Case Study: Nursing Management and Holistic Patient Care Approach

This case study examines the nursing management and holistic care approach for a patient, Mrs. X, admitted to the hospital with Type 1 diabetes after a fall. The study details the legal and safety aspects of insulin administration, specifically Insulin Aspart, including dosage, administration methods, and medicolegal considerations. It critically evaluates a holistic care approach involving a multidisciplinary team, intensive insulin therapy, dietary management, and family support to address issues such as depression, risk of falling, and medication adherence. The study emphasizes the importance of a multidisciplinary team, including a general physician, orthopedist, endocrinologist, counselor, and nurse assistant, in providing comprehensive care and support to improve the patient's physical and mental well-being. This document is available on Desklib, where students can find a variety of solved assignments and past papers.

NURSING MANAGEMENT AND HOLISTIC APPROACH TO PATIENT CARE
Contents
INTRODUCTION..........................................................................................................................................................1
LEGAL, REGULATORY AND SAFETY ASPECTS OF DRUG ADMINISTRATION............................................1
CRITICAL EVALUATION AND PROVISION OF HOLISTIC CARE APPROACH................................................2
ROLE OF WIDER MULTI-DISCIPLINARY TEAM...................................................................................................3
REFERENCES...............................................................................................................................................................5
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INTRODUCTION
Owing to the diagnosis of Type 1 diabetes, Mrs X. has been admitted to the hospital after she fell
down at her home. Although there were no physical injuries observed on her body, yet she
became anxious and was mentally unstable due to which it was necessary to examine her
condition and bring her state back to normal. Also at the same time, it was essential to ensure
that her blood glucose levels are back to normal so that she can resume back her normal life.
While on examination, it was found that her blood glucose levels were phenomenally raised due
to which it became essential to plan a holistic approach which can accomplish the required
aspects of care (Vegas, et al. 2016). The following discussion is based on the care approach
chosen for Mrs X along with a critical evaluation of the selected methods and is finally followed
by recognition of the role of a multi-disciplinary team.
LEGAL, REGULATORY AND SAFETY ASPECTS OF DRUG
ADMINISTRATION
Subcutaneously administered insulin is the first line of treatment for the patients suffering from
type 1 diabetes. Being a Trainee Nursing Associate, I was extremely particular with the chosen
methodology of drug administration and tried to understand the legal and safety aspects of
insulin. Insulin can either be of a short-acting, intermediate-acting or long-acting type and
usually in such case, short-acting insulin are preferred as they have a rapid onset and are suitable
for a short duration of time. In the case of Mrs X, this was appropriate as by the time the effect of
insulin would subside, the other measures could be regulated for controlling the blood glucose
levels. Insulin Aspart is the chosen drug here which has a rapid onset of action (about 5-15
minutes) and the total drug effect continues for a period of 2-4 hours. The recommended drug
dose for Aspart is 0.2-0.6 unit/kg/day administered to the patient in divided doses (Angulo, et al.
2015).
While administering the glucose drug dose, use of either needles or pens is suitable. Needles of
smaller length are usually suitable as it prevents the risk of Intramuscular drug dose and is also
less painful and better tolerated. Along with this, there are certain safety considerations such as
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adequate site disinfection and use of clean hands while administering insulin to the patient. If pen
needles are being used, then it should be remembered that the pens and cartridges can only be
used once and must be immediately disposed of after the single use. Along with this, the medico-
legal issues such as unsafe and illegal administration of insulin should be discussed clearly with
the patient and all the healthcare professionals should be following the protocols for complying
with the standard FDA regulations (Coventry, et al. 2015).
It is also essential to monitor the levels of glucose before administering insulin so as to prevent
the risk of hypoglycemia. At times, the insulin drug dose may be required twice or thrice in a day
and therefore monitoring the glucose levels and timely administering the insulin drug dose is
essential for avoiding night hypoglycemia (Whitehead and Seaton, 2016).
CRITICAL EVALUATION AND PROVISION OF HOLISTIC CARE
APPROACH
The holistic approach of care that is most suitable in the provided case consists of a specialist
multi-disciplinary team management along with an intensive insulin therapy or insulin pumps
with dietary management and care and assisted support received from carers and family. Along
with this, co-ordinated training and accreditation for the supporting individuals should be
considered so that they can realize their individual roles and responsibilities.
Further, the following problems must be addressed appropriately with the involvement of a
multi-disciplinary team to address the individual needs of Mrs X:
Depression: Mrs X is prone to develop depression due to the long-term health condition and
deteriorating health. Also, as she lives alone she often feels unattended and unsafe. This should
be addressed with an appropriate caregiver who can extend the work hours during an emergency
(Horta, et al. 2015).
Falling: since Mrs X already had a fall, this should be taken into prompt attention as it may lead
to skeletal problems owing to her age and weak bone strength. At this stage, she should also be
assisted with the complications that commonly develop due to diabetes such as vision problems,
dizziness due to increased blood sugar levels, and lack of sensation in the lower body part or
feet.
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Medicines: Diabetic individuals often are not cautious about their medicines due to weak
memory and often skip their drug dose. In such case, it is essentially required to make use of
alarm systems or employ nurse assistant who can assure timely intake of the prescribed drugs
(Kennedy, et al. 2014).
ROLE OF WIDER MULTI-DISCIPLINARY TEAM
Mrs X was found to experience extreme levels of stress and anxiety due to the fall she had.
Moreover, she was living alone in the house due to which the assisted care and support was not
available at that period of time which would have also augmented the distress. These are the
factors which need to be addressed immediately. For assisting with the mentioned parameters, a
multi-disciplinary team is needed who can address the specific matters with their specialist
approach (Kropff, et al. 2015).
