Patient Management and Psychosocial Evaluation of Diabetes

Introduction:

Management of patient is associated with promoting their health and wellbeing by improving the support system and treatment process that are provided to patients in terms of managing their medical condition. Through managing patient physical and psychological condition, health professional make proper investigation on current health status in order to make their sooner recovery. This essay is going to discuss the entire journey of a patient in the selected case study and highlight the overall investigation on patient’s health assessment and interpretation of proper clinical database.

Case presentation:

Steve is 70 years old widower and a retired staff of a private organisation in London. He had been recommended by general practitioner [GP] of a local hospital for psychosocial evaluation of diabetes. He had been admitted into Emergency Room [ER] in the hospital with hypoglycaemic episodes after taking overdose of insulin. He informed that he had taken overdose of insulin lispro instead insulin glargine dose. After the clinical assessment it had been seen that he has fluctuating blood sugar level ( high blood sugar level is 200mg-dL and low is 120mg/dL) and suicidal tendency. After a weak he had been discharge from hospital after his blood glucose level is stabilised [140mg/dL] through using proper dose of insulin glargine. At the time of his discharge his haemoglobin was 7.9%, lower than the last seven years. During his health assessment process, he informed that his fluctuating glucose range makes him apathetic about his activities, self-management process and eating method. His personal history shows that he had lost his father and sister in a car accident ten years ago. He lived in east London with his wife. Unfortunately, he had lost his wife two years ago due to her severe urinary inflammation. These consecutive events pose adverse impact on his psychology and wellbeing which is the reason behind his cognitive impairment and depression.

Health assessment and investigation:

Clinical investigation of the case study illustrates, the current health condition of the patient, his pre-medical history, reasons behind his current health status and the health needs of this patient. This case study shows that, health condition of the patient with diabetes as well as history of severe hypoglycaemia is associated with in integration of social, cognitive and functional issues. Along with diabetes and hypoglycaemic health condition, the patient also has cognitive impairment which leads to intellectual impairment, severe destructiveness and high level of confusion. As stated by Powers et al. (2015), cognitive impairment can present severe issues for the clinicians, as it enhances the chances of patient to have several unpredicted as well as undetected health condition. Analysis of pre-medical history and personal history of the patient in the case study it is seen that he had experienced severe bereavement that pose adverse impact on his memory, psychology and brain functioning.

The clinical investigation of the patient in case study shows that he also has suicidal tendency, which is associated with his past experience of loss and bereavement. On the contrary Bruix et al. (2016) argued that, it is not necessary that if someone has past negative experience so that the individual will have the suicidal tendency, rather the current studies show strong connection with biological issues with the cognitive impairment and suicidal approaches. Through investigation it has been seen that the patient in case study needs careful diagnosis and progressive psychiatric treatment, which will assist the clinicians and psychiatrist to recover his cognitive skill and psychological strength. In this case study it can also be seen that the consequences of bereavement and severe recurrent hypoglycaemia is associated with development of diabetes. On the contrary Hamine et al. (2015) argued that, recent researches on diabetes shows that hypoglycaemic condition sometimes occurs due to over secretion of insulin, which cannot be related to development diabetes in individuals.

