Essay on "Diabetes Type 1 As a Long-Term Illness in the Community"

Essay 10 pages (3366 words) Sources: 10

[EXCERPT] . . . .

Managing Long-Term Health Care Needs

The management of patients with type I diabetes presents a number of challenges to health care professionals. Of all the various chronic conditions, complicated diabetes is particularly challenging. In order for diabetics to achieve the medical goals suggested by current guidelines diabetic patients are required to self-monitor their blood glucose, take frequent insulin injections, properly administer their various medications, attend to their diet, pay particular attention to their foot and dental care, maintain a proper diet, and make sure they get proper exercise. It is a daunting task and it is one that few diabetics are able to manage on their own. Most diabetic patients require frequent and consistent monitoring. The intent of this care plan is to provide an outline of what needs to be addressed in such monitoring.

The patient who is the focus of this treatment plan, Mrs. Lee, possesses a number of the typical problems suffered by elderly type I diabetics. The goal of this treatment plan will be to address these problems in the most efficient and least invasive manner possible. Mrs. Lee is an active professional which offers some benefit in the treatment of her disease but such fact also acerbates the need for any treatment options to be conducive to her lifestyle. The goal of this treatment plan will be to take a multi-disciplinary approach to Mrs. Lee's treatment so that all her needs will be addressed and her various problems placed under control.

Mrs. Lee is a life-long type I diabetic who has been on insulin treatment for a considerable number of years. At the time of her last annual review she was 70 years old but still actively employed in the operation of her own transportation company. She only works three days a week but she works an eleven hour shift and must drive 45 minutes each way in order to reach her office. Her home is not particularly diabetic friendly in that it is a three story structure. Fortunately, she does have the advantage of having live-in housekeeper.

The results of her annual review reveal some specific medical concerns. First, there is the issue of her blood pressure. Her blood pressure was tested at 160/90 which is approaching the dangerous range (IK Prospective Diabetes Study Group, 1998). Although she has been taking Enalapril to control her blood pressure, her tested pressure is a major concern and it must be addressed. An investigation into her diet, exercise regimen, and stress factors should be initiated. Her blood pressure reading makes her a candidate for the development of cardiovascular disease and it is imperative that this matter be addressed immediately. A comprehensive review of her medication needs may be necessary.

Complicating the matter of Mrs. Lee's blood pressure is the fact that her pulse rate (90 bpm) is also in the danger zone. Although her age dictates that a higher pulse rate is acceptable, her rate does not qualify as an acceptable rate. The fact that she is a life-long, insulin dependent diabetic makes the fact that she has an elevated pulse rate a significant concern. Additional testing is likely warranted under the circumstances to insure that Mrs. Lee is not in any immediate danger of suffering a stroke or other vascular. The fact that Mrs. Lee has been previously prescribed Simvastatin indicates that her physician had concerns regarding her cholesterol and her high pulse rate may indicate that the present drug treatment is inadequate and that her situation should be reviewed.

Finally, Mrs. Lee's HbA1c results are also an issue of concern. HbA1c is a lab test that measures the average amount of sugar in a patient's blood over a period of 3 months. It is believed by many medical experts to be the best evaluation of how well a patient's diabetes is being controlled (Heisler, 2005). As a normal HbA1c is concerned to be a reading of 6% or less, Mrs. Lee's result of 9% is highly elevated and indicates that her diabetes needs to be addressed.

One positive result from Mrs. Lee annual review is your weight. Her measured weight of 60 kg. is a slightly outside the optimal range but it is manageable. Theoretically, her optimal weight would be near 54 kg. But this is a part of her treatment plan that can be addressed without significant intervention from other health care professionals. Weight control is extremely important for diabetics and Mrs. Lee should be counseled regarding this aspect of her treatment plan (Resnick, 2000). As her present weight is only marginally above her optimal weight, a program that addresses her diet and suggests adjustments would be advisable. Additionally, an exercise program appropriate for her age should be included as well.

The most immediate concern that arises from Mrs. Lee annual review is her ulcerated foot. Diabetic foot problems are the most common cause of hospitalization among diabetic patients and must be addressed aggressively in order to avoid the development of more serious conditions (Jeffcoate, 2004). A complete neurological and vascular examination of the foot should be performed as quickly as possible (Lipsky, 1997).

A collateral, and possibly related concern, is the presence of swelling and oedema in Mrs. Lee's ankles. Swelling of this nature is often a sign of a more serious problem and, therefore, it should not ignored and treated immediately. Swelling may be an indication that Mrs. Lee is experiencing problems with her kidneys or is in danger of suffering heart failure (R.D.S.Watson, 2000). Although the swelling may be due to non-life threatening conditions, it best to err on the side of caution and follow up with differential testing that can eliminate the possible causes.

Similarly, the fact that Mrs. Lee is complaining about experiencing blurred vision should also raise concerns. The fact that Mrs. Lee has a long history of diabetes and is experiencing blurred vision may be indicative of bleeding in the back of the eye or some other ophthalmological problem (Sinclair, 2000). This is a condition that should be addressed immediately.

The immediate goal in regard to Mrs. Lee is to address each of her immediate problems without resorting to hospitalization. Each of the conditions that raise concern as a result of Mrs. Lee's examination and testing can be treated effectively on an out-patient basis if they are addressed promptly but, at the same time, if they are neglected hospitalization may be the only viable solution (Caminal, 2004). Providing treatment in an outpatient setting allows treatment to be received by the patient in a timely manner which serves to prevent further deterioration of their health. Outpatient treatment also cost less for everyone and frees up the availability of beds, staff, and other resources for those who really need them. Additionally, keeping Mrs. Lee out of the hospital allows her to continue her live her life in the manner that she is accustomed which should serve to keep her more comfortable.

Before reviewing Mrs. Lee's medical needs some discussion is necessary regarding her work schedule and commute and her living arrangements. It is likely that nothing can be done relative to any of these concerns but in order to fully treat Mrs. Lee's various medical conditions some preventative measures should be examined in order to possibly alleviate her continued deterioration.

The fact that Mrs. Lee has to travel 45 minutes each way in order to get to work is a significant problem. While Mrs. Lee is driving she is unable to move her legs in a way that promotes circulation and maintaining proper circulation is a concern with diabetics especially one who has been insulin dependent for nearly sixty years. As there is little likelihood that this situation can be alleviated, some patient education would be appropriate and as part of this education Mrs. Lee should be encouraged to use support stockings or hosiery whenever she makes the commute to work. The use of compression stockings will assist in increasing blood flow, improve venous valve function, and reduce coagulation. Taking this simple action will serve to prevent Mrs. Lee from developing serious problems in her legs. She may not even beware of this preventive measure and it is the responsibility of her health care professionals to keep you advised of potential risks.

The fact that she is still working and working long shifts may also be contributing to her apparent deteriorating health. Work often contributes to one's stress level and stress can serve to acerbate health problems related to diabetes. Although there is nothing in her medical history to indicate that work related stress is present in her life, the subject should be broached in order to eliminate it as a possible cause for her medical conditions.

The proper professional approach for addressing the above issues is a referral to a social worker who is trained to handle problems related to diabetes. Such individual would be best able to discuss with Mrs. Lee the pragmatic aspects of her life and suggest some viable alternatives.

The decision to get a… READ MORE

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