Patient-Centered Care: A Case Study on Diabetes and Pain Management

This case study centers on a 50-year-old male patient admitted with abdominal pain, a history of type-2 diabetes mellitus, hypercholesterolemia, and a prior laparoscopic cholecystectomy. The patient lives alone, with his son residing six hours away. The assignment requires an assessment of the patient's current condition, including gathering cues such as pain levels, medication adherence, and the integrity of abdominal dressings. The analysis reveals concerns about high blood glucose levels due to a missed insulin dose and oozing from a lower left port. The identified problems highlight the patient's limited understanding of his health condition and medication management. Goals include documenting the wound, educating the patient on medication adherence and self-administration of insulin, and ensuring doctor's visit for insulin prescription. Nursing actions prioritize medication adherence and ensuring the patient's competence in self-administering insulin. The expected outcomes include improved wound healing and the patient's ability to manage his diabetes effectively. The case study emphasizes the importance of patient-centered care, holistic health assessment, and the critical role of medication adherence in achieving positive health outcomes. The case study emphasizes the importance of patient-centered care, holistic health assessment, and the critical role of medication adherence in achieving positive health outcomes.

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Consider the Patient Situation
 What current information do you have
on this patient?
 What new information have you
gathered?
A 50-year-old male patient is admitted with
complaints of abdominal pain. The patient has
a past history of hypercholesterolemia (high
cholesterol), type-2 diabetes mellitus and has
undergone laparoscopic cholecystectomy, that
is, gall bladder removal.
Recent revelation state that the patient’s son
does not live with him and stays 6 hours away
from home, where the patient lives alone
Collect Cues/Information
 What further cues and information
would be useful? Why?
Further information required to assess the
patient’s health condition primarily is the
routine of pain-relieving medication followed
by patient, abdominal pain level and a quick
check whether the patient has adhered to all
prescribed medications. Physical assessment
of the patient to assess the skin’s integrity of
the affected region, general characteristics
like height and weight in addition to
observation of the dressings applied over the
abdomen to check whether its intact or not.
With the help of a collection of
aforementioned cues and patient health
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information, patient-centered health care
delivery can be ensured (Cleary, 2016).
Process Information
 What changes do you notice in the
cues and information provided?
 Which changes are significant for this
patient, and why?
 What do you think these changes
could indicate and why?
 What could be the outcome of these
changes?
Cues from the inspection of abdominal
dressing revealed oozing from a lower left
port, and all the rest four ports are observed to
be intact.
The patient has not been administered with a
prescribed dose of insulin, and the blood
glucose levels are high.
An uncontrolled increase in the blood sugar
levels could lead to the patient going in a
diabetic coma; thus, it is necessary to control
the blood glucose levels (Sydow et al., 2018).
The diabetic condition of the patient and
missing insulin dose is reflecting
consequences in the form of an increased
amount of urine (Tanaka et al., 2017).
Identify Problems/Issues
 Given the facts that you have available
and comparing those to what you
think the changes and indicate/identify
one potential patient problem/issue.
The patient has very little understanding of
his own health condition and regarding
administration of prescribed medications.
Further education on the importance of
medication adherence and self-administration
of insulin should be given to the patient to
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ensure that he takes insulin at the prescribed
time.
Establish Goals
 Describe what you want to happen.
 Who do you want involved, and what
do you want them to do?
 In what timeframe?
I want to document the cue of abdominal port
oozing, and complete abdominal dressing of
the patient’s lower left port under the
supervision of a Registered Nurse.
I want the Nurse Educator to help the patient
understand his diabetic health condition and
educate the patient on the importance of
medication adherence in addition to routined
self-checkup of blood sugar levels.
I want the doctor to pay a morning visit
before 10 a.m. and explain how to self-
administer insulin dosage.
Take action
 What nursing actions will you take?
 What will be your nursing priorities?
Routined checkup following medication
adherence will be the primary nursing priority
for the patient.
It is ensured that the patient is capable of self-
administering insulin competently and is
taking medications right on time.
Evaluate Outcomes
 What do you expect to achieve from
the actions you have taken?
With the redressing of lower left abdominal
port, it is expected that no further complaints
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of oozing will be observed.
The patient has become competent in self-
administering insulin doses and follows high
medication adherence as prescribed by the
doctor.
Reflect on the Process and new Learning
 What have you learnt from this
exercise?
With the help of critical patient health
assessment, identification of health issues and
taking necessary actions to address them, I
have developed the importance of prioritizing
patient centered care with increased efficiency
in time management.
Patient centered care is a holistic approach to
delivering high quality health care services
based on a particular patient’s health
condition, which increases the efficacy of
prioritizing care (Zatzick et al., 2018).
High levels of medication adherence are
critical in ensuring positive health outcomes
and prevent deterioration of health conditions
(Capoccia, Odegard & Letassy, 2016).
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References
Capoccia, K., Odegard, P. S., & Letassy, N. (2016). Medication adherence with diabetes
medication: a systematic review of the literature. The Diabetes Educator, 42(1), 34-71.
Cleary, P. D. (2016). Evolving concepts of patient-centered care and the assessment of patient
care experiences: optimism and opposition. Journal of health politics, policy and
law, 41(4), 675-696.
Sydow, K., Kueting, T., Musshoff, F., Madea, B., & Hess, C. (2018). 1, 5-Anhydro-d-glucitol in
vitreous humor and cerebrospinal fluid—A helpful tool for identification of diabetes and
diabetic coma post mortem. Forensic science international, 289, 397-407.
Tanaka, H., Takano, K., Iijima, H., Kubo, H., Maruyama, N., Hashimoto, T., ... & Kaku, K.
(2017). Factors affecting canagliflozin-induced transient urine volume increase in
patients with type 2 diabetes mellitus. Advances in therapy, 34(2), 436-451.
Zatzick, D., Russo, J., Thomas, P., Darnell, D., Teter, H., Ingraham, L., ... & Sandgren, K.
(2018). Patient-centered care transitions after injury hospitalization: a comparative
effectiveness trial. Psychiatry, 81(2), 141-157.
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