Clare Giardini is a 70-year-old woman, who frequently presents to both her local General practitioner and also the local emergency department. In the last three months, she is presented with complaints of shortness of breath six times. On this occasion, she missed the appointment with the GP and ran out of medications. She is living happily and for the last five years, she is facing complications with diabetes and living in government housing. She has a social group of friends with whom she is having lunch twice a week. The medical history of Clare Giardini is implying osteoarthritis, non-insulin-dependent and hypertension. The recent echocardiogram is implying the dysfunction of systolic and poor left ventricular ejection fraction. To better get an idea of the condition of the patient; medication, objective data and subjective data are collected (Fitriyani et al., 2019). The assessment will discuss the comprehensive nursing assessment and contributing factors for selected case conditions. After that, it will take the nursing assessment, intervention and strategies that can be utilised for self-management. Lastly, it will take the primary and secondary health promotion education strategies that are accurately applied in the case study.
Based on Clare's objective data, it is shown that HbA1C 75 mmol/mol and BGL 8 mmol/L are reported implying high blood glucose levels in the blood. Furthermore, based on subjective data of Clare’s Fatigue, Orthopnea, and Nocturia up to six times per night have been reported. The reported medical history of Clare illustrates the presence of osteoarthritis, non-insulin-dependent diabetes and hypertension. Assessment of Clare with physical conditions that record the blood pressure, blood glucose level and heart rate(Nouwen et al., 2019). The blood pressure reading is high in this case because of a medical history of hypertension and an increased amount of glucose. It leads to an increased risk of an increase in blood pressure as the blood thickens (Su et al., 2019). On the contrary, Differential diagnoses suggest that ECG will also be performed by which the condition and its assessment can be analysed. Collected objective data will be reflected on the cardiac system, pulse and heart rate and blood glucose level. It is implying that diabetes is the root cause behind admission in emergency settings.
Intervention for management of Clare’s condition: Clare's condition is worsening due to the poor management of their diabetes and cardiac condition. She is running out of medication and living a sedentary lifestyle evidenced by facts; she enjoys most of the time in Knitting and playing with her pet car. She meets in a local club for lunch twice a week. About the mentioned lifestyle activities, the following are the interventions that need to be implemented. Normalising insulin activity, the main goal is to reduce the vascular and neuropathic complications that reduce the complications of diabetes. The intervention is an important one by which the various aspects can be eliminated (Fisher et al., 2019). Second is an intensive treatment which is an injection of insulin per day in a subcutaneous way. In addition, insulin pump therapy leads to the frequent monitoring of blood glucose levels and contact with the diabetes educator every week (Lo et al., 2018). For instance, in the case of Clare, it is noted that the patient is not having enough medication which leads to hypertension and further outcome in shortness of breath (Taylor et al., 2019). Therefore, it is crucial to give insulin injections to manage diabetes and blood glucose levels. Third is providing a plan for the diet and meal intake that will regulate the sugar intake and calories in the blood.
Medication plan and timely dosage: Taking note of subjective and objective data of Clare, the following are the medications prescribed. Metformin is a drug prescribed for helping in controlling the amount of glucose in the blood. It reduces the amount of glucose that is absorbed in the blood. The medication manages insulin-dependent diabetes. Paracetamol will be used for the management of pain and to reduce the high temperature. The medication is provided for reducing the pain of osteoarthritis in Clare's situation. Diclofenac reduces the swelling and pain that is used for treating aches and pains. It reduces the hormones that are associated with inflammation and pain in the body. Quinapril treats high blood pressure that is provided in combination with other medicines to treat heart failure. Lastly, Furosemide is a loop diuretic that overcoming the overload of volume and edema that is subjected to congestive heart failure.
Lastly, exercise caution that brings responsible behaviour at the end of family and patient. The interventions result in the management of chronic conditions that lead to the management of diabetes (Zarora et al., 2022). In addition, intervention needs to be provided for cardiac and respiratory by which vitals can be regained. As it is seen that shortness of breath is the reason. It can be managed with the administration of medication. All these interventions play an important role in the management of chronic conditions of patients.
Effective management for condition and nursing plan: Clare is living a life that is lacking physical activities, she is running out of medication and not having good financial resources. BP 112/65 mmHg, Cardiac system S1 and S2, present, no murmurs, Respiration rate: 22 breaths per minute and shallow, SpO2 94%, Lung sounds: crackles in both bases. To manage the recorded readings, an action plan would include providing medication that will help in regulating the glucose level. Followed by checking the feet every day for cuts, blisters and red spots. It will manage the neuropathic condition and reduce the chance of swelling and numbness at the end of the feet (Goodall et al., 2020). Managing and controlling lifestyle activities that are exercise, smoking and alcohol that leads to worsening the condition (Lo et al., 2018). It will lead to effective control over diabetes due to which Clare is facing shortness of breath, high blood pressure, and fluctuations in the pulse rate (Carpenter et al., 2019). With this, consuming balanced meals in appropriate portion sizes is much needed by which the level of glucose, and hypertension can be regulated.
