This case examines Type II Diabetes in a 45-year-old black woman, an immigrant from Africa and a high school graduate, whose husband died a year ago. She is a restaurant manager and has a health insurance plan as one of the benefits offered by her employer. Her vision is slightly impaired but that does not concern her much, because with glasses her sight is almost normal. However, she sometimes experiences blurred vision, most prevalent in the afternoon. This has been occurring for about 4 months. She has been in good health, believes she lives a healthy lifestyle all her life, and has had no concern about her health until recently. About two months ago she started to feel weak and noticed that she tires more rapidly than usual.
On questioning, she admitted to getting up two or three times per night to urinate. She also is often thirsty at those times and drinks a glass of water each time. Her weight has been average through high school, where she had been active on the basketball team. After leaving school however, she had gradually gained weight over the years. Her appetite has remained excellent but she now is losing weight and becoming weak.
Nursing care will be provided for this patient primarily out of her home and via out patient clinical visits. Counseling can also be offered the patient on an out-patient basis. No family members are involved in the client's treatment, however a dietician and exercise physiologist will be consulted regarding the nurses recommendation for health care. The dietician's role will be to provide nutritional guidance and counseling, and the exercise physiologist will assist in developing a moderate exercise regimen to assist in managing the patient's weight.
II. Priority Psychosocial Need
The primary psychosocial need for this patient is stress management and adaptation. Nursing interventions for this patient will include social and behavioral adjustments which are necessary to improve the psychological adjustment this patient will deal with living with diabetes (Knoll, 2003). Stress management techniques are necessary to help combat the fatigue and depression typically associated with diagnosis of long-term illness. Additionally, stress management education will likely assist the patient in realizing and identifying healthier lifestyle choices, which include appropriate nutrition, activity, social interaction and exercise.
Women coping with Type II diabetes typically experience more anxiety, social worry and a "decreased ability to cope with the disease" (Knoll, 2003), therefore stress management and coping techniques will be essential to improving the outlook of this patient. As a restaurant manager this woman is likely to experience an increased level of stress. Additionally, she lacks support from relatives, and is also still adjusting to the loss of her husband less than one year ago. All of these factors may contribute to increased feelings of anxiety, stress and depression. These factors may also contribute to an increased outlook for failure if not addressed adequately in treatment protocols.
Additionally the patient is struggling with necessary dietary and lifestyle changes which are often hard to cope with initially. It will be critical to assess her mental outlook and measure her stress level on a weekly basis, to assess how this affects her nutritional and lifestyle choices.
III. Priority Basic Human Need
The priority basic human need identified for the patient is nutrition. Appropriate interventions will include nutritional assessment, counseling and monitoring. The patient is presenting with classic Diabetes II symptoms. Diabetes II is commonly controlled through diet alone. Though the patient will also benefit from an activity and exercise routine, diet is the first mode of improvement.
Type 2 diabetes is a major form of diabetes very prevalent within the United States, and is characterized by abnormal insulin production (Knoll, 2003). Typically the treatment of the disorder includes alleviation of symptoms and securing of blood glucose control to promote an optimal "quality of life" (Knoll, 2003). Blood glucose control is often established through appropriate nutritional interventions. The patient currently has indicated that her diet includes many high fat and sugary foods. To control the symptoms of diabetes, it will be necessary to counsel the patient regarding appropriate dietary choices, which will include the reduction of refined sugars and fat intake in the diet. The assistance of a dietician will be enlisted to assess the patient's current diet, and assign changes that will impact her ability to moderate blood glucose levels. Accordingly, the patient will be required to monitor blood glucose levels on a daily basis as part of treatment protocol.
IV. Primary Professional Standard Relevant to this Case
Relevant to this case is the professional standard of medication administration. Medication can and is often administered to assist in treatment of Diabetes II. True diet and exercise are very effective interventions in treating a patient presenting with this condition. However oral medications are also often administered to assist in maintaining appropriate blood glucose levels. Oral medications are typically categorized into four classes of drugs that assist the body in utilizing insulin, they include: sulfonylureas, metformin, troglitazone and acarbose (Nebergall, 2003). Metformin is perhaps the most popular, working as a catalyst to assist the body in detecting its own insulin (Nebergall, 2003).
Medication administration for this patient is an important consideration and should be considered as an appropriate intervention should the techniques of stress management, changes in diet and increased exercise protocol prove inefficient in controlling the patients primary symptoms, including urinary frequency and increased fatigue levels. Studies have also shown that new medications are being developed that may reduce some of the long-term effects of diabetes, and these medical interventions will be closely examined and followed to assess whether they are appropriate for future patient management of symptoms (Nebergall, 2003).
V. Research in nursing related to this client scenario
In the Journal article "Psychiatric Morbidity and Metabolic Control in Diabetic Patients" published in the German Journal of Psychiatry, the implications for stress management in type II diabetic patients are among the topics examined and surveyed. The article discusses the increased risk of psychiatric morbidity and depression present in patients with type II diabetes. The article is relevant because it reaffirms the need for psychosocial interventions related to stress management and behavioral changes for patients with this disorder.
In this article, a survey of patients revealed that the incidence of depression in patients diagnosed with Diabetes II is increased between 8.5% and 27% (Mousleh, et.al 2003). The study also revealed that among the other variables affecting patients, obesity and the duration and side effects of the disease were among the most prevalent causes of increased morbidity (Mousleh, et.al 2003). The article affirms that it is triply important to teach lifestyle changes and help this patient, who is dealing with increased weight gain and fatigue. The patient also is dealing with the death of her husband which occurred approximately one year prior to diagnosis of Diabetes II. This factor will increase the likelihood of depressive symptoms associated with long-term illness.
Appropriate measures to counterbalance these stressors will include counseling and support through potential group counseling resources. Such modalities, according to this article, are likely to prove beneficial for the long-term outlook of the patient. The article also points out that depression may be related to common symptoms of diabetes II diagnosis, including fatigue (Mousleh, et. al 2003). This fact is relative given the patients recent history of loss. The article points out the importance of analyzing patient history sufficiently to assess whether symptoms are the result of the disease alone or other psychosocial factors.
VI. Research Questions
What nutritional changes have been proven to reduce dependence on oral medications in Diabetes II patients?
What are the effects of stress management techniques including massage and group counseling on reducing the incidence of depression in patients with Type II Diabetes?