NRSG372 Diagnose And Evaluate Information Of Elderly Diabetic Patient Assessment Answer

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Question :

School of Nursing, Midwifery and Paramedicine

Faculty of Health Sciences Australian Catholic University

NRSG372 Written Assignment

Weighting
50%

Word limit

1500 words +/- 10%

Assessment Criteria

Appendix A of the NRSG372 unit outline





Learning Outcomes
LO1 demonstrate advanced understanding of developmental, lifespan, social, spiritual and cultural factors that impact on the quality of life of people experiencing chronic illness and/or disability and their families; (GA1, GA4, GA5)
LO2critically apply the Roper-Logan-Tierney Model of Nursing across the lifespan, to the principles of caring for people experiencing chronic illness and/or disability and their families; (GA1, GA, GA5, GA9)
LO3use advanced pathophysiological knowledge to implement the Levett-Jones’ Clinical Reasoning Cycle across a range of settings, to plan safe, evidence-based, culturally sensitive, person-centred care; (GA3, GA4, GA5, GA8, GA9)
LO6reflect on the lived experiences of the person with chronic illness and/or disability, their family and community. (GA1, GA2)

Presentation
1.5 spacing; 11-point Arial or Calibri font
No bullet points, numbering, tables, or diagrams are to be used.
Headings are required - Please use the headings in the template below. Please include the word count of your assignment in the header.


Referencing
APA 6th Edition as per the ACU study guide
References must meet the academic standards of recency, relevance and reliability. 15 high quality resources are to be used (minimum) with no resources over 5 years old





Task

You are required to conduct a 30 minute phone or video call interview with a person in your community who has experience with having a chronic illness or disability to discover the impact this has had on their life and the life of their family, and to identify care priorities/areas of need. Present your paper based on the Roper, Logan & Tierney (2008) model for nursing as a framework and use the first 5 stages of Levett-Jones (2018) Clinical Reasoning Cycle to identify care priorities. It is expected that appropriate evidence-based literature will be used to support the essay. You will need to gain written consent from your interviewee PRIOR to conducting your interview and upload this evidence to LEO
and inform your interviewee they may be called at random by the LIC to confirm consent.

Instructions for students

  • You will need to prepare for your interview. McGrath, Palmgren & Liljedahl (2019) suggest twelve steps for conducting research interviews, and this article is linked on the NRSG372 reading list for Module one.
  • There must be evidence that you have interviewed (via phone or video call) a real person in your community.
  • If there is evidence that students have not conducted an interview an NN grade for the assessment will be awarded.
  • This is an academic essay and as such, 3rd person writing is required. The student nurse may use the abbreviation SN when referring to themselves, if needed.
  • Academic references must be used to support the discussion. Avoid using consumer resources. The use of consumer resources significantly impacts on the quality of support for the discussion, and significantly reduces the ability to score marks for content sections requiring literature support.

Student and interviewee safety

  • Confidentiality must be maintained. You must de-identify your interviewee in your paper, by use of a pseudonym, and state this in your paper.
  • This assessment does not encourage you to diagnose conditions or suggest treatments for your interviewee
  • Students are not to approach strangers for interviews, or to put themselves into situations of risk.
  • Please be aware of the impact of conducting an interview on your interviewee. Should your interviewee become upset, please finish the interview at that point, and contact the LIC for further advice.

Assessment Template

Please use the following headings for your assessment:

Introduction

  • Provide a concise overview of your paper. Outline the topic, scope, content and sequence of your paper

Background (CRC 1 & 2)

  • Introduce the reader to your interviewee using a pseudonym
  • Provide an overview about your interviewee’s health status and personal background
  • Link this information to pathophysiology/pharmacology/culture etc and use literature to support your information

Discussion (CRC 3)

  • Discuss your interviewees condition/disability and the impact this has had on their life and family. Use literature to support your information
  • Relate this information to RLT model of nursing

Care priorities and goal setting (CRC 4 & 5)

  • Clearly identify two nursing care priorities/health education areas of need that you have developed with your interviewee
  • Discuss goals of care that you have developed with your interviewee using the NSQHS Partnering with Consumers Standard

Conclusion

  • Provide a concise summation of the key points of your paper

References

  • Your reference list is not included in the word count.
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Answer :

Assessment 

Introduction

Through this assignment, the purpose is to access, diagnose, and evaluate the information of an elderly patient who is having diabetes. The main goal is to identify the problematic challenges of an elderly patient having diabetes and to relate with life challenges. Diabetes is increasing at a rapid pace with more than 1 million getting affected due to this (WHO, 2018). The essay would discuss the developmental, lifespan, social, spiritual and cultural factors impacting the life of a person suffering from the chronic illness. Through the paper, the aim is to establish the care priorities of the elderly patient and how the Roper, Logan & Tierney (2008) Model for nursing as a would-be applied along with the first 5 stages of Levitt-Jones (2018) Clinical Reasoning Cycle to identify care priorities. 

