NSB334: Integrated nursing Practice- Online Healthcare Modules- Case Study Assignment

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Case Study Assignment:

Task:

Mr Michael Brennan 52yrs is attending his General Practice surgery for his regular six monthly check-up. He presents today with complaints of fatigue, difficulty losing weight and no motivation. He denies any polyuria, polydipsia, polyphagia or blurred vision. He notes a marked decrease in his energy levels, particularly in the afternoons. He is tearful and states that he is not taking his antidepressants. He states that every time he tries to cut down on his eating he has symptoms of shakiness, diaphoresis, and increased hunger. He does not follow any specific diet and has been fearful of hypoglycaemia that he often eats extra snacks.

Question:

Use the Clinical Reasoning Cycle on the following pages to review the nursing priorities in relation to the care of Michael.

Question 1:
Review the anatomy and physiology of the three types of diabetes (Type 1, Type 2 and Gestational).
a. What type of diabetes do you think that Michael has? Justify the reason for your answer

Question 2:
a. What is Michael’s BMI and how is this calculated?
b. Discuss what this BMI means for Michael?

Question 3:
Review and recall your knowledge of diabetes and the possible adverse complications that may occur.
a. List four signs and symptoms of hypoglycaemia that Michael might experience
b. Using your knowledge of anatomy and pathophysiology, explain in detail why one of these signs and symptoms
could occur.

Question 4:
Review current information: review and think about Michael’s presentation, the observations that have been carried out and what further assessment you would want to carry out now.
a. Lexapro is a commonly used medication to treat anxiety and depression in adults. Describe the mode of action of this medication for Michael.
b. How should this medication be taken?
c. List two side effects of the medication.

Question 5:
A normal BGL is:
a) 2.5-3.5mmol
b) 4.0-8.0mmol
c) 5.0-10.0mmol
d) > 10.0mmol

Question 6:
Obesity puts Michael at risk of what four conditions?

Question 7:
Michael has indicated that he does not follow any specific diet and takeaways are an easy option. What allied health professional would you consider referring Michael to?

Give a rationale for your answer.

Question 8:
Of the physical assessment on Michael – what finding is of most concern?
a. BGL
b. BP
c. Temperature
d. Pain
Discuss why this is of most concern.

Question 9:
Select from the list below the three highest priority relevant nursing diagnoses for Michael. Justify your answers.
a. Activity intolerance
b. Impaired social interaction
c. Cognitive impairment
d. Insomnia
e. Impaired nutrition
f. Antisocial personality disorder

Question 10:
From the list below choose the three most important short-term goals and justify the importance for Michael’s management at this time:
a. For Michael to lose weight
b. For Michael to sleep for eight hours/night
c. For Michael’s BGL to stablise
d. For Michael to be more social
e. To improve Michael’s mood
f. For Michael to take time off work.

Question 11:
The GP suggests to Michael that he might need to commence insulin. List two strategies that you would suggest and educate Michael on to avoid this.Justify these strategies.

Question 12:
If Michael develops a wound, being diabetic puts him at higher risk of healthcare associated infections. Explain why this is the case?

Question 13:
For Michael’s ankle and knee pain from osteoarthritis, in addition to taking the prescribed Non-Steroidal Anti-Inflammatory Drug, as a nurse you should also instruct him to:
a. Start a regular exercise program
b. Avoid all fatty foods
c. Ensure eight hours sleep each night
d. Rest the ankles and knees as much as possible to decrease inflammation.

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Posted on : February 21st, 2018
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