Diabetic Case Study
Diabetes Case Study NUR/427 January 13, 2011 Diabetes Case Study Diabetes mellitus (DM) is a chronic disease that affects millions of people across the nation. According to LeMone and Burke (2008), “Approximately 1. 3 million new cases of DM are diagnosed each year in the United States” (pg 563). The Centers for Disease Control and Prevention estimate that 23. 6 million people in the United States have DM. Collectively 17. 9 million people were diagnosed and 5. 7 million people were undiagnosed with DM in the year 2007.
Of all the documented cases 90-95 percent have type II DM and the remaining 5-10 percent have type I DM (Centers for Disease Control and Prevention, 2008). In the United States DM is the sixth most leading cause of death by a disease. Deaths are commonly caused by the cardiovascular effects associated with DM that result in coronary artery disease, atherosclerosis, and stroke. People diagnosed with DM are two to four times more likely to have heart disease or have a stroke than people who are not diabetic. DM is the leading cause of end-stage renal disease in the United States.
DM is also the most common cause of nontraumatic amputations and newly diagnosed blindness (LeMone & Burke, 2008). Signs and Symptoms Before someone is diagnosed with DM he or she usually experiences common signs and symptoms of the disease that leads him or her to see a physician. In type I DM the signs and symptoms that commonly present are the result of hyperglycemia. According to LeMone and Burke (2008), “Hyperglycemia causes serum hyperosmolarity, drawing water from the intracellular spaces into the general circulation.
The increased blood volume increases renal blood flow and the hyperglycemia acts as an osmotic diuretic” (pg. 566). The resulting osmotic dieresis causes polyuria. The increase in urinary output results in increased thirst which results in polydipsia. The person with type I DM also has a decrease in energy because glucose cannot enter the cells without insulin. This will cause the person to have an increased hunger and eat more food. However, even with the increased consumption of food the person with type I DM usually loses weight because the body is breaking down fats and roteins to try and increase energy. Because of a loss of energy the person will also have complaints of fatigue and malaise. Also because of the osmotic effects, swelling of the lenses of the eyes can result in blurred vision (LeMone & Burke, 2008). In type II DM the signs and symptoms also result from hyperglycemia but are often unnoticed by the person because of gradual onset. The person generally will not experience polyphagia and weight loss as in type I DM. Most commonly he or she will experience polyuria, polydipsia, blurred vision, and fatigue.
They may also have complaints of paresthesias and skin infections. Type II diabetics are often diagnosed by a physician when they come in with complaints of a different nature (LeMone & Burke, 2008). Potential Effects of Diabetes DM is a chronic illness that leads to multiple effects on the human body. It can affect various body systems at once. One of the most common chronic effects are coronary artery disease and is considered the most common cause of death in diabetic patients. Hypertension is also common with these patients affecting 20 to 60 percent of diabetics.
Other effects include peripheral vascular disease of the lower extremities caused by nerve damage. Diabetic retinopathy, which are the changes occurring in the retina leading to blindness in people between 20 and 74 years of age. Diabetic nephropathy, which involves the kidneys progressing to renal insufficiency. Visceral neuropathies, which can involve gastroparesis, bladder and sexual dysfunction. Also other common effects are periodontal disease and susceptibility to infection (LeMone & Burke, 2008). Teaching Requirements and Learning Objectives There are teaching requirements that support patient learning.
The teaching requirements involve steps similar to the nursing process. It is important to start with the assessment of readiness to learn, come up with a learning diagnosis, set learning goals, provide teaching as an intervention, and evaluate the learning. Our learning objectives include the patient expressing the desire to learn before teaching is initiated, the motivation to learn, and the ability to understand what is being taught. To evaluate if teaching was successful the patient will be able to state back what he or she has learned. It is important to follow the steps of the teaching process n order to aid the patient in their learning. In this way, the nurse will be able to find problem areas and adjust the teaching accordingly (Redman, 2007). Psychosocial Challenges Psychosocial issues that diabetic patients commonly face are economic burdens related to medications and supplies, missed work because of doctor appointments, and other expenses related to vascular, renal, or visual complications (Power, 2000). Patients may find it difficult to adhere to dietary restrictions or medication regiments during social events, travel, or schedule conflicts.
Stress factors, such as unexpected events, changes in marital or parental status, and job issues also influence diabetic care compliance. According to Neighbors and Tannehill-Jones (2006), “Exercise and stress can alter insulin needs and must be considered as part of the treatment plan” (pg. 254). Compliance is often increased if the patient receives positive family support and positive interaction with his healthcare provider. If patients’ families understand and assist with maintaining schedules and dietary restrictions, patients are more likely to see the benefits to their health.
Patients who experience supportive work environments are also more likely to adhere to their healthcare needs (Power, 2000). Summary The incidence of type I and type II DM affects millions of patients and their families and has the potential for numerous complications if not managed properly. The highest risks are for cardiovascular, renal, and visual complications, which can significantly alter patients’ quality of life, even leading to disability and death. Patients typically exhibit signs and symptoms before being diagnosed and often present with other complaints and subsequently receive a diagnosis of DM.
Immediate medical intervention and patient education to promote compliance is necessary. Support groups or a personal support system promote adherence to significant lifestyle and dietary changes, and can significantly improve patients’ outcomes. References Centers for Disease Control and Prevention. (2008). National diabetes fact sheet: General information and national estimates on diabetes in the united states, 2007. Retrieved from http://www. cdc. gov/diabetes/pubs/pdf/ndfs_2007. pdf LeMone, P. , & Burke, K. (2008). Medical-surgical nursing: Critical thinking in client care (4th ed. . Upper Saddle River, NJ: Pearson Prentice Hall. Neighbors, M. , & Tannehill-Jones, R. (2006). Human diseases (2nd ed. ). Clifton Park, NY: Delmar Cengage Learning. Power, M. M. (2000). Insulin-dependent diabetes mellitus psychosocial, educational and lifestyle implications. M. Ed. dissertation, Memorial University of Newfoundland (Canada), Canada. Retrieved January 11, 2011, from Dissertations & Theses: Full Text. (Publication No. AAT MQ54950). Redman, B. K. (2007). The practice of patient education: A case study approach (10th ed. ). St. Louis, MO: Mosby Elsevier.
