Health History
The interviewee is a 60 y/o Black American widowed female. She was born in LA on October 1, 2023, but currently resides in California. She is a Christian, educated to a tertiary level, and was a teacher before her retirement, when she ventured into the grocery store business. The lady is straight and identifies as a black woman. She was diagnosed with type 2 diabetes mellitus three years ago and started using Glucophanage for the management of her symptoms.
People with diabetes have abnormal responses to insulin and the pancreas (Delahanty, 2023). The condition is exacerbated by being overweight, like the interviewee, due to excessive fat stored around the stomach. Consequently, part of her post-discharge recommendation from the doctors was to lose weight. She combines diet, exercise, and pharmacotherapy, including Lescol and Zetia, but remains obese. She has no known allergies to any of the medications.
Subjective and Objective Data
She reports that her diet is mostly organic, and she exercises twice a week at the gym. Her main prescription medications include Glucophage, Lescol, and Zetia without any OTC or herbals. Her PMH reveals no surgery, hospitalized 3x for treatment of diabetes complications, with frequent outpatient appointments.
She was a healthy child, completed all immunizations, had no major surgeries except CS for the delivery of the second child, and never used drugs. Her daughter and son visit frequently. She is social, and they have a good relationship, with no specified roles except that they help with her financial management and premium medical insurance. A medical genogram reveals that her mother passed away due to complications caused by poorly managed diabetes, and two of her living sisters have the same condition.
The ROS reveals no signs of paleness, black hair, or abnormal-looking nails. She has no complaints about her head, neck, lymphatic system, or ENT. There are no lumps on the breast and axillae, no cardiovascular, abdominal, sexual, or peripheral complaints.
However, she breathes heavily and complains about a burning sensation in her feet and hands at night, which is a cause for respiratory and neurological concerns. In addition, she experiences back pain after prolonged sitting, urinary incontinence, and abdominal pain. She was awake and alert, with no signs of acute distress during the interview.
Nursing Considerations
Various nursing considerations must be done to ensure that the patient can have a high quality of life despite her condition. People who have diabetes spend 2.3 times more money on medical health care compared to other individuals in the United States (Powers et al., 2021). Nurses need to advocate for more affordable lifestyle changes to ease the burden on patients. For instance, the interviewee faces a challenge in maintaining a normal weight, which can lead to more complications. Therefore, the nurse should collaborate with the nutritionist and the gym instructor to develop a suitable exercise and diet routine for the patient.
Another essential consideration for nursing is the effectiveness of the medications. There are four primary groups of anti-diabetic agents, including biguanides, insulin secretagogues, insulin sensitizers, and insulin (Artasensi et al., 2020). Sometimes, using a combination of drugs may prove more effective than monotherapy. Moreover, it is vital to educate patients to check for any signs of adverse reactions, drug-drug interactions, and allergies.
Aging results in a significant decline in body functions, which may make the patient more susceptible to complex medical conditions. For instance, older adults who are 65 years and above experience increased fragility, decreased metabolism, sarcopenia, hypoglycemia, and possible cognitive impairment (Bellary et al., 2021). The complications may make the management of diabetes more difficult. Therefore, focusing on patients’ education and empowerment helps them to understand how to monitor vital signs and the steps to take in case of an emergency.
Active Problems
The interviewee had two primary active problems, both of which require proper management to achieve optimal wellness. For the past three years, she has been trying to manage her weight with little success despite following a strict diet. Her old age and genetics are contributing to a slow metabolism, which makes it difficult for her to lose weight. Moreover, some intensive insulin therapy and oral medications for managing diabetes can cause weight gain (Khardori, 2023). The nurse can help the patient understand other available options, such as medications for weight management, to enhance her health.
In addition, the interviewee complained that she has been having more cavities and has lost three molars since she was diagnosed with diabetes. Her teeth are becoming increasingly sensitive to cold, hot, and sweet foods. It is now difficult for her to maintain oral hygiene, which gives her stress and makes her self-conscious. Sometimes she feels that her mouth appears sunken due to the loss of her molars on the left side. She is now saving some cash to have artificial teeth so that she can smile again.
Potential Issues
The potential health concern for this patient is that she is at risk of developing comorbid disorders, which will lead to dependency on many drugs and a poor quality of life. Her trouble losing weight is a risk factor for several other chronic conditions, including cardiovascular diseases, stroke, and hypertension. People who have diabetes and are obese, with a basal metabolic index greater than 35 kg/m2, should consider surgery in case of failure of other weight management programs (Apovian et al., 2018). If the patient continues to gain weight and develops other diseases, their quality of life will deteriorate, leading to more frequent hospital admissions.
Diabetes can cause multiple complications apart from poor oral hygiene, which the interviewee is already complaining about. For instance, one study established that at the point of diagnosis with type 2 diabetes, 25% of the patients had retinopathy, 8% had nephropathy, and 9% had neuropathy (Khardori, 2023). The implication is that people with diabetes have an increased risk of developing complications with their vision, nerve functioning, and the kidneys. The interviewee can potentially experience such health issues, especially when she has poor glycemic control.
Disease Prevention and Health Promotion Topics
A sedentary lifestyle and eating fast foods are responsible for the onset of diabetes and poor glycemic control in patients. For instance, people should become accustomed to reading the nutritional labels of the food products they purchase (Delahanty, 2023). Foods that are cooked through boiling and use natural organic ingredients are better than deep-fried fast foods. Additionally, the serving portion should be minimal to prevent wastage and excessive consumption, which can lead to weight gain.
Physical activities are a significant component in enhancing metabolism, exercising the heart, and maintaining a healthy body weight. For older adults, such as the interviewee who participates in regular aerobics and resistance training, this helps build muscle and tone fat, leading to a delayed presentation of diseases (Bellary et al., 2021). Moreover, engaging in physical exercise has a positive impact on promoting better cognitive function and psychological well-being.
Conclusion
The interviewee was relatively healthy with an average socio-economic lifestyle until her diagnosis with type 2 diabetes. Moreover, she is obese and can potentially get other chronic diseases, such as hypertension and cardiovascular conditions, due to her high body mass index. However, she has a supportive family, a good business, and insurance coverage. Nursing considerations should focus on managing complications, patient education, and preventing drug interactions. Healthcare providers should encourage the patient to adopt a healthy lifestyle to achieve a better quality of life.
References
Apovian, C. M., Okemah, J., & O’Neil, P. M. (2018). Body weight considerations in the management of type 2 diabetes. Advances in Therapy, 36(1), 44-58.
Artasensi, A., Pedretti, A., Vistoli, G., & Fumagalli, L. (2020). Type 2 diabetes mellitus: A review of multi-target drugs. Molecules, 25(8), 1-20.
Bellary, S., Kyrou, I., Brown, J. E., & Bailey, C. J. (2021). Type 2 diabetes mellitus in older adults: Clinical considerations and management. Nature Reviews Endocrinology, 17(9), 534-548.
Delahanty, L. M. (2023). Patient education: Type 2 diabetes and diet. Wolters Kluwer.
Khardori, R. (2023). Type 2 diabetes mellitus clinical presentation: History, physical examination. Medscape Reference.
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L. M., & Uelmen, S. (2021). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists’ Association. The Science of Diabetes Self-Management and Care, 47(1), 54-73.