Background (CRC 1 & 2)

Case-:  In the case, the patient is an elderly woman aged 84 years resides in the aged care facility.  Currently, the women stay all alone and are lonely has been alone and lonely most of the time in her life. The patient is diagnosed with T2DM and spinal cord compression and the medical history shows she is a patient of asthma, HT, stroke, myopathy, and also experiences depression and anxiety.  The patient also has a skin cancer and recently she faced a fracture in her hand's legs and her back. Subsequently, diabetes has further weakened the elderly person physical and often she gets fainted causing multiple breaks and fracture.  So far, the patient survives on the BGL and gets a count of 5-6 most of the time. She maintains her independence and even ensures to get personal hygiene and remans mobile by doing her daily physical activity. The patient is aware of her inability to move heavy loads due to the spinal cord compression and she keeps herself busy by reading books and remaining in the good health.  The patient keeps a tab on her medication, regulates her blood sugar, and keeps a check if it is in the normal range or not, before proceeding to have her daily meals. She regularly takes her medicine and if the diabetes range is in the borderline then she injects herself with insulin. The patient also has asthma and takes precautionary measures along with the puffers if required.

Qualitative interviews 

It shows the researchers opportunities which would depict an in-depth manner, and result in the interviewees, should be identified with an experienced interest as per the data-collection method and research.

Through the Levett-Jones’ Clinical Reasoning Cycle the best practices to access in the given settings is to understand the safety plans,  evidence-based practices and also have a culturally sensitive approach to the person-centered care;

Collecting Cues 

As observed, the patient is a diabetic and is an Australian resident. The patient is aged 84 years, and is in the sound emotional and mental condition (World Health Organization, 2015). She has a daughter but she stays away. Currently the elderly women reside in a residential place. The patient has suffered five times fall and hurt her back, arms, and legs. The patient has a medical history that shows that the patient also experiences the T2DM and spinal cord compression and the medical history shows she is a patient of asthma, HT, stroke, myopathy, and also experiences depression and anxiety. As the patient is physically mobile and mentally active, she timely takes her medication and takes the precaution measures, such as checking her diabetes, taking insulin if necessary, or the inhaler for the asthma attack. The patient also is aware not to hold any heavy loads, which would worsen her condition of the spinal cord comprehension. Mentally and emotionally the patient shows positive signs and even knows how to take care of her health even at the age of 84 years old. 

Processing Information

As identified from the case, the patient shared that her diabetic condition is the most challenging problem (Reena, personal communication, December 12, 2019). Due to diabetes, the patient has complained about the increased thirst, experiencing frequent urination faces extreme hunger sometimes, has an unexplained weight loss. The patient often complains of the fatigue, constant irritability, experiences the blurred vision and there is also a slow-healing sore

The pathophysiology of the patient is diabetes which is identified through a several different hormones (for example the insulin, glucagons, and growth).  As the patient has diabetes the pathophysiology shows that there is an interaction of these hormones which happens with the liver and then subsequently it activates the renal function causing an impaired with the pathological mechanisms while experiencing the disease. The pathophysiology experienced is the high glucose and to control the reaction of the body is inability to absorb entire insulin. Further, in some stages, if not treated and intervened it would lead to type 2 diabetes along with obesity. Eighty percent of type 2 has shown in diabetic patients can be seen as obese and often the fat can be seen in the upper body and everywhere (Australian Institute of Health and Welfare, 2018).

Pharmacologically is how the elderly patient would be treated with the people with Type1 Diabetes needs to have the source of exogenous insulin, to overcome the diabetic ketoacidosis (DKA) and the Diabetic 2, the problem can be controlled through the diet along with the combination along with the non-insulin glucose-lowering drugs. The use of insulin in the diabetes Type 1 stage, can be identified as the pharmacokinetic profiles and how there can be differentiated diabetic cases which can minimize the prandial hyperglycemia.  Some of the  ‘oral hypoglycaemic agents’ can interact with the non-insulin glucose-lowering drugs which can work as the obsolete, and eventually be new glucagon such as the  peptide-1 analogues (GLP-1 analogues) and also be using the peptides, which would be injected (Levett-Jones, 2018).

