Altered Health Status and Health Promotion
Diabetes mellitus is a common disease affecting approximately 5% of the population (1995), and presents a life-long condition that affects almost every aspect of daily living. A number of factors are said to contribute to the onset of diabetes, including genetics, lifestyle, diet, other medical conditions and diseases, and the environment. One of the most common forms of diabetes to be encountered is the Type II Diabetes mellitus or the non-insulin dependent diabetes mellitus, which is caused by decreased sensitivity of target tissues to the metabolic effect of insulin (2000). As such, being one of the most common diseases in the population, the medical condition of a patient with this disease is to be examined.
The purpose of this essay is to explore the altered health status of Mr. Burdock (not his true name), who is suffering from Type II Diabetes mellitus. The client is 39 years of age, and was initially admitted to the hospital due to hyperglycemia, renal failure, gangrene, and blurred vision. The client is exhausted and lethargic, and confused as to time and place. Mr. Burdock is also complaining of blurred vision, thus, his wife, brought him to the hospital, as the client returned home from work and was acting unusually. Aside from hyperglycemia, hypertension, blurred vision, and renal failure seen in the client, it was also found out that the gangrene of the Mr. Burdock on the right foot has gone worse. The physician of the client has suspected that Mr. Burdock has Type II Diabetes mellitus, but results of tests and examinations have been unconvincing. In addition, the wife of the client states that the father of Mr. Burdock died from the same medical condition and its complications due to poor management and control. In this regard, the client has strong fears of dying the same way, as his father did. In this regard, based on the initial observation and his brief medical information, the medical and physical condition of Mr. Burdock would be examined and assessed. From the assessment of the client, outcomes, management, and conclusions would be made based on other health promotion issues.
Assessment Tools Used
It has been reported that any framework for assessment should be flexible and able to be adapted to a variety of circumstances, must be appropriate to the audience it is intended for, must be capable of balancing and incorporating the views of a number of carers, users, and agencies, and able to provide a mechanism for bringing different views together, while recognizing the diversity and variation within individual circumstances (2004). Based on such framework, several assessment tools have been used to examine the medical condition of Mr. Burdock. Initially, the client was asked to answer a questionnaire that would help the healthcare practitioner and the client himself to assess his medical condition. This questionnaire is the Diabetes Impact Measurement Scales or the DIMS, which contains 44 items, takes 15 to 20 minutes to complete, and divided into five categories, namely, Diabetes-specific symptoms, Non-specific symptoms, well-being, Diabetes-related morale, and social role fulfillment ( 2006). In addition, assessment of Mr. Burdock would also be done using the Diabetic Management Sheet, which contains all the necessary information regarding the medical condition of the client. This includes the diet and lifestyle of the client, medical history, the presence of complications, diabetes education, and foot assessment. To complete the complete nursing assessment of the client, several physical and laboratory tests have been done, including blood pressure examination, pulse rate, respiration, blood tests, and urinalysis. With such examinations and procedures, the medical condition of the client would be reviewed and assessed completely, thus, helping to arrive at substantial and effective diagnosis of the condition.
Outcomes of Assessment
From the series of tests and examinations done, it has found out that the blurred vision, lethargy and confusion, and the hyperglycemia of the client are manifestations of Type 2 diabetes mellitus. Such conditions are also supported with other findings, such as renal failure, severe inflammation of other body parts, hypertension, and the presence of the gangrene on the right foot. Specifically, the temperature of Mr. Burdock was 38 degrees Celsius or 101 degrees Fahrenheit, which means that the client has a fever, being over the standard temperature of 37 degrees Celsius (2006). Another support of the manifestation of his condition was the increase in blood sugar levels of 530 mg/dL, exceeding the normal blood glucose levels, which falls within the range of 80 to 120 mg/dL, thus, due to the extremely high glucose levels of Mr. Burdock, he was said to manifest hyperglycemia ( 2000). In terms of pulse rate and respiration, his pulse rate was 67 beats per minute and 15 respirations per minute. Such readings were normal as the normal pulse rate for adults ranges from 60 to 90 beats per minute, and normal respiration ranges from 12 to 18 respirations per minute ( 2004).
Another manifestation that confirms the complication of the client was determined by his blood pressure levels, which read 160/90, indicating that Mr. Burdock has high blood pressure levels. This is because the standard blood pressure levels of adults must be lower than 140/90, and because the blood pressure level of Mr. Burdock exceeded the standard reading, he was said to have hypertension (2003). Pain was also determined as a manifestation of the complications of the client, being due to the presence of gangrene in his right foot. The gangrene was observed to have swellings and inflammations around the wound, with the presence of pus. Pain was also expressed by the client, as coming from his lower back, chest and lower abdomen. Such manifestations may confirm that the client has tendencies for hypertension and obesity and causes the increased risk for diabetes ( 2005). This may also indicate the urinary complication of his condition, which contains a high amount of glucose and cholesterol, with presence of blood. Blood in the urine of the client indicates that Mr. Burdock has hematuria, which may indicate damage in the kidneys (2003). Another physical condition of the client that indicates the severe condition of the client was his blurred vision, which was observed due to the client’s sensitivity to light and inflammation of the iris (2006). Such condition supports the claim for non-proliferative diabetic retinopathy, which may consist of retinal capillary microaneurysms, hemorrhages, and lipid exudates ( 2000). Such conditions enable the client to experience confusions and lack of alertness in consciousness and orientation, thus, lacking the informed and proper orientation of time and place.