For this, the patient was injected with the standard drug dose of insulin and this was done only
after the standard education was provided. Along with this, the suitable interventions for
minimizing the pain and controlling the injection fear should be taken so that the patient is able
to face the condition normally. While injecting the drug dose, the clinician was compliant with
the national, international and legal considerations for insulin injection. Along with this, strict
care was taken to make safe use of the injection needles followed by which the needles were
safely disposed of. The preferred sites of insulin infusion are the middle third posterior aspect of
the upper arm, an upper third anterior aspect of thighs, abdomen and the posterior lateral aspect
of upper buttocks (Leach, et al. 2015). However, the site determination has been done based on
the location which was minimally painful after the fall Mrs X had. The healthy subcutaneous
tissue has been inserted to avoid any injury from lipo-atrophy, skin irritation, and scarring.
Therefore, in this case, a general physician would be suitable to look into the initial injuries of
Mrs X followed by an orthopaedic who can assure the absence of injury at the skeletal level.
Also, the endocrinologist should be called for understanding the unstable levels of blood glucose
and the appropriate reasons must be immediately called for action. Further, a counsellor or
psychologist should also assist Mrs X and make her understand the impact of stress on her blood
glucose levels. She should also be advised to initiate participation in social groups and music
therapy sessions which can help her to reduce her growing anxiety (Reeves, et al. 2014). As she
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is alone at home during the night hours, an arrangement should be made for a female nurse
assistant to stay with her throughout the day so that she does not have to face any odd situation
alone. She should also be taught to ask for immediate help and take extra caution while leaving
her bed or while getting up from sitting/reclining position. Bed rails, walker or a walking stick
should be advised to prevent the scope of future falls (Taylor, et al. 2014).
Along with this, her children are the only primary source of support and affection for her and
they should be asked to make more frequent visits so that she can feel safe and protected.
Relaxation techniques would also play an important role here as it would guide Mrs X to control
the growing distress during the hours she has to spend alone in the house. She must also be
taught to take part in activities which are of interest such as watching television, reading
motivational books, listening to light music, etc.
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REFERENCES
Angulo, P., Kleiner, D.E., Dam-Larsen, S., Adams, L.A., Bjornsson, E.S.,
Charatcharoenwitthaya, P., Mills, P.R., Keach, J.C., Lafferty, H.D., Stahler, A. and Haflidadottir,
S., 2015. Liver fibrosis, but no other histologic features, is associated with long-term outcomes
of patients with nonalcoholic fatty liver disease. Gastroenterology, 149(2), pp.389-397.
Coventry, P., Lovell, K., Dickens, C., Bower, P., Chew-Graham, C., McElvenny, D., Hann, M.,
Cherrington, A., Garrett, C., Gibbons, C.J. and Baguley, C., 2015. Integrated primary care for
patients with mental and physical multimorbidity: cluster randomised controlled trial of
collaborative care for patients with depression comorbid with diabetes or cardiovascular
disease. bmj, 350, p.h638.
Horta, B.L., Loret de Mola, C. and Victora, C.G., 2015. Long‐term consequences of
breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic
review and meta‐analysis. Acta Paediatrica, 104(S467), pp.30-37.
Kennedy, A., Rogers, A., Bowen, R., Lee, V., Blakeman, T., Gardner, C., Morris, R., Protheroe,
J. and Chew-Graham, C., 2014. Implementing, embedding and integrating self-management
support tools for people with long-term conditions in primary care nursing: a qualitative
study. International journal of nursing studies, 51(8), pp.1103-1113.
Kropff, J., Del Favero, S., Place, J., Toffanin, C., Visentin, R., Monaro, M., Messori, M., Di
Palma, F., Lanzola, G., Farret, A. and Boscari, F., 2015. 2 month evening and night closed-loop
glucose control in patients with type 1 diabetes under free-living conditions: a randomised
crossover trial. The lancet Diabetes & endocrinology, 3(12), pp.939-947.
Leach, C.R., Weaver, K.E., Aziz, N.M., Alfano, C.M., Bellizzi, K.M., Kent, E.E., Forsythe, L.P.
and Rowland, J.H., 2015. The complex health profile of long-term cancer survivors: prevalence
and predictors of comorbid conditions. Journal of Cancer Survivorship, 9(2), pp.239-251.
Reeves, D., Blickem, C., Vassilev, I., Brooks, H., Kennedy, A., Richardson, G. and Rogers, A.,
2014. The contribution of social networks to the health and self-management of patients with
long-term conditions: a longitudinal study. PloS one, 9(6), p.e98340.
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Taylor, S.J., Pinnock, H., Epiphaniou, E., Pearce, G., Parke, H.L., Schwappach, A.,
Purushotham, N., Jacob, S., Griffiths, C.J., Greenhalgh, T. and Sheikh, A., 2014. A rapid
synthesis of the evidence on interventions supporting self-management for people with long-term
conditions: PRISMS–Practical systematic Review of Self-Management Support for long-term
conditions.
Vegas, A.J., Veiseh, O., Gürtler, M., Millman, J.R., Pagliuca, F.W., Bader, A.R., Doloff, J.C., Li,
J., Chen, M., Olejnik, K. and Tam, H.H., 2016. Long-term glycemic control using polymer-
encapsulated human stem cell–derived beta cells in immune-competent mice. Nature
medicine, 22(3), p.306.
Whitehead, L. and Seaton, P., 2016. The effectiveness of self-management mobile phone and
tablet apps in long-term condition management: a systematic review. Journal of medical Internet
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