 As per the Roper, Logal model, the main identification of the factors are related to twelve daily activities, lifespan, dependence and independence continuum, factors influencing the living activities and individualized nursing. Applying these elements to the case of interviewed elderly brings in following observations-:

Developmental/ Biological Elements

The resident is 84 aged and is an elderly citizen of Australia. She is strong headed, is aware about her wellbeing such as not to life heavy things and how to maintain her health, such as monitoring her diabetes and taking necessary actions.

Lifespan/ Psychological elements

The mental, physical, and emotional wellbeing of the patient is pretty normal. She is positive and has overcome some of the life challenges such as depression, and anxiety-free.

Social/Socio-cultural Elements

She stays in the residential area, near to the daughter's house and so far has access to the necessary details.

Spiritual/ Politico-economic Factors

She is positive, enjoys reading books and spending quality time with herself. As she is part of the political environment, she stays in a stable and secure environment  of Australia with proper funding, insurance and government support for elderly (Chang,

2018).

Cultural/ Environmental Factors

She is an Australian elderly patient residing in the residential aged care unit and proactively works over her hygiene and ensure a free environment from the infectious disease (Chang, 2018).

Discussion (CRC 3)

Identifying problems

The problems identified are the lack of awareness, control, and being unable to remain mobile. From the reference of the (Reena, personal communication, December 12, 2019), the patient has shown dizziness, fatigue, there is increased thirst. Excessive experiences the frequent urination, and faces the extreme hunger, itchiness, along with the sudden unexplained weight loss and causing the irritability along with experiencing blurred vision (Cormac McGrath, 2019).

As per the Roper-Logan-Tierney (RLT model of nursing), the action and the discussion would be identified as below-:

Assessment-: The patient vital signs such as weakness, urination, and even excess hunger. Any sort of itchiness, checking of the intensive treatment and monitoring the insulin activity (Aronowitz, 2018).

Diagnosis-: The patient should be checked for the physical symptoms such as the blurred vision, un-control eating, excess urination, and even for the related factors such as the patient anxiety, stress level and even the inability to handle the physical and the mental problems (Deravin, 2016).

Planning-: Constantly to have the medication management, to take the precautionary measures for the control and checking the exercise levels, educating the patient with adequate knowledge, and how to handle the stress.

Intervention-: To check for the signs of hyperglycemia, to determine the blood glucose level which would be done before and after the meals, identifying the patient’s HbA1c-glycosylated haemoglobin, anxiety, tremors, and slurring of speech.

Evaluation-: The patient would be checked with the blood glucose levels, any type of changes in the physical appearance such as anxiety, depression, and keeping a check on the healthy diet of the patient.

Care priorities and goal setting (CRC 4 & 5)

Establishing & taking goals-: The patient meal eating such as balanced meal plan, checking the patient’s food preferences (including more fibre), adopting a healthy lifestyle, controlling the un- usual eating times and habits (Haley, 2015).

To have the behaviour modification strategies such as the patient can adopt the yoga or the routine morning/evening walk to check and control her weight. It can further be worked over the weight reduction goals (Holland, 2019).

Checking the knowledge of the patient and guiding her, such as if she is experiencing the unstable blood glucose, the patient can be educated about how to take precautions such as break down in the meal plans, eating at short intervals not as whole, taking action to remain infection free and checking her mental and cognition levels.  (NSQHS Partnering with Consumers Standard, n.d.). 

Evaluating outcomes-: 

Outcome-: The patient needs to adopt standard lifestyle recommendations, and how the patient should be timely monitored for the metformin and placebo for any potential risk of type 2 diabetes. The patient would be monitored with lifestyle modifications and how they would substantially reduce the weight such as 7% of initial body weight and then to increase the activity moderately. Further to have the behaviour modification strategies such as to continue to adopt a weight reduction goals and start with the exercise (Audetat Voirol 2019).

The two nursing care priorities would be the

To check the patient weight signs, to educate about the healthy fiber meals, to have moderately exercise plans and also to make the patient be encouraged to adopt healthy lifestyles.

The nursing care would be medication management, to check the vital signs and any signs of infection and any related issues (Audetat Voirol, 2019).

Conclusion

To conclude, the patient needs to be diagnosed with the diabetes history and understanding how the personal intervention of the material would be accessed. The diabetes diagnosed needs to be intervened and should be taken precautionary measures.  The main goal is to overcome diabetes and how to balance the life challenges along with the long term solution. The patient’s developmental, lifespan, social, spiritual and cultural factors was accessed and interpreted to provide the caring priorities.