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Armitage Case Study
Patient Background -- Mr. Armitage is a 50-year-old male of Aboriginal descent. His major complaints are: Shortness of breath, dizziness, frequent urination, occasional tinnitus. He has a five-year history of poorly controlled Type-2 diabetes mellitus. This was diagnosed in 2004 after a 2-year hiatus of symptoms that were suggestive of hyperglycemia. His general state of health is fair; he reports bouts of dizziness, dry mouth, frequent urination, occasional tinnitus, weight gain and slow healing of minor wounds. He is clinically obese with a relative sedate life-style.
Armitage is married and has two adult children, one of whom helps he and his wife with their grocery store business. The Armitages live about an hour from their business and commute daily by automobile. Both report that the commute is, at times, stressful for both. It appears that the high cholesterol, apnea, hypertension and type-II diabetes that Mr. Armitage is experiencing may have some potential genetic predispositions as well as lifestyle issues. His father died of coronary disease at age 78 and his uncle at age 72.
Mr. Armitage reports no allergies, but does admit that he has been unable to remain on a healthy diet (low-glycemic) due to work schedules and pressures (time, etc.). He drinks alcohol in moderation and limits sugary sodas, but admits to not drinking enough water during most days. He sleeps less than 8 hours, but because of frequent urination and apnea, he does not feel that he ever gets enough sleep. His current medical regimen includes an 80mg low dose of aspirin and a statin that he admits to not using regularly.
Using the model of Evidence-Based Practice, we must first outline the overall issues presented by Mr. Armitage. These include Type-II diabetes, Hypertension, Sleep Apnea, High Cholesterol, and Obesity. Evidence for these issues should be primarily scholarly, with the bulk of the materials available from peer-reviewed journals or publications, even Web-Based materials, as long as those materials are written by qualified scholars and/or medical professionals.
Type II Diabetes: II Diabetes, also known as diabetes mellitus, is also called non-insulin-dependent diabetes or adult onset diabetes. It is a medical disorder that, due to a number of factors codependent with the modern world, is characterized by higher than normal blood glucose levels that play havoc with insulin deficiency and resistance. There is no cure, per se, for the disease, although if managed through exercise and diet it usually diminishes. However, if untreated, Type II Diabetes may become quite serious and require the medication of symptoms in order for the patient to maintain a productive life (Australian Diabetes Society, 2013)
Diabetes mellitus type II, formerly called non-insulin dependent diabetes or adult onset diabetes is a metabolic disorder that is medically characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. It is initially managed by increasing exercise and dietary modification, but if the condition is unresponsive, medications may be needed. Typically, there is little tendency toward ketoacidosis, but often nonketonic hyperglycemia. Longer-term complications from high blood sugar can increase risks of heart attacks, strokes, amuptation, diabetic reinopathy, and kidney failure. In extreme cases, circulation of limbs is affected; as is loss of hearing, eyesight and cognitive ability (Inzuccian, S., et al., 2012).
There are three major causitive factors for Type-2 diabetes, typically a combination of genetic and lifestyle factors:
Lifestyle -- Individuals with normal weight and high levels of physical activity have over an 80 per cent less chance of contracting diabetes. Obesity contributes to almost 60 per cent of cases, along with increased consumption of saturated fats and trans fatty acids, alchohol, and cigarette smoking. Additionally, environmental toxins have been shown to recent increases in type-2 diabetes; likely due to pollutants including some ingredients in plastics. In individuals that move to different environments and who adopt different lifestyles, even if genetically predisposed to diabetes rarely manifest the disease unless they move to environments with increased liklihood of overeating and sedentary lifestyles (Saaristo, T., et al., 2010)
Medical Conditions -- There are a number of factors that can increase the likelyhood of type-2 diabetes: hypertension, eleveted cholesterol, and a condition called Symdrome X, or metabolic syndrome (combination of obesity, high cholesterol, sedentary lifestyle, stress, and poor diet). Cushing's syndrome, cortisol excess and testosterone deficiency are also associated with the disease. Often, it is a number of co-dependent conditions that seem to give rise to diabetes (Hawthorne, K., 2010)
Genetics -- There is ample evidence that there is a strong inheritable genetic condition in type-2 diabetes. In addition, there is a genetic mutation to the Islet Amyloid Polypeptide gene that results in early onset diabetes. There is a stronger inheritance pattern for type-2 diabetes with a significant association between family members. Typically, this is excacerbated by cultural and lifestyle factors that, while not inherited, are culturally shared. Gene expression promoted by a diet of high fats and sugars results in individuals that a prone to insulin resistance (Don't Blame Your Genes, 2009).