Moreover, the author also stated that, hypoglycaemic condition sometimes cannot be considered as the diabetes rather it can be considered as outcomes of diabetes treatment. This investigation also shed light on another aspect of the case study, whether there is any relationship between recurrent hypoglycaemia and cognitive impairment. According to 90, there is obscure relation between the hypoglycaemic condition and cognitive impairment, which cannot predict any proper interpretation. During the investigation of psychosocial health condition of patient in the case study, clinicians have faced methodological issues in determining whether a patient suffering from episodes of recurrent hypoglycaemia would be prevalent to the cognitive impairments. On the other hand, the patient, Steve in the case study has history of recurrent hypoglycaemia as well as cognitive impairments. In this context Funder et al. (2016.) argued that, comorbid neuropathy shows that patient with prolonged episodes of diabetes have higher chances of cognitive deficit as compared to patients who do not have diabetes or are diagnosed with diabetes recently. During this investigation, clinicians have done Diabetes Control and Complications Trial (DCCT), which demonstrated that, recent episodes of hypoglycaemic condition of patent in the case study poses adverse impact on brain functioning and level of neurotransmitter within brain cells, which can be potential reason behind cognitive deficit in this patient. In this aspect Zumla et al. (2015) argued that, sometimes it is difficult for clinicians to find out exact impact of recurrent hypoglycaemic condition on brain cells due to other biological health complications that do not permit clinician to make the brain therapy of surgery. During the investigation process, clinicians have done all kind of important tests such as electroconvulsive therapy (ECT), neuropathy test and retinopathy test, in terms of understanding interpersonal relation of diabetes, hypoglycaemic condition and cognitive impairment. Throughout the investigation process, clinicians in the case study have faced issues in determining whether depression and cognitive impairment in the patient are associated with his prolonged diabetes and hypoglycaemic condition. However, the investigation has also shed light on the fact that, as the patient in the case study has recurrent hypoglycaemia and prolonged diabetes, there is chances that it might pose the adverse impact on his thoughts, decisions and current mental condition. This can be good reason behind of his recurrent suicidal behaviour, cognitive deficit and depression. In this aspect Ortiz et al. (2018) argued that, along with the biological and physical health issues, clinicians need to consider psychosocial issues as strong reason behind cognitive deficit and depression. During the investigation, it is seen that the patent in case study has consecutive events of loss and bereavement which might pose adverse impact on brain functioning as well on his thought and decision making ability. From the overall investigation process it can be stated that, during making the effective health assessment of patient, clinicians need to consider different aspects of health such as psychosocial aspect, biological aspect and mental aspect in order to determine the actual reason behind their physical and mental condition.

Treatment ad management of the patient:

Effective treatment and management of patient in the case study assist him to deal with his health condition and make proper self-management process to make his own recovery. Proper clinical evaluation has been done by the health professional, which shows the overdose of the insulin is occurred due to lack of attention of patient rather than his suicidal intention or hypoglycaemic condition. In this aspect McCrindle et al. (2017) argued that, in most of the cases patient with diabetes and hypoglycaemia forget about their medicines and theories due to poor brain functioning which is associated with depression, anxiety and lack of intellectual ability. Health professional makes the regular check-up of blood sugar level of patient in the case study. With using proper dose of insulin on regular basis, clinicians were able stabilise the blood sugar level a 140mg/dL. Moreover, the clinicians in the case study, made health assessment of Steve, which shows that he grappled with retinopathy, neuropathy and unpredictable blood glucose level which can fluctuate at any time. For this reason, nurse was advised to check the blood glucose level at 8-14 times per day. As the patient in the case study also had sleep apnea, which means that the individual will have low sleeping tendency, health professionals have done neurological tests. Though conducting this test, they analyse the brain functioning of this patent. This test assists health professionals to understand that overdose of medicines and fluctuating blood glucose level pose impact on functioning of neurotransmitter of brain cells. Based on his test, clinicians have recommended different medicines such as isinopril, hydrochlorothizide, atorvastatin and folic acid. All these medicines have been proved to be highly effective for Steve, which stabilise his blood sugar level and reduce tendency of hypoglycaemic condition.

Additional diagnosing has been made by the health professional in determining whether Steve have hypertension, Meniere's disease, atrial fibrillation and arthritis. In this aspect Inzucchi et al. (2015) argued that, in most the cases of hypoglycaemic condition and depression, clinicians need to focus more on the psychological therapies and neurological test rather than emphasizing on some conventional test such as determining arthritis or Meniere's disease. Here the health professional has done neuro imaging studies in order to determine any kind of neuronal injuries or stroke in brain. Through using the electroconvulsive therapy (ECT, clinicians determine whether there is any kind of abnormalities in brain functioning of Steve. As stated by Basch et al. (2016) management of health and wellbeing of patient is not only associated with conducting appropriate clinical tests but also with providing them proper emotional and physical support. In the case study, nurse and health care staffs are advised to form heathy a well as friendly relation with Steve in order to improve his psychological condition. Steve had been provided with regular counselling and psychosocial therapies in order to assist them to get rid of past memories. Moreover, clinicians and nurse tried to involve Steve into interesting as well as playful activities such as gardening, cleaning and making argument on favourite topic with nurse. According to McCrindle et al. (2017), involvement of intellectual tasks is one of the most important process in managing health and wellbeing of patient.

