Clinical Insights: Evaluating Mr. Nguyen's Case and Nursing Care Strategies

Introduction

The discussion of case study of patients is important because it contains invaluable records of the clinical practice regarding the nursing care provided to the patients. Moreover, they act as a record for clinical interactions that assist in framing questions for further rigorous designing of case studies. In this presentation, the case study of Mr Nguyen is to be discussed and the patient’s situation along with his key elements of health needs are to be identified. Thereafter, the patient information is to be processed to identify and discuss the key activities of life influenced by his current health condition. On the basis of the assessment, nursing care goals for the patient is to be discussed. An evaluation and reflection regarding the care provided to Mr Nguyen is to be explained.

patient assessment

The case study explains that Mr Nguyen is current diagnosed with type-2 diabetes. He was increasingly unwell for the past few weeks and reported facing fatigued, lack of sleep due to frequent urination needed during the night, increasingly thirsty, increased body weight, cool and dry hands and others. His family has no history of type-2 diabetes. Mr Nguyen has a past history of suffering from asthma, gout and hypothyroidism for which he is daily on thyroxine hormone replacement along with he is currently waiting to be analysed for sleep study out of possible detection of Obstructive Sleep Apnoea (OSA).

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According to the current health condition of Mr Nguyen, one of the further health assessments required is identifying his level of blood glucose level at the fasting stage and after eating. This is because examining and monitoring the blood glucose level in type-2 diabetes patients leads to identify the level of sugar in the body and extent of insulin resistance which allows keeping a check on the glucose fluctuations through timely use of medication to avoid hindered health (Arnold et al., 2018). The glucose level at the fasting stage and after eating is to be determined in type-2 diabetes patients to identify the increased amount of glucose after eating in the patients and in normal conditions during fasting (Nanayakkara et al., 2021).

Patient Situation

In the current condition, Nguyen is mentioned to be suffering from type-2 diabetes and previously been detected with asthma, gout and hypothyroidism for which he has been taking medication. The pathophysiology of type-2 diabetes mentions that dysfunction of the β-cells of the pancreas leads to the impairment of normal insulin secretion during stimulation of glucose. It leads to create a low level of insulin present in the body that causes hindered amount of glucose to be used by the body in developing energy resulting in high blood glucose level as seen in type-2 diabetes patients (Pearson, 2019). The study by Wang & Wei (2017) argued that development of insulin resistance in the body is another cause of type-2 diabetes. This is because during insulin resistance, the body is unable to use enough amount of insulin to convert glucose into energy that results in high blood glucose level indicating the presence of diabetes.

The presence of asthma creates increased risk of development of type-2 diabetes. This is because of the increased use of corticosteroids by asthma patients that causes adverse metabolic changes in the body leading to development of glucose tolerance and insulin resistance (Rogala, Bożek & Gluck, 2020). In case of Nguyen, he is mentioned to be using Budesonide which is a corticosteroid used for improving respiration in asthma patients. Thus, the adverse metabolic impact of the drug may have led Nguyen to develop diabetes. The case study mentions that Nguyen has increased fat in the waist and is suffering from obesity as his BMI rate is 35.7 units. As asserted by Czech (2017), obesity causes the body to develop increased amount of fat present on the muscle cells which makes them impair to effectively use insulin and glucose from the blood. The insulin resistance created out of fat surrounding the muscle cells in obese patients makes them develop type-2 diabetes and remain at increased risk of worsened conditions of diabetes. Thus, Nguyen’s obese condition may have also contributed towards his development of type-2 diabetes.

The people with type-2 diabetes shows symptoms of increased thirst and frequent urination because the excess build-up of glucose in the body due to insulin resistance or dysfunction leads the kidneys to work overtime for filtering increased amount of glucose from the blood. The frequent urination creates low amount of water in the body that results to increase thirst among diabetes patients (Voets, Vriens & Vennekens, 2019). Moreover, the presence of high blood sugar level causes feeling of fatigue in diabetes individuals (Voets, Vriens & Vennekens, 2019). The case study informs that Nguyen is facing all the discussed symptoms indicating he is suffering from type-2 diabetes.

Processing Patient Information

The frequent urination, fatigue and increased thirst in case of Nguyen is abnormal. Moreover, his disability to sleep even after executing enough physical activity at the work is also abnormal. The current vital condition of Nguyen informs that he has low blood pressure with increased heart rate, but his respiration, oxygen saturation and body temperature is normal. It is evident as normal heart rate is 60-100 beats/min and blood pressure is 120/90 mm Hg (healthdirect.gov.au, 2021). In case of Nguyen, heart rate is 106 beats/min and blood pressure is 102/65 mg Hg that is low blood pressure. The case study informs that Nguyen is already prescribed to take Metformin 500mg which is effective in controlling type-2 diabetes (Kumar et al., 2019). However, no additional medication is been provided to normalise the low blood pressure and high heart rate. The continuation of the current situation would lead Nguyen to maintain stable glycaemic control ensuring stable condition with type-2 diabetes. However, the lack of any treatment of the low blood pressure and increased heart beat would lead Nguyen to experience cardiac issues such as myocardial infractions similar to his dad. This is because myocardial infraction is caused by low blood pressure out of hindered flow of blood through the constricted arteries caused by deposition of plaque in the inner lining of the arteries (Ameloot et al., 2020). The frequent need for urination has led him to stay aware at night which has disrupted his sleep cycles. The continuation of hindered sleep cycle would led Nguyen to develop increased fatigue and needs to be resolved.