Self-management promotion for Clare: For self-management, the following are the ways that can be implemented. It involves the empowerment of patients with a focus on diabetes education. Clare needs to be educated about eating unprocessed food like whole grains, fruits and vegetables. Also, having fat-free and low-fat milk reduces the content of sugar in the blood (Triantafyllidis et al., 2019). Encouraging the patient to pursue life goals and interests leads to the intake of a little of each sugar each day. It will make the patient be encouraged to take the exercise in the schedule. In conclusion, it will lead to the effective management of patients and allow the vital signs to be regained.
Tharani et al., (2021) study implies that self-management support is considered an important task for the nurses placed in the chronic care provision. The complex nature of the diseases is seen as leading to the rise of factors that affect the behaviour of nurses supporting the patient. The study will be taking the PICO framework which is giving a comprehensive model of self-management support. It needs to take into account self-management support where the emotional aspect and patient-as-partner approach are taken. It will help the nurses to show a supportive role in chronic care. Chan et al., (2021) study show that chronic diseases are a leading cause of death and disability worldwide. It will be leading to a rise in numbers due to poor illness management skill that makes people suffer from low self-efficacy and aversion to participating in self-management activities. To deal with the multiple aspects, an integrated approach is needed that targets the common risk factors of chronic diseases like cardiovascular diseases, diabetes and cancer. Nurses play an important role in serving as care coordinators and case managers that is making the complexity to get simplified. Yildirim (2021) identifies the perceived barriers that are the emotional and spiritual state of the patient. It is important to eliminate the barrier with the consideration of diet and medication management that holds the potential to deal with chronic conditions. To implement the practices, healthcare professionals should implement self-care programs into account all the variables that are affecting the patient with the diseases.
Clare is not having enough livelihood opportunities which leads to the mismanagement of diabetes and hypertension to progress. The supporting objective data implies that BP 112/65 mmHg, Cardiac system S1 and S2, present, no murmurs, Respiration rate: 22 breaths per minute and shallow, SpO2 94%, Lung sounds: crackles in both basePrimary and secondary health promotion comprising primary prevention that overcomes unhealthy and unsafe behaviour. It will be overcoming resistance to diseases. For conditions like diabetes, education about healthy and safe habits that are making an individual get involved in eating and exercising will make the better inclined to healthy practices (Ren et al., 2018). Secondary prevention aims to reduce the diseases that are taking place. Encouraging personal strategies will help in preventing the progression of chronic diseases progression (Emami et al., 2020). It comprises regular examinations and screening tests to detect the diseases at the earliest stages. The primary and secondary promotion strategies will help in suggesting the best ways individuals by which chronic conditions can be better managed.
Clare's education is important as she is living a life that is very unhealthy and lacking physical activities due to which respiratory and cardiac issues have been reported. Education strategies for diabetes patients include taking medicines for diabetes and other health problems on time. It will help in keeping the blood sugar regulated and manage the side effects. Second is having the meal and its size in a definite manner that is ½ vegetables and fruits, ¼ protein and ¼ grains that is fulfilling the body. Third is an exercise that is getting at least 150 minutes per week that is dedicated to moderate-intensity exercise (Polonsky et al., 2022). Walking, running, cycling and water aerobics are suitable forms of exercise that keep the system active and strengthen the metabolism. Lastly, taking the help of healthcare practitioners in terms of keeping track of vitals. It will allow the blood glucose to be regulated and manage hypertension that is present in medical history. Medication adherence will manage the vital signs and regulate the signs and symptoms of shortness of breath. It is seen that High blood glucose level is reported and high blood pressure exerts pressure on the heart (Abdulrhim et al., 2020). Furthermore, it creates pressure on the lungs which is responsible for SOB. Education will help in the awareness of patients that manage chronic conditions. The prevention promotes the management of Clare's condition.
As a registered nurse, discharge the selected cases from the hospital. Nurses have to work in primary health care that is inclined toward ongoing care. Clare is presented in an emergency setting with the complaint of shortness of breath which might be due to the medical history. It involves diabetes, hypertension and atrial fibrillation that is leading to a change in the vital signs and results in the worsening of the condition. It is found that poor visits to the clinic and lack of medication adherence will result in the worsening of signs and symptoms. Therefore, it is crucial to manage the activities like intake of meals, physical activities and medication adherence. Performing assessment allows the factor to appear for the patient and after that interventions will be provided. In conclusion, assessment, intervention and education of patient help in dealing with chronic conditions. To attain the goals of chronic condition management implementation of Primary and secondary health promotion is recommended. Henceforth, the practices and interventions manage chronic conditions.
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