In order to conduct highly effective and well-organised patient management in the case study, health professionals focus not only on physical and psychological tests, but also on improving knowledge, skill and understanding of patient about his own health. As stated by McCrindle et al. (2017) health literacy and health training process are effective system which assaults patient to be informed about their current health condition and reason behind condition, in the case study, Steve has been provided with Blood Glucose Awareness Training session, It is well-organised and well-documented psychoeducational training program, that increase knowledge and interesting of patient about Type 2 and Type 1 diabetes . This training session assists Steve to make proper estimation of his own blood glucose level. Moreover, this training process also assists Steve to monitor the hyperglycaemic and hypoglycaemic condition. This training process assists Steve develop his understanding about how to make proper self-management in order to reduce the chances of depression and anxiety. On the contrary Ortiz et al. (2018) argued that, sometimes training is not effective in case of patient with cognitive deficit due to the lower ability to evaluate and analysing each aspect.

Neuropsychological tests are conducted by the health professions in order to improve the overall mental and physical health condition. Through this test, clinicians gas determines that effects is posed on mental and physical health of Steve by hypoglycaemic condition and diabetes.

Steve also get the assistance id dieticians, who provide proper advice on eating habits and food choice. According to Reiner (2015), treatment of patient during from both diabetes and cognitive impairment, eating habit and food choose play important roles. In this case study, nurses are trained and advised about choosing of appropriate food and drinks for Steve which would be highly effective for his physical and mental health and wellbeing. Moreover, timely medicines is provided to Steve in order to improve his health condition. through using appropriate dose of insulin in each day, clinicians were able to stabilise the blood glucose level of Steve. Moreover, trained and high-skilled nurse are assigned for providing medicines in time to Steve in order to eliminate chances of error in providing appropriate dose of insulin. In this context Steegmann et al. (2016) in sometimes providing timely medicines as well as food are not sufficient for promoting health and wellbeing of patent rather health professionals needs to focus on improving the cognitive and psychological skill of patent. In the case study, Steve had received high level of support and care nurse and health professional in each aspects of his recovery. For example, nurses play important roles in discussing the health ad illness of Steve, which allowed him to express his health issues and psychological status status in front of nurses. Moreover, health professionals made heathy and friendly relation with Steve which made him easy to share his views, preference and thoughts about his own treatment process. Moreover, clinicians also assisted Steve to understand the proper process self-management in which he can use then appropriate technique and clinical methods to detect is own blood sugar, critenin and BP.

During the treatment and management if patient in case study, clinicians has also conducted the ongoing support and monitoring system. In this aspect Kanis et al. (2017) mentioned that, ongoing support system is important aspects of patient management, especially in case of patient suffering from cognitive deficit. Here Steve has severe cognitive impairment and diabetes that made its is obligatory for the health professionals to check and monitor his health status of regular basis. Clinicians and nurses focused on determining the emotional wellbeing, tolerability of medication, blood sugar level, blood pressure, lipid amount and glycemic status. In this context, Grever et al. (2017) argued that in some cases of cognitive impairment and diabetes, ongoing monitoring is not enough for detecting the current mental health status of patient, rather the patient needs proper health evaluation process in which, health professionals make thorough research on current health condition of patient.

