Morbidity Dual Diagnoses., Symptoms, Assessment, Impact, Treatment

¶ … morbidity dual diagnoses., symptoms, assessment, impact, treatment June Porter. The purpose assessment undertake assessment a clinical scenario, demonstrating consolidating assessment problem solving skills.

Clinical case scenario -- Co-morbidity for neuropathy

The case of June Porter manifests many of the clinical complications associated with Type 2 diabetes mellitus. June's diabetes is attributed to her significant weight gain and inactivity. June's foot abrasions and blurred vision are causes for alarm, given that they are symptoms of neuropathy. (What you need to know about diabetic neuropathy, 2013, Scottsdale Neuropathy Institute). Smoking can further exacerbate neuropathy by causing narrowing and hardening of the arteries and smokers like June who take birth control pills while smoking further run the risk of blood clots (What you need to know about diabetic neuropathy, 2013, Scottsdale Neuropathy Institute; Cornforth 2009). To improve June's health, it is necessary to control her diabetes. Unfortunately, treating the symptoms of diabetes is further complicated by June's co-morbidity for both substance abuse and depression and smoking.

Substance abuse is defined as a pattern of behaviour "accompanied by 1 or more of the following…failure to fulfil major work, school, or home responsibilities" because of the substance abuse; consuming the substance in situations which are dangerous to the self and others (such as driving); having legal problems related to the substance abuse; and having significant social problems due to the substance (Ringold, Lynm & Glass 2006). June's alcohol abuse and smoking are putting herself at significant risk because she is unable to exercise enough control over her blood sugar because of her denial of the significance of both her diabetes and alcohol abuse. Drinking makes it more difficult for diabetics to monitor their blood sugar and also interferes with glucose metabolism.

A critical component of treating June is the necessity of making her take her condition seriously. At present, there are many factors which complicate effective self-care. June has a job which requires her to dine out in restaurants, which makes it difficult for her to control the fat, sugar, and carbohydrate content of her meals and also makes smoking and drinking part of her 'job.' She exacerbates her foot problems with high heels and with being in a sitting position while driving for most of the day. She is in denial of the severity of her problems, mistakenly thinking that it will 'go away' like her gestational diabetes and fails to appropriately monitor her vital signs. She is no longer exercising or moderating her weight and alcohol use lowers her inhibitions in terms of consuming unhealthy food and reduces her ability to judge her blood sugar levels.

June also shows signs of being co-morbid for depression, given her sense of hopelessness about her condition and the significant changes in her exercise and eating habits. Her partner George is unemployed, further adding to her stress levels, and additionally the couple is experiencing difficulties but June may be reluctant to leave George given that he takes care of her daughter while she is away at work. The lack of support structures in June's lifestyle for healthy living is also of concern.

Thus June's diabetes mismanagement is exacerbated by her substance abuse and depression. The worsening of the diabetes may also be caused by these conditions; given the caloric intake and glucose disruption generated by alcohol abuse and her over-eating (which can be a symptom of depression, just like under-eating). Her poor diet and a lack of exercise has led to neuropathy, exacerbated by stress, smoking, and contraindicated use of oral contraceptives. June's symptoms of blurred vision and foot ulcers, along with other symptoms of diabetes will progress along with her neuropathy unless her blood sugar is under control and she is able to moderate her diet and engage in regular exercises. However, without treating her depression and alcoholism, the self-awareness required by diabetes management will prove to be difficult.