themselves. This assignment would mainly
depict a case study of a patient who had been suffering from diabetes and the ways the professional can
help the patient to lead better quality life.
Case study:
A patient of 61 years old names Clara Mitchell was admitted to the ward after she had faced a fall
in the garden while she was watering her plants in the garden. She complained to her granddaughter that
she was feeling dizzy and she was feeling weak as well. Before her granddaughter could call her son, the
patient had fallen down resulting in bruises and cuts on the skin. After she was admitted to the healthcare
center, the nursing professionals conducted a diagnosis and found several other cuts and wounds on her
body that was ill maintained and was not healing properly. Moreover, her son complained that her mother
always used to remain confused about the medications and the insulin doses and even used to forget about

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taking the insulin on the right time. There had been many situations where the patient had forgotten to
take the medications and therefore took the insulin doses altogether. Besides, the patient often used to feel
thirsty and extremely fatigued. Her daughter in law had requested her to take walks and be physically
active but she complains that she is fatigued and does not feel like going outside houses. Her wounds are
giving her hard time as well. Moreover, her vision has become blurry for which she has lost her
confidence to take walks or even in driving which she used to like a lot. She had thereby isolated herself
and had got tired of the various issues that she is facing with her health. She remains depressed, as her
heavy weight had also made it difficult for her to be active and participate in social gatherings. She has a
BMI of 30 that gives her the status of obesity. The patient wanted the professionals to help her overcome
all the issues so that she can live a better quality life.
Analysis of the case study:
The nursing professionals need to conduct a critical analysis of the case study in order to collect
cues and thereby understand the main factors that had resulted in the situation of the patient in the case
study. It is extremely important for the nursing professionals to undertake clinical reason cycle so that
they can address the patient cues and symptoms, identify the contributing factors, relate them with the
pathophysiology of the disorders, identify the care priorities, develop the goals and action plans and
thereby help in providing the best care to the patients (Frauenfelder et al. 2018).
After the documentation of the medical history of the patients, the narratives of the family
members and identifying the cues from the physical condition of the patients, nurses need to develop
interventions and management programs that match with the requirements of the patient. After thorough
analysis, it was found that the main issue that had resulted the patient to fall is hypoglycemia. Symptoms
of hypoglycemia involve feeling of dizziness where patients complain about feeling blinded before
collapsing. Such issues were identified in the case of the patient and this was verified after conducting the
blood sugar level test (Fan and Sidani 2018). The blood sugar test was mainly conducted and it was found

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to be below 4.0 mmol/L. In case of the patient the blood glucose level test showed that the glucose level
of the patient’s blood was fallen below 3 mmol/L. therefore, it was seen that the patient was suffering
from low blood glucose level and it was important to understand what had led to the situation. Detailed
analysis revealed that the patient had actually forgotten to take the insulin injections at the right time and
therefore she had taken two insulin injections together when she suddenly remembered that she had
forgotten the previous insulin injection (Sapkota et al. 2015). She was completely not aware of her
condition and did not know the steps of taking medication, the effect of the medication and the dosage of
the medication and the harmful effects of the wrong doses of wrong procedures of the medication. This
could be attributed to the fact that she was not properly educated about her disorder of diabetes. She did
not know the details of the disorders and even complained that she becomes tired of taking the medication
as she is not aware why she as taking the medication (Moorhead et al. 2018). Therefore, one of the most
important care priorities that is required is helping the patient to develop health literacy about how to
manage the symptoms of diabetes effectively and thereby develop a detailed knowledge about how proper
lifestyle management would help her to overcome dangerous situations.
A number of other cues were also found that gave the idea that the patient was not being able to manage
her blood glucose levels effectively. It has been found in the patient that she was having several infected
wounds that were not healing for a long period. This is mainly because she was diabetes patient and she
was not being able to maintain her blood glucose levels effectively. Researchers are of the opinion that
diabetic patients suffer from issue of wound healing due to a number of factors (Kuipers et al. 2016).
High levels of blood glucose levels that mainly result from improperly managed diabetes can, over time,
affect the nerves of the patients. It can thereby lead to poor blood circulation and therefore it makes it
difficult for the blood that is extremely important for the skin repair to reach the different parts of the
body that are affected by the wounds. This results in the wounds to remain open making the wound stay
in unhealed situations for months (abubakari et al. 2016). Researchers are of the opinion that when
wounds remain open for long period and is not properly dressed, the skin is exposed to a number of the