During the treatment and management of patient in the case study, clinicians also focuses on assessment of key characteristics of patient, such as his preference, current lifestyles, eating habits, behaviour and mentality. According to Chiauzzi et al. (2015), assessment patient’s characteristics, clinicians as well as nurses are able to understand the psychology and perception of the patient. This process has assisted the clinicians in the case study in order to determine that how the past experience of Steve poses adverse impact on his thoughts, ideas and perceptions. This is why he suffer from cognitive impairment and suicidal tendency. Through analysing the behaviour of Steve, the health professionals are able to determine that whether Steve needs any special therapeutic treatment. On the contrary Powers et al. (2015) argued that, recent researches have stated that, assessment of patient characteristics cannot be considered as the effective treatment and management of patients suffering from mental and physical illness. The author also stated that, assessment of key characteristics patients can provide indication of some physical issues in patient but it us unable to provide proper understanding of an internal disturbance in patient’s mind or body. There is some controversies with these statement, in which some of the general practitioners stated that, assessment of key characteristics of Patient can be effective way of determining the physical issues on patient which can assist the health professional to sense that patient suffer from some kind of psychological illness.

Clinicians in the case study have also used the shared decision-making process, in order to assist Steve to share his own thoughts, ideas and decisions regarding their own health as well as treatment process. As stated by Bruix et al. (2016) the process of shared decision making is important in case of promoting effective and appropriate treatment as well as management of patient. During this process Steve was allowed to share his thoughts and decision regarding his tolerance level of medication and overall health improvement. Moreover, clinicians are to discuss about the additional health needs of Steve that he wanted to receive.

This shared decision-making process, assist he health professions to discuss about the new and innovative treatment with patients (Hamine et al. 2015). Steve was allowed to discuss any issues and preference reading treatment process with the health professionals as well as with the nurses which assisted him to understand his own health recovery as well as current mental and physical health condition.

Interpretation:

Based on the abovementioned discussion and investigation of patient’s health in the case study, it can be interpreted that, poor mental health and cognitive impairment of Steve is associated with his past experience of bereavement. Overall investigation, health assessment process and the treatment and management process of Steve, interprets that, he has fluctuating blood glucose level which is associated with his cognitive impairment. Due to high level of depression, anxiety and suicidal tendencies, he forgets to take his insulin dose in systematic manner which raises or reduces his blood glucose level. From the above-mentioned discussion it can also be interpreted that, Steve needs proper rest, emotional support and all-time guidance in order to conduct proper self-management of his own health. Moreover, he needs weekly counselling and psychiatric therapies in order to get rid of suicidal tendencies. He needs to take timely food and medicines in order to have improved brain functioning. Moreover, he needs to take nutritious food as per the recommendation of dietician, in order to intake proper protein, calorie and fats on regular basis. Apart from the healthcare facilities, Steve needs to get proper social support from his neighbours and relatives. In this aspect, the health professional, can inform local health and social care committee to assist Steve to get proper social and emotional support from his community which is important his recovery.

Conclusion:

From the above-mentioned discussion it can concluded that patient management is process of promoting their health and wellbeing by using effective treatment process and improving care process. Analysing and interpretation of patient’s health in the case study, it can concluded that, patient with cognitive impairment and diabetes needs proper health assessment and investigation in order to determine their actual health needs. Moreover the discussion also concludes that, it is possible that there may not be any strong relation between recurrent hypoglycaemia and cognitive impairment as there is lack of proper evidence regarding this relationship. However, with this analysis of health condition and needs of patient in the case study it can be stated that, individual with recurrent hypoglycaemic condition can have the prevalence towards the cognitive impairment due to changes in neurotransmitter inside he brains. Whatever the relationship is between the recurrent hypoglycaemic condition and cognitive impartment, patient needs proper management of disease and treatment process in order to make their recovery.

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Reference list:

Baril, J.G., Angel, J.B., Gill, M.J., Gathe, J., Cahn, P., van Wyk, J. and Walmsley, S., 2016. Dual therapy treatment strategies for the management of patients infected with HIV: a systematic review of current evidence in ARV-naive or ARV-experienced, virologically suppressed patients. PLoS One, 11(2), p.e0148231.

Basch, E., Deal, A.M., Kris, M.G., Scher, H.I., Hudis, C.A., Sabbatini, P., Rogak, L., Bennett, A.V., Dueck, A.C., Atkinson, T.M. and Chou, J.F., 2016. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. Journal of Clinical Oncology, 34(6), p.557.

