poorly controlled diabetes type 2
Case Study-A 48 year old man with morbid obesity, poorly controlled diabetes type 2, sleep apnoea and obesity ventilation syndromeMultiple factors influence the care of patients with chronic conditions. As a Primary Heath Care nurse, it is important that care given is prioritised based on clinical and patient needs. Prioritisation of the patient needs for care is integral to daily nursing practice. This requires integrating and collaborating different aspects of patient needs in order to maximise care activities and the effectiveness of nursing interventions.
This case study is designed to demonstrate the integration of various principles of managing care of patients with chronic conditions. Students will be expected to analyse the case scenario, identify the care needs and from the list of identified needs discuss two COMPLEX care priorities.
The case scenario
Michael Anderson is a 48 year old male with morbid obesity and type 2 diabetes who was admitted to the medical ward with poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. Michael was referred by his GP after he presented with symptoms of shakiness, diaphoresis, increased hunger, high BGL levels and finding it difficult to breathe when he sleeps.
On the previous admission, Michael was seen by the dietician and was commenced on low energy, high protein diet (LEHP) to help him reduce weight. His GP had previously mentioned weight loss however he had never wanted to do anything about it as it ‘seemed too hard’. Michael had also been seen by the physiotherapist and was commenced on light exercises which he was to continue at home on discharge.
Michael has been discharged home, with referral to community care unit for ongoing support and follow up, after three weeks in the medical ward to manage his weight and clinical comorbidities.
Past medical history
• Obesity (weight165kgs with a BMI of 57.09m2).
• Type 2 diabetes ( diagnosed 9 years ago)
• Hypertension, (HTN)
• Depression (Diagnosed three months ago y GP).
• Sleep apnoea
• Gastro oesophageal disease reflux disease
Michael is an unemployed male who is on financial benefits. Michael lost his job three years ago as a fork lift driver at the Moranbah coal mine in far North Queensland.
Michael states that he has always been a ’biggish guy’ with his ‘normal weight’ sitting at around 95kg but since starting insulin and losing his job he has gained a significant amount of weight. Consequently, because of his weight issues Michael has difficulty finding work due to fatigue and feeling generally ‘uncomfortable’ about his size.
Michael is a divorcee who lives alone, his daughter and son live in the same state but live in different cities and rarely visit him. He is socially isolated because he is embarrassed by his size and he rarely goes out. Michael is also finding it increasingly hard to perform activities of daily living (ADL). Michael realises that he is in the prime of his middle age life and he wants to lose weight.
• Insulin novamix 30/70 DB (20 units mane and 10 units nocte)
• Novarapid sliding scale
• Metformin 500mg BD
• Lisinopril 10mg daily
• Nexium 20mg daily
• Metoprolol 50mg BD
• Pregabalin (Lyrica) 50mg nocte
Last observation on discharge
• Weight 165kgs
• BP 180/92
• RR 23
• HR 102
• Sp02 RA 95% on Room Air (R/A)
Demonstrate the integration of various principles of managing care of patients with chronic conditions.Analyse the case scenario, identify the care needs and from the list of identified needs discuss two COMPLEX care priorities.