Bachelor of Nursing: Chronic Conditions - T2DM Case Study

This case study focuses on a 62-year-old Maori woman, Luna Brown, diagnosed with Type 2 Diabetes Mellitus (T2DM). The document details her medical history, symptoms (frequent urination, polydipsia), and diagnosis based on elevated HbA1c levels (8.5%). It covers the onset, pathophysiology (insulin resistance and pancreatic beta-cell dysfunction), and prognosis of the disease. Lifespan considerations, the impact on the patient and her family (financial and psychological), and the social construction of the illness are explored. The nursing care needs are discussed, including palliative care and symptom management, considering the patient's age, cultural background, and social isolation. The case highlights the importance of patient-centered care, trust-building, and addressing the patient's challenges in managing her condition. The document provides valuable insights into the multifaceted aspects of managing T2DM, including the role of nurses in providing effective care and support to patients and their families.

Running Head: T2DM 0
Type 2 diabetes mellitus
JANUARY 24, 2020

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Table of Contents
Case presentation...................................................................................................................................2
Onset.................................................................................................................................................3
Pathophysiology................................................................................................................................3
Prognosis...........................................................................................................................................4
Lifespan consideration.......................................................................................................................5
Impact on the patient and her family.................................................................................................5
Social construction............................................................................................................................6
Nursing care needs............................................................................................................................7
Conclusion.............................................................................................................................................9
References...........................................................................................................................................10

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Introduction and case presentation
Type 2 diabetes mellitus (T2DM) is recognised as one of the main causes of death
around the world. It is characterised by the increased levels of sugar in the patient’s blood. It
has been identified that around 241,463 people are diagnosed with this health issue in New
Zealand in 2016 (Casey, 2018). A 62-year-old Maori woman named Luna Brown with no
substantial medical history, with unhealthy eating habits and an inactive lifestyle was
detected with diabetes mellitus type 2 at the local hospital after showing symptoms like
frequent urination and polydipsia for some weeks. Increased analytical levels of the serum
glycosylated hemoglobin (HbA1c) 8.5% (58 mmol/mol) established the diagnosis. She has
three years of LDL hyperlipidemia and hypertriglyceridemia. She has been prescribed with
metformin and insulin. Her vital sign assessments showed that she has BMI 41.4 kg/m2,
blood pressure is 143/84 mmHg, increased respiration rates, and temperature of 101-degree
centigrade. She is also diagnosed with increased glycosylated hemoglobin levels, deprived
glucose controls and increased levels of glycosylated hemoglobin persevered [HbA1c= 9,1%
(76mmol/mol)]. Laboratory assessment discloses trace of protein on urine analysis, blood
urea nitrogen is measured as 14 mg/dl, serum creatinine is 1.2 mg/dl, random serum glucose
levels are 169 mg/dl, normal electrolytes, and usual levels of thyroid-stimulating hormone. A
one-day urine collection discloses a urinary albumin elimination rate of 250 mg/day. She has
been living alone for the last 5 months after the death of her husband due to chronic disease.
She is not very interactive with other people and isolated herself from the community. She
manages her daily life work herself and experiencing financial issues. she has two daughters
and one son living in other cities. Both the daughters visit her once in a month and her son
visits her once in two months. She complained that she frequently forgets to take medicines
on time and she also does not think that the treatment is effective anymore. She frequently
experiences psychological issues like depression, stress, and annuity. T2DM affecting her life