Nursing Diagnosis

The three key nursing issues to be managed for Nguyen as identified through use of NANDA diagnosis are:

Sleep deprivation

Readiness to accept and implement enhanced healthy diet and nutrient in take

Controlling blood glucose level to normal

The NANDA diagnosis informs that there are mainly four focussed diagnosis made for patients that are problem-focussed, risk, health promotion and syndrome (omicsonline.org, 2021). The problem-focussed diagnosis for Nguyen is presence of sleep deprivation. The sleep deprivation is important to be managed because reduces sleep leads to development of psychological stress and hindered working of the body that causes ineffective control of blood sugar and create risk of heart disease (Khandelwal et al., 2017). Since Nguyen express sleep deprivation and predicted to be suffering from sleep apnoea, thus, supporting effective sleep cycle management is necessary for his health.

The health promotion diagnosis mentions that Nguyen needs support to be ready in accepting and implementing nutrient rich diet. This is important as healthy diet help in controlling and minimising obese state along with assist in keeping the blood sugar as well as blood pressure under control to lead a healthy life (McMacken & Shah, 2017). It is evident as nutrient rich food with presence of low fat and increased complex carbohydrate helps in lowering bad cholesterol in the body, avoid fat deposition and ensure normalisation of blood glucose level (Jannasch, Kröger & Schulze, 2017). In case of Nguyen, it is important as he is involved in unhealthy diet of fast food which may have also contributed to his obese and uncontrolled diabetic state. Thus, intake of nutritious food would help in controlling the symptoms regarding the illness and promote his well-being.

The syndrome diagnosis informs that blood sugar level is to be controlled to normal in case of Nguyen. This is important because normalising blood sugar level would help to stabilise the glycaemic level in the body that in turn assist to avoid development of diabetic neuropathy which results in low blood pressure among diabetic patients (Zhao et al., 2019). Since Nguyen is mentioned to be suffering from low blood pressure and type-2 diabetes, it is important to control the blood sugar level to avoid further worsen impact on his health.

Activities of Living

The Roper-Logan-Tierney model is used for identifying key health needs of the patient because it supports holistic analysis of the health of the patient from all aspect to determine their key needs to improve health and well-being (Holland & Jenkins, 2019). In case of Nguyen, the three activities living which are disrupted by his current health condition and required to be managed through effective nursing intervention are:

Eating and Drinking (Promote healthy intake of food and drink for Nguyen by avoiding fast food and beer which is his current diet)

Sleeping (Resolving sleep apnoea and hindered sleeping cycle in Nguyen)

Working and playing (Reduce working hours)

The study by Hackett & Steptoe (2017) informs that individuals involved in overworking faces increased stress at job which makes them with time develop worsened conditions of type-2 diabetes. This is because increased psychological stress causes hindered functioning of insulin-producing cells present in the pancreas leading to reduce amount of insulin in the body and increase change of worsened type-2 diabetes (Harris et al., 2017). The case of Nguyen mentions he is overworking extensively to support his family that is also causing him stress which is required to be managed and avoided to support enhanced well-being of the individual with type-2 diabetes. Thus, the psychological factor that is stress due to overworking is found to be responsible for the current condition of diabetes in Nguyen.

The case study Nguyen mention he is facing trouble with sleeping which is one of the key activities of life. This is because enhanced sleep helps the body to relax and promote enhanced functioning along with ensure effective working of treatment and medication administered in the body (Tan et al., 2018). The suffering from type-2 diabetes and increased stress due to work act as key factors influencing less sleeping in Nguyen.

In case of Nguyen, he is seen to extensively consume fast food and increased amount of beer due to socio-cultural condition of ability to eat and drink which is harmful to his health and required to be changed. This is because increased intake of fast food worsens the blood glucose level by promoting high insulin resistance in the body. Moreover. increased alcohol intake causes the pancreas to show chronic inflammation that impairs its ability to produce enhanced insulin leading individuals to experience diabetes (Li et al., 2020). Thus, it indicates that sociocultural condition of Nguyen which is influencing him to eat and drink in unhealthy manner nature has influenced his development of health and well-being with controlled type-2 diabetes.