Care and Management of Mr. Burdock
The primary care of Mr. Burdock was directed at the gangrene at his right foot, which was done by examining the presence of any or all of the following, namely, infection, ulceration, calluses, skin breaks, nail deformity, foot deformity, pedal pulses, and sensory. The presence of pus and inflammation on the gangrene of the patient was then managed through administering antibiotics and dressing the wounds. In addition, management of the gangrene was done through footwear assessment and education of the client, which would be helpful in lessening the pain and infection, and fever of the client. In relation to the pain felt by the client that stems from his chest, abdomen and lower back, analgesic drugs, both orally and intravenously was administered in order to help alleviate the pain felt by the client. This is also to help Mr. Burdock sleep and rest in the hospital. In managing the increase in blood pressure of Mr. Burdock, he was provided with smaller and titrated doses of anti-hypertensive drugs, given two to three times a day. Such has been done to directly lower the blood pressure of the patient, with regular checking throughout the day. In controlling blood sugar levels, Mr. Burdock was given an anti-hyperglycemic intervention, along with altering the diet of the client to reducing carbohydrate intake, and increasing vegetable intake. This was to help the client get used to the prescribed dietary plan suggested by the physician, thus, reducing the risk of Mr. Burdock to increase his blood sugar levels through food intake.
In relation to addressing and managing the renal failure and hematuria of the client, this involves the intravenous pyelogram or the x-ray of the urinary tract (2002) of the client to overrule other medical conditions. Dialysis of the client is also needed, which indicate the renal failure of Mr. Burdock. In managing the tendency of Mr. Burdock to suffer from diabetic retinopathy, continuous guidance, consistent education, and update of the condition of the client was done in order to provide him with relief from anxiety and depression. This also extends to the confusion and lethargy experienced by the client, thus, education and information regarding his condition was thoroughly provided so as not to present psychological and emotional traumas. Furthermore, management and care of the client was done through communication with the client, which provided him with the relevant and important information he must know regarding his condition. This is in observance of the right of a client to information, which would enable him to assess his condition based on the facts given to him.
Health Promotion Issues
Health promotion issues refer to the different interventions that can be used by the client and his friends and family in order to hasten the treatment and cure of his medical condition. One of the many health promotion issues or interventions that can be advised to Mr. Burdock is to modify his lifestyle and the lifestyle of his family or the persons he is living with in the household in terms of diet. Dietary modification means that he would be advised to control his food intake, with control in the number of calories per meal, the timing of food intake, and the amount or volume of food intake. In this regard, the use of a food diary or planner can be helpful in order to keep track of the client’s eating patterns and change of eating habits ( 2006).
Another form of lifestyle modification is to avoid excessive alcohol and smoking, as these substances contribute to different complications. Last form of lifestyle modification in to engage in regular exercise in order to lessen effects of obesity and other complications, thus, involving management of the medical condition. Another health promotion issue to be taken note off is the education of the client and his family. This must involve attending seminars and focus group discussions in order to allow the client and his family to obtain updated and relevant information regarding his medical condition. Another health promotion issue to be advised is providing treatment options for the wounds of the client, thus, not always dependent and reliant on strong antibiotics, which can be used by the client for pain management. Another health promotion advice for the client is to undergo other forms of therapy, which are not only focused and directed on the diabetes of the client, but on other aspects of his individuality as well. Other forms of therapy that can be advised to Mr. Burdock include spiritual, emotional and psychological therapies that would be directed on providing the client with the right behavior and attitude in addressing the problems associated with his medical condition. In this regard, the support, understanding, and cooperation of the family of the client would be crucial in order for him to survive the situation. Another health promotion advice is to have consultations from physicians and other healthcare professionals regarding the updated and recent developments on right practices and approaches for the treatment of diabetes. In this regard, through communication, both the client and the healthcare professional are involved the proper treatment and approach for the disease. Last health promotion issue is to set short and long-term goals that would motivate the client and his family to have a positive light and approach on the disease. Setting goals would give the client hope to sustain his health and direct his energies and attention in his treatment and cure.
Conclusion
Based on the assessment and medical evaluation of Mr. Burdock, it can be concluded that the condition of his diabetes mellitus is already severe, due to the severity of his gangrene, the incidence of renal failure, high amounts of sugar in the blood, and hypertension. This means that complications can already be detected in his medical condition. This means that a wide range of therapy and treatment must be provided to the client. However, such treatments would not be effective as much without the self-control and education of Mr. Burdock and the support of his family and friends. As such, in order to attain maximum treatment, the client can utilize the different health promotion issues or advices provided for.
Credit:ivythesis.typepad.com
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