Recent studies have shown that there is now a global consequence of obesity -- and the resulting diabetes and other problems as not just a medical issue but a true social, cultural and economic problem. In fact, since 1999 there is a clear relationship between the consumption of certain foods and type-II diabetes, leading to the epidemic spreading from the developed world into the developing world, largely as a result of globalization, advertising, and availability of processed foods (Bagchi & Preuss, 2013)
Obesity- - One need only look at a sampling of billboards, magazine and television ads, or local grocery store aisles to see that in modern America, one of the most egregious issues facing the public health paradigm is obesity and the link between being overweight and unhealthy. Both scholars and public health professionals agree that there is a true link between food and health. Daily, we are besieged with advertisements for diet fads and pills, new products promising low fat or low calorie offerings, all designed to support America's need for a quick fix to the burgeoning problem of obesity (Fumento, 1998). Are there negatives to healthful eating? Certainly none that are medical -- but, in our society of fast food, it is more expensive to eat right, fresh vegetables, hormone free meat, low sugar beverages all are a bit more expensive that the high-carbohydrate, fast foods so popular (Robbins, 1998).
The Australian Public health community is alarmed that there is a clear epidemic of obesity in the country, one of which shows no reversing. This is defined as a condition in which excess weight or body fat contributes to potentially negative effects for the person. There are also numerous health risks; heart disease, cirrhosis of the liver, arthritis, diabetes (most especially those overweight), and numerous other aches and pains that keep Australians out of work, and at far more risk of developing chronic cardiovascular and other diseases. Alarmingly, 25% of Australian children are obese, and 3 in 5 adults are now considered obese. In Australia, over 30% of indigenous populations and those living in remote areas are obese as opposed to major cities (Australian Government, 2011).
An estimated 280 Australians develop diabetes daily; with a 2005 study showing that 1.7 million had Type-2 diabetes diagnosed and that likely another 1 million were undiagnosed. The total financial cost for this was estimated at over $10 billion dollars annually with $4 billion lost in productivity. A reduction in type-2 diabetes will not only result in cost savings, but in increasing the health of all Australians (Diabetes in Australia, 2010). In addition, the cost burden of obesity is staggering and it is expected to increase. Demographically, it is moving from an adult disease to a pandemic across the entire age spectrum without regard to ethnicity or demographic/psychographic modifiers. While there is no single effective approach to the disease; we suggest a multistage approach in which a combination of lifestyle and dietary modification/exercise, legislation aimed at prevention in children, and exercise/healthy lifestyles at work to be an appropriate response to the issue. Each intervention alone (counseling, diet, or exercise) may be somewhat appropriate, but the combination will prove to be the most efficacious. In fact, over 14 million Australians are currently obese or overweight, and if the trend continues, by 2025 over 80% of all Australian adults will be obese with obesity and related issues becoming the leading cause of premature death (Obesity in Australia, 2012)
Sleep Apnea- Sleep apnea is a type of sleep disorder that manifests itself in various breathing difficulties during sleep. Typically, these are pauses in breathing that may last from a few seconds to minutes and may occur 5-30 times per hour. There are a number of forms of sleep apnea, but all are characterized by the individual rarely realizing they have a breathing problem, and either realized through other's observations and/or symptoms of fatigue, daytime sleepiness, or other issues. Sleep apnea is often exacerbated in individuals who are obese, and can be quite…[continue]
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