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and she is facing issues in managing thinks like cleaning the house, cooking food and
walking. As diabetes affects the visual ability of a person it can also lead to falls (Zheng, Ley
& Hu, 2018). She also at high risk of fall as she is living in a two-floor building and use
stairs. Diabetes also causes trouble in moving the fingers or hands which might also
contribute to a fall incident. Checking blood sugar is an important task for every diabetic
patient (Chatterjee et al., 2017), which becomes difficult in the case of Luna. Her age is also
contributing to her reduced ability to perform the medical task.
Onset
Being more than 45 years old is a risk aspect for type 2 diabetes. Persons of this age
and older must take active stages to prevent the illness, counting steady, light-to-moderate
workout and controlled nourishment (Cloete et al., 2017). However, the progress of the
condition is contingent on too many other aspects to accurately foresee on an individual
source. A comprehensive mix of well-being and lifestyle aspects can influence the
development of the disorder. Many individuals have diabetes for many years without being
conscious they have the disorder (Zhang et al., 2017). This sources a wide difference between
the age of onset and age of diagnosis. The risk factor associated with the occurrence of these
health issues includes an unhealthy lifestyle, being over 45 old, being Asian, pacific islander,
native American, Latino, or African descent. Having the first-degree family members with
any type of diabetes also increases the chance the developing type 2 diabetes mellitus
(Wilmot & Idris, 2014).
Pathophysiology
Type 2 diabetes mellitus is frequently associated with certain hereditary
predispositions, environmental aspects, lifestyle adoptions, and the lively interactions
between all of these dissimilar aspects (Cersosimo et al., 2018). This T2DM is an illness state
which includes the dysfunction of the insulin- creating pancreatic β cells, the resistance of

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insulin hormone in cells of the human body, or a mixture of both. Diabetes mellitus type 2 is
an illness that characteristically begins with a confrontation of insulin by cells, that
deteriorates over time (Thrasher, 2017). This confrontation, and the recompensing secretion
of insulin by the pancreatic β cells, might ultimately result in the failure of the beta-cell.
When the β cells are non-functional, the endogenous insulin secretion s stopped (Stumvoll et
al., 2016). Resistance to insulin is the incapability of body cells to use the hormone, which
constrains the capability of the cell to absorb and then initiate the metabolic process for
glucose. This is of main concern in body cells that are characteristically high in the metabolic
function, for example, muscle, liver, and different adipose tissues. Meanwhile, insulin is
accountable for the cellular consumption of glucose, the molecules of sugar will continue in
circulation (Zheng et al., 2018). The pancreatic β cells, which take part in producing and
discharging insulin, might also dysfunction in diabetes mellitus type 2 (Zheng et al., 2018). If
the supply of insulin diminishes completely, the patient will be reliant on outside insulin.
Whether insulin is not existing because of low secretion, or if the hormone is become useless
due to resistance of insulin, the end outcome will be hyperglycemia (Jehan et al., 2018).
Hyperglycemia, or raised level of glucose within the bloodstream, is the symbol of type 2
diabetes mellitus. Hyperglycemia, and the related inflammatory procedures, result in the
micro and macro-vascular variations that are understood as problems of diabetes mellitus
(Zaccardi et al., 2016).
Prognosis
In the case of Luna, the treatment plan is probably to require modification over time.
Resistance to insulin upsurges with age. And the insulin- creating cells in the patient’s
pancreas might wear out as the pancreas make efforts to sustain with the body's additional
insulin requirements. After the initial few years, most of the individuals with T2DM need
more than one drug to control blood sugar (Wilmot & Idris, 2014). The prognosis of these