Bruix, J., Reig, M. and Sherman, M., 2016. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology, 150(4), pp.835-853.

Chiauzzi, E., Rodarte, C. and DasMahapatra, P., 2015. Patient-centered activity monitoring in the self-management of chronic health conditions. BMC medicine, 13(1), p.77.

Dhir, M., Melin, A.A., Douaiher, J., Lin, C., Zhen, W.K., Hussain, S.M., Geschwind, J.F.H., Doyle, M.B.M., Abou-Alfa, G.K. and Are, C., 2016. A review and update of treatment options and controversies in the management of hepatocellular carcinoma. Annals of surgery, 263(6), pp.1112-1125.

Funder, J.W., Carey, R.M., Mantero, F., Murad, M.H., Reincke, M., Shibata, H., Stowasser, M. and Young Jr, W.F., 2016. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 101(5), pp.1889-1916.

Grever, M.R., Abdel-Wahab, O., Andritsos, L.A., Banerji, V., Barrientos, J., Blachly, J.S., Call, T.G., Catovsky, D., Dearden, C., Demeter, J. and Else, M., 2017. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood, 129(5), pp.553-560.

Hamine, S., Gerth-Guyette, E., Faulx, D., Green, B.B. and Ginsburg, A.S., 2015. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. Journal of medical Internet research, 17(2), p.e52.

Inzucchi, S.E., Bergenstal, R.M., Buse, J.B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A.L., Tsapas, A., Wender, R. and Matthews, D.R., 2015. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care, 38(1), pp.140-149.

Kanis, J.A., Cooper, C., Rizzoli, R., Abrahamsen, B., Al-Daghri, N.M., Brandi, M.L., Cannata-Andia, J., Cortet, B., Dimai, H.P., Ferrari, S. and Hadji, P., 2017. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporosis International, 28(7), pp.2023-2034.

McCrindle, B.W., Rowley, A.H., Newburger, J.W., Burns, J.C., Bolger, A.F., Gewitz, M., Baker, A.L., Jackson, M.A., Takahashi, M., Shah, P.B. and Kobayashi, T., 2017. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation, 135(17), pp.e927-e999.

Ortiz, A., Germain, D.P., Desnick, R.J., Politei, J., Mauer, M., Burlina, A., Eng, C., Hopkin, R.J., Laney, D., Linhart, A. and Waldek, S., 2018. Fabry disease revisited: management and treatment recommendations for adult patients. Molecular genetics and metabolism, 123(4), pp.416-427.

Powers, W., Rabinstein, A., Ackerson, T., Adeoye, O., Bambakidis, N., Becker, K., Biller, J., Brown, M., Demaerschalk, B., Hoh, B. and Jauch, E., 2018. 2018 guidelines for the early management of patients with acute ischemic stroke. Stroke, 49(3).

Powers, W.J., Derdeyn, C.P., Biller, J., Coffey, C.S., Hoh, B.L., Jauch, E.C., Johnston, K.C., Johnston, S.C., Khalessi, A.A., Kidwell, C.S. and Meschia, J.F., 2015. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 46(10), pp.3020-3035.

Reiner, Ž., 2015. Management of patients with familial hypercholesterolaemia. Nature Reviews Cardiology, 12(10), p.565.

Steegmann, J.L., Baccarani, M., Breccia, M., Casado, L.F., García-Gutiérrez, V., Hochhaus, A., Kim, D.W., Kim, T.D., Khoury, H.J., Le Coutre, P. and Mayer, J., 2016. European LeukemiaNet recommendations for the management and avoidance of adverse events of treatment in chronic myeloid leukaemia. Leukemia, 30(8), p.1648.

Zumla, A., Chakaya, J., Centis, R., D'Ambrosio, L., Mwaba, P., Bates, M., Kapata, N., Nyirenda, T., Chanda, D., Mfinanga, S. and Hoelscher, M., 2015. Tuberculosis treatment and management—an update on treatment regimens, trials, new drugs, and adjunct therapies. The Lancet Respiratory Medicine, 3(3), pp.220-234.