Care Goal

Goal 1

To resolve sleep apnoea and deprivation in Nguyen

To resolve sleep apnoea and deprivation in Nguyen

Goal 2

To promote readiness to accept and implement enhanced healthy diet and nutrient intake in Nguyen

To promote readiness to accept and implement enhanced healthy diet and nutrient intake in Nguyen To promote readiness to accept and implement enhanced healthy diet and nutrient intake in Nguyen

Goal 3

To control high blood glucose level to normal in Nguyen who is suffering from type-2 diabetes

To control high blood glucose level to normal in Nguyen who is suffering from type-2 diabetes

Nursing Action

The interventions to be made for achieving the mentioned goals for Nguyen are as follows:

Goal 1

The use of continuous positive airway pressure (CPAP) machine is to be made that would allow steady flow of air through a mask while sleeping to keep the airways open to avoid sleep apnoea (Malik, Masoodi & Shoib, 2017).

In order to avoid sleep deprivation, it is ensured a calm and comfortable environment is present in the room for Nguyen as it would promote consistency in sleeping (Stavrou et al., 2019).

Nguyen is to be importance of currently reducing overworking and are to be referred to a social care organisation who would help his son to get a job to assist Nguyen to avoid to over work and earn for the family that is causing him increased stress and hindering sleeping.

Goal 2

A dietician is to be introduced for Nguyen who would analyse his health condition and provide him with a diet chart to be followed for each day to involve in health eating and drinking habit. This is because dieticians are qualified individuals who understand the amount of calories and nutrients in each food and can determine the nature of food along with the amount needed for the healthy living of different individuals as per their health condition (Stojanovska, Naemiratch & Apostolopoulos, 2017).

The nurses are to make communication with Nguyen’s mother-in-law and son regarding the way they can develop simple cooking skills by watching cooking videos, health channel and others to involve in healthy diet for themselves as well as Nguyen. This is important as family members of Nguyen by developing cooking skills would able to cook food and avoid fast food from takeaways that hinder their health condition (Varadaraj et al., 2021).

Goal 3

Nguyen is to be administered Metformin 500mg as mentioned in the case study for 4 weeks and the dose is to be reconsidered after 4 weeks based on his health condition. This is because Metformin acts to inhibit the mitochondrial respiratory chain present in the liver that causes AMPK activation and enhance insulin sensitivity in the body resulting in increasing the efficiency of the body to use extra glucose. It also impacts to lower cAMP which reduces release of gluconeogenic enzymes in the body resulting in low formation of glucose in the body (Zhou et al., 2018).

Evaluation, Conclusion and Reflection

The strategy which would determine the effectiveness or success of nursing intervention for Nguyen is measuring health vitals of the patients before and after the implementation of the mentioned intervention. This is because the range of each health vitals before and after the interventions are to be compared to determine the extent to which they are normalised and determine the extent impact of the intervention on the well-being of the individual. Moreover, feedback is another strategy to be used by nurses in which they would interview Nguyen to determine the effectiveness of each of the intervention on his health.

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The study concludes that Mr Nguyen is currently suffering from type-2 diabetes which is mainly caused due to his hindered lifestyle, overworking, use of medication regarding asthma, hindered diet and others. The three key nursing issues to be managed for Nguyen are sleeping deprivation and apnoea, diet and drinking practice and control of blood glucose. The three activities of living to be implemented for Nguyen are sleeping, working and playing and eating and drinking.

The case study led me to learn regarding the way vital health units are important in deciding the health condition of the patients and the nature of disease the person is suffering from that is hindering their health and well-being. I also learned about the way physical symptoms of the diseases are to be assessed and related to determining the disease the patients are suffering from in the current condition. The study also led me to understand regarding the way nursing interventions are to be made for type-2 diabetic patients to improve their health condition.

References

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Arnold, S. E., Arvanitakis, Z., Macauley-Rambach, S. L., Koenig, A. M., Wang, H. Y., Ahima, R. S., ... & Nathan, D. M. (2018). Brain insulin resistance in type 2 diabetes and Alzheimer disease: concepts and conundrums. Nature Reviews Neurology, 14(3), 168-181. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6098968/

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Harris, M. L., Oldmeadow, C., Hure, A., Luu, J., Loxton, D., & Attia, J. (2017). Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PloS one, 12(2), e0172126. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172126

Khandelwal, D., Dutta, D., Chittawar, S., & Kalra, S. (2017). Sleep disorders in type 2 diabetes. Indian journal of endocrinology and metabolism, 21(5), 758. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628550/

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Li, H., Lv, J., Yu, C., Guo, Y., Bian, Z., Fan, J., ... & China Kadoorie Biobank Collaborative Group. (2020). The association between age at initiation of alcohol consumption and type 2 diabetes mellitus: a cohort study of 0.5 million persons in China. American journal of epidemiology, 189(12), 1478-1491. https://academic.oup.com/aje/article/189/12/1478/5900219

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