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health issues in individuals varies. It is based on how well Luna adapts her risk of problems.
Some of the associated problems like Heart attack, stroke and kidney illness can lead to
premature death (Sommese et al., 2017). Incapacity because of impaired vision, amputation,
heart disease, stroke, and nerve injury may happen. Some individuals with type 2 diabetes
turn out to be reliant on dialysis treatments or need a kidney transplant due to kidney failure
(Marín-Peñalver et al., 2016).
Lifespan consideration
T2DM is a complex disorder with numerous variables. during the diagnosis process,
the clinician may not be able to express how the disorder will affect an individual's life
expectancy (Yang et al., 2017). The variety of projected life expectations is extensive,
contingent on an individual's age, lifestyle aspects, and treatments (Wright et al., 2017).
People with old age must consider lifestyle modifications for example exercise, nourishment,
managing blood sugar, restraining alcohol, and evading smoking (DeFronzo et al., 2015).
Development from prediabetes to confirmed diabetes can be reduced with a diabetes
deterrence program. A healthcare professional will assess Luna’s overall health and progress
the best care strategy based on individual goals, functional position, geriatric syndromes,
sarcopenia, and other different chronic diseases. Care plans are modified and dissimilar for
each individual.
Impact on the patient and her family
Diabetes is frequently called a “family disease” since it affects more individuals than
just the individual who is detected (Asmini, 2017). As the diseased person is required to alter
old practices (and accept new ones) crossways a wide range of areas in her life, important
changes by all of those nearby to the patient are also essential in order to confirm good illness
management and physical well-being. For instance, managing diabetes necessitates careful
consideration of diet, counting what diets to include (and in what servings) and what diets to

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evade (Trikkalinou et al., 2017). Type 2 diabetes mellitus is the long-term health issue which
indicates that the family members must support the patient for a longer time. Type 2 diabetes
mellitus not only affects the patient but also impact the family both mentally and financially
(Jane et al., 2019). The treatment procedure for T2DM may cost a lot for the family which
directly causes a financial crisis. The family members of Luna Brown will also experience
long term stress and anxiety of losing her due to the disease (Redmon et al., 2014).
Social construction
The social construction of type 2 diabetes mellitus includes 4 different categories:
socioeconomic status, psychosocial aspects, neighborhood environment, and education (Feng
& Astell-Burt, 2017). Psychosocial aspects can be observed as one’s mental and societal
surroundings, which comprise mental states for example depression, in addition to,
influences, for instance, social support (Walker et al., 2014). In the case of Luna social
support is negligible as she avoids socialization and her daughters and son visits her monthly.
This causes psychological problems like stress and depression. These issues are supposed to
be both cause and significance of how Luna manages her diabetes. Diabetes is an
expressively and behaviorally challenging disease; consequently, psychosocial issues can
impact most features of its management. Psychosocial aspects are significantly related to
poorer diabetes results and recommended that poor social support might be more strongly
linked with diabetes management than stressful actions or a stress-prone character.
Additionally, an analysis captivating both socioeconomic and mental components of the
social construction of health consideration found that though socio-economic aspects were
most frequently linked with diabetes results and diabetes information, psychosocial aspects
were most regularly linked with self-care and quality of life (Feng & Astell-Burt, 2017).
Patient’s self-efficacy and apparent stress had the sturdiest and most reliable relations with
self-care, and depression, severe psychological distress, and societal provision had the

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sturdiest and most reliable relations with patient’s quality of life. Luna belongs to the Maori
population and has different cultural values. Lack of trust is another issue Maori’s commonly
face when receiving health care in the hospital. As the patient already discussed that she does
not think that the treatment is working in her case. Living in a neighborhood with diabetes
problems may worsen the situation of the patient (Jaya et al., 2017). Neighborhood
withdrawal has been linked with increased diabetes occurrence and incidence and worse
control rates. Education is the construction of diabetes in the case of Luna. Most of the
Maori population is not very aware of the cause associated with type 2 diabetes mellitus. It
has been identified that the incidence of T2DM for Maori and Pacific individuals is above
three times higher compared to the European individuals and Maori and Pacific individuals
are more than five times as probable to die from type 2 diabetes mellitus. Lack of education
and information about the disease and its management is one of the main reasons for such a
problem (Amorim et al., 2016).
Nursing care needs
Palliative care is distinct as a method that advances the quality of life of diseased
person and her families living with a life-threatening illness. The role of a nurse, in this case,
is vital as the patient is old and belongs to the Maori population. A nurse plays a key role in
delivering effective care to the patient with long term health issue they spent more time they
compare to other health care professionals (Lee et al., 2016). A nursing must receive a
consent form from the patient. She must provide patient-centered care and palliative to Luna
for achieving already set health goals. Diabetes often faces problem in mobility which
enhances the chances of patient fall. A nurse must help the patient while she walks and
changes her position on the bed. she has been experiencing a lack of trust in the treatment, a
nurse can rebuild the trust and enable the patient to stick to the treatment. A registered is
skilled in developing a therapeutic relationship with Luna. This can be done by using