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infections with increased risks of attacks resulting in fungal infections, bacterial infections as well as
gangrene. Researchers are of the opinion that when patients are able to keep glucose levels under control,
it can result in the reduction of the slow healing of the wounds that help in less suffering and better
quality lives (Sherifiali et al. 2015). Researchers are also of the opinion that slow healing of different
wounds mainly like that of the grazes, blisters and cuts when occurring in feet, it becomes particularly
problematic. This is mainly because when such situations affect the feet, there might rise situations when
infections become so uncontrollable that there requires amputation of the feet. In order to help the patient
to manage her conditions of diabetes effectively, it is very important for the patient to help her learn how
to measure blood sugar level effectively (Jones et al. 2016).
The symptoms of the patient show that she not only had the feeling of continuous thirst but also
had issues with blurry vision and extreme fatigue. Researchers are of the opinion that excessive thirst as
well as increased urination is two of the most classic diabetes symptoms. When patients are seen to have
diabetes, excess of blood glucose levels are seen to build up in the blood. This makes the kidneys to work
overtime for filtering as well as absorbing excess of sugar. When the kidneys ultimately fail to keep up
with the procedure, excess sugar starts to release huge amount of sugar into the urine. This procedure
results in the dragging of excess of fluids from the tissues that result in frequent urination as well in the
patient (Baird 2015). This results in making the patient dehydrated and results in feeling of extreme thirst
in the patients. The individuals are seen to drink more fluids that result in urination that is more frequent.
Therefore, in the patient of the case study as well, the nursing professionals can ensure that as the patient
had been failing miserably to maintain a proper blood glucose level, there is high chance that
hyperglycemia is resulting in increased thirst for the patient. The fatigue that has been experienced by the
patient also has clear explanation when evidence based articles are searched (Harris 2018). Many of the
researchers say that dehydration from the cause of increased urination is one of the factors that make
individuals feel fatigued. On the other hand, as the cells do not get enough glucose to produce energy, the

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organs are seen to network properly and this lack of energy results in a feeling of fatigue where the
individuals do not feel like working anymore (Lohan et al. 2015).
Management:
Insulin should be administered in ways by which it can mimic the natural pattern of the insulin
secretion by the pancreas. However, it is true that the complex pattern of natural insulin is very difficult to
achieve. Various types of insulin are seen to differ in the pharmacokinetics that is mainly the amount of
time until the insulin starts to work as well as the duration of their action after the injection is pushed.
Four different types of insulin injection doses like the rapid acting insulin that begins to work after 5
minutes after the time of administration are present (Games et al. 2016). The peak effect mainly occurs in
one hour and the effect lasts for 2 to 4 hours. Another is the regular insulin that takes place within 30
minutes to take action and peaks after 2 to 3 hours after injection and last for about 3 to 6 hours.
Intermediate acting insulin typically begins for lowering of the blood glucose about 2 to 4 hours after
injection, with peak above 4 to 12 hours and lasting for about 12 to 18 hours. Long actin insulin mainly
takes place within 6 to 10 hours lasting for 20 to 24 hours. After the nursing professionals identify the
requirements of the patients, they need to develop a care plan by integrating the insulin injection timings,
doses and procedures and accordingly educate the patients. For helping the patient to remember the
timings, the nurse can suggest for alarm calls as well as alarm reminders so that the patient does not
forget them. One of the most important interventions that the nurse should also undertake is to develop
the health literacy of the patients (Zhang et al. 2015). The patient should be given detailed explanation
about the reason of the occurrence of the diseases, the causes that result in the disease as well as the
symptoms. Researchers are of the opinion that health education helps patient to understand the cause of
their disorder and makes them more careful as they understand the threat associated their ignorance. It
makes them more careful and reduces their anxiety helping them to be compliant with the medication.

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The procedure of the use of insulin should be also discussed in details. The nurses should educate about
the use of insulin pumps as well as the pre-filled insulin pens that would be used/ the nurse should
provide a demo and accordingly ask the patients to conduct a practical session in front of them to ensure
that the patient has learnt well.
Lifestyle management:
Educating the patient about the details of the lifestyle interventions would help the patient to be out of
risk of the serious threats that low blood sugar may result. Researchers are of the opinion that the
recommended lifestyle of diabetes mainly includes taking two and half hours of moderate intensity
physical activity in each of the weeks or one hour and fifteen minutes of high intensity exercises. Other of
the interventions that should be involved is the losing of weight gradually for achieving of the high
intensity exercise so that healthy body mass index can be achieved. Therefore, many of the studies
suggest that patients with diabetes should mainly participate in replacing refined carbohydrates with
wholegrain foods (Dunkley et al. 2014). The patient should also concentrate on the increase of the use of
vegetables in the diet as well as with foods that are high in the dietary fibers.
Many of the researchers are of the opinion that constant stress can make blood glucose level rise very
high and when an individual becomes highly stressed, there is high chance that threatening situations may
occur. Therefore, the nursing professionals can teach effective management techniques such as
mindfulness, which is mainly a simple, as well as a non-toxic way for controlling stress related blood
sugar levels (Fan and Sidani 2017). It has been seen in the studies that by the effective reduction of the
stress levels, there are high chances that risks of many disorders like that of the heart diseases, stroke,
hypertension as well as the mental health conditions including depression and anxiety will also reduce.

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Conclusion:
From the above discussion, it becomes extremely important for the healthcare professionals to develop
total knowledge about the disorders to help the patients develop their life conditions. Therefore the
professionals need to properly identify the symptoms present in the patient and identify the issue that the
patient faces in effective management. Proper medication administration as well as effective management
of the lifestyle patterns is extremely important for the patients to develop proper quality life and be safe
from any threatening situations. Effective management of the insulin treatment and helping the patient to
learn about the procedures helps to ensure that the blood glucose level remains in check. The patent
should monitor the blood glucose level regularly. The patients should also be able to adapt different
lifestyle intervention like diet and exercise so that risks of developing the symptoms of the disorder
decrease. Moreover, the development of stress can also influence rise of blood glucose level. Therefore,
effective stress management techniques should be also taught to the patient to endure better quality life.
Development of health literacy of the patient can help the patient overcome different barriers and conduct
her won treatment successfully reducing life-threatening risks.

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