Case Study: Medical and Nursing Management for Diabetic Patient

This case study focuses on a 58-year-old patient, Bill, diagnosed with type 2 diabetes and hypertension. The case explores potential medical and nursing management approaches. Bill, a smoker with a history of heavy alcohol use, presents with uncontrolled glucose levels and elevated blood press...Read More

Case Study on Diabetic Patient

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
POTENTIAL MEDICAL AND NURSING MANAGEMENT APPROACHES FOR A
HYPERTENSIVE DIABETIC PATIENT......................................................................................1
CONCLUSION................................................................................................................................2
REFERENCES................................................................................................................................3

INTRODUCTION
Hypertension linked to diabetes can make the condition worse for patients. It becomes
important to adopt better effective management approaches to bring the condition under control.
The report discusses regarding nursing management plan that can be taken into consideration so
that condition of bill can be brought under control.
POTENTIAL MEDICAL AND NURSING MANAGEMENT APPROACHES
FOR A HYPERTENSIVE DIABETIC PATIENT
The case discusses regarding a patient, Bill, who is 58 years old, diagnosed with type 2
diabetes. He is a chain smoker and have a heavy alcohol history as well. He is presently on
increased dose of oral metformin of 1000mg since last 6 months. However, medicine has not
been able to control his glucose level and hence, fluctuating since last 3 months. Increased blood
pressure of 170 / 100 mmHg has also been noted which is currently asymptomatic (Dunning,
2013). Increased level of protein in urine, that is, 4+ and blood test reflected increased level of
urea (25 mg / dl) and serum albumin (6.1 mg / dl). It also revealed the increased Glomerular
Filtration rate.
Hypertension is extremely common comorbid condition in case of diabetes, affecting
approximately 20 to 60% of the patients. In the patient with type 2 diabetes, hypertension is
actually present as a part of metabolic syndrome of body getting resistant to insulin. It generally
increases the incidence of stroke, Cardio Vascular Disease, retinopathy, neuropathy and other
macro and micro vascular complications (Brown and et.al., 2017).
It is important to follow nursing and medical interventions that can help patient to bring
the glucose level in blood under control. A nurse must be involved in assessing nursing
interventions for the detection of high blood pressure. A collaborative nursing plan with the
patient can help in promoting healthy lifestyle among the diabetic patients. Improving the
management of blood pressure is an important aspect to be followed. The process of
management generally starts with bringing change in lifestyle (Tricco and et.al., 2012). It can be
in the form of weight reduction, regular exercising and allowing only moderate use of alcohol,
sodium and protein. Other dietary approaches can also help patient in better management of
hypertension. It includes fibre, calcium, saturated fat, hike in potassium, low intake of sodium
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and high consumption of fruits as well as vegetables can help in decreased blood pressure to a
high extent (6 Hypertension Nursing Care Plans, 2013).
The combination of hypertension and diabetes can be deadly and together can increase
the occurrence of stroke and heart attack. Having a family history of diabetes and blood pressure
increase its presence in the next generation as well. In case of Bill, his mother died due to heart
failure. Hence, prevalence of the same can be quite common in case of Bill as well. Hence,
nursing approach must also be inclusive of checking laboratory data at regular intervals such as
blood cell count, electrolytes, cardiac enzymes, urea nitrogen and CBC report. The nurse must
also be aware of blood, wounds and secretions on the body of Bill. Since, he has been facing
increased blood pressure, it is his duty to monitor and record BP at regular intervals from both
arms and thighs for three times in a day (Lin and et.al., 2012). He / she must be knowing correct
cuff size and accurate technique of measuring it.
It is also important for the nurse to observe moisture and colour of skin, temperature and
capillary refill time. Dependent or general oedema must also be noted on regular basis. It is also
important for a hypertensive diabetic patient to be kept in some calm and restful surroundings
with minimal activity and noises so that an uninterrupted rest can be gathered by the patient.
Monitoring medications and its control activity is also an important aspect of measuring the
condition of Bill, as a nurse so that any side effect can be assessed at an initial stage only. In case
of extreme non-comfortability of Bill, collaboration of medications in the form of analgesic and
sedative drug can also be given (Hendriks and et.al., 2012). In such cases, the main purpose is
maintaining blood pressure and glucose level at permissible range. Moreover, the intervention
will help in extending medical advice to Bill and ensuring that it is effectively being met. It will
also help in delivering better outcomes and functioning of the body (Hwang and et.al., 2012).
CONCLUSION
It can be concluded from the above report that adoption of healthy lifestyle measure can
effectively help in controlling the medical condition of Bill. Hence, it is the duty of nurse to
make him follow a particular diet plan, check laboratory data in regular intervals and keep an eye
over changing body functions.
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REFERENCES
Books and Journals
Brown, D. & et.al. (2017). Lewis's Medical-Surgical Nursing: Assessment and Management of
Clinical Problems. Elsevier Health Sciences.
Dunning, T. (2013). Care of people with diabetes: a manual of nursing practice. John Wiley &
Sons.
Hendriks, J. M. and et.al. (2012). Nurse-led care vs. usual care for patients with atrial fibrillation:
results of a randomized trial of integrated chronic care vs. routine clinical care in
ambulatory patients with atrial fibrillation. European heart journal, 33(21), 2692-2699.
Hwang, L. C. & et.al. (2012). Prevalence of metabolically healthy obesity and its impacts on
incidences of hypertension, diabetes and the metabolic syndrome in Taiwan. Asia Pacific
journal of clinical nutrition, 21(2), 227-233.
Lin, E. H. and et.al. (2012). Treatment adjustment and medication adherence for complex
patients with diabetes, heart disease, and depression: a randomized controlled trial. The
Annals of Family Medicine, 10(1), 6-14.
Tricco, A. C. & et.al. (2012). Effectiveness of quality improvement strategies on the
management of diabetes: a systematic review and meta-analysis. The Lancet, 379(9833),
2252-2261.
Online
6 Hypertension Nursing Care Plans. 2013. [Online]. Available through
<https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/>
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