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effective communication with her. A nurse must give respect to Luna and communicate with
her empathetically. It is significant for blood glucose observing to endure until the final
phases of palliative care. When the patient is very unwell it might be hard to identify when
her blood glucose is extra high or extra low. It can also be difficult to work out the cause why
the patient feels unwell, for instance, Luna may feel ill because of her diabetes, the medicines
she is taking, or her other disease. Checking the levels of blood glucose is a method of
identifying whether the patient’s blood glucose level could be increasing the problem and
help health professionals make the patient comfortable (Busetto et al., 2015). Education and
provision, including remembrance support, are vital for persons with diabetes, their relatives
and frequently health specialized carers. A sensitive conversation about the requirement to
adjust drugs and other variations to recognized self-management practices is essential.
Additionally, diabetes experts are in a superlative position to take chances during discussions
to begin deliberating palliative care issues, for instance during yearly problem screening
programs and when the life-threatening difficulty, for example, a myocardial infarction
happens. It is important that care plans include spiritual requirements and makes
establishment to assist the person and their relatives find meaning and purpose in life
(Shahbazi et al., 2016). Another most important aspect of palliative care is including Luna
and her family in the decision-making process of treatment. The patient and her family must
be informed about the treatment. This will develop a sense of trust in the patient and their
family. Family carers of Luna can play a dynamic role in the care by helping her with
diabetes self-management and other practices of daily living. They are at high risk of sleep
deficiency, abridged immunity, depression and unsettled bereavement as she experienced the
stigma after the death of her husband. Elucidation to the diseased person and her family the
explanations behind the variations in treatment is significant. This might help them to
recognize why any variations are being made. It is important to screen her health and deliver

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counseling and provision. As the patient is suffering from psychological issues, she must
provide emotional support. Management of Diabetes also aims to evade the symptoms
associated with hypoglycemia (reduced levels of blood glucose) which might happen if the
individual is eating less and still getting their usual medicines (Gómez-Huelgas et al., 2018).
Conclusion
Luna Brown is 62 years old Maori women, diagnosed with type 2 diabetes mellitus.
Her vital sign assessment performed by nurses identified that she has an increased level of
LDL, high blood pressure, and temperature. She was prescribed with metformin and insulin.
The onset of the disease generally takes place after the age of 45 and other aspects like being
obese, unhealthy habits, and having other health issues. This particular health issue takes
place when there is dysfunctional insulin in the body or the pancreatic beta cells produce low
insulin or when the body becomes resistant to the hormone. The disease affects both Luna
and family in two different ways: financial and psychological. There are different aspects
associated with the social construction of Luna's health issue. Lack of socialization ad social
support is one of them. After the death of her husband, Luna is suffering from psychological
issues like stress and depression. Thus, she needs effective nursing care. In palliative care
plan a nurse must support her emotionally and develop a therapeutic relationship with her.
her blood glucose level should be maintained and it should also be assessed by the health care
professionals on regular basis. Luna and her family must also be included in the decision-
making process of the treatment. During the palliative care to Lina, the physician might
suggest some variations in the treatment process. The patient should be informed about all the
changes related to the treatment process as not informing might cause anxiety and fear to the
patient. Luna is an old lady; therefore, the healthcare providers must deal with her
respectfully and empathetically. The healthcare workers assigned for her care must work in a

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team and the information about the patient should be shared with all of them. as it will help in
them to provide effective care to Luna.

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