Community Nursing: Critical Thinking Case Study

Topics: Diabetes mellitus, Blood sugar, Insulin Pages: 5 (1660 words) Published: June 20, 2013
Current Health Needs
Mrs. MH is a 72 year old woman who has a primary diagnosis of Diabetes Mellitus Type II. Her secondary diagnosis and the reason why she was referred to Hackensack home health agency was a non-healing wound on the second toe of her right foot. Upon assessment of the patient, current health needs which were identified pertain to wound care, nutrition, and proper management of Diabetes through compliance with insulin treatment, and knowledge on prevention of hypoglycemic and hyperglycemic episodes. The current plan of care for Mrs. MH and the visit skill relate to wound care and Diabetes self-management. “Diabetes Mellitus is a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization, or both” (Lewis, Heitkemper, Dirksen, O’Brien, & Bucher, 2007, p. 1253). According to Lewis, Heitkemper, Dirksen, O’Brien, and Bucher (2007) some of the clinical manifestations of Type II Diabetes involve fatigue, recurrent infections, visual changes, and prolonged wound healing. As seen with Mrs. MH prolonged wound healing could become a main concern given that it puts patients at increase risk for infection. The desired goals in the treatment with Mrs. MH is to reduce symptoms of Diabetes, promoting healing and well-being, preventing acute complications of hyperglycemia, and delaying the onset and progression of long-term complications Lewis, Heitkemper, Dirksen, O’Brien, and Bucher (2007). Standards of Care

The ANA Scope and Standards of Diabetes nursing practice (2003) states that standards of care describe a competent level of practice demonstrated through the nursing process. Starting from adequately collecting patient health data, identifying potential problems with the physical or spiritual being (e.g safety environment, depression), to formulating realistic goals for improving overall health status ( e.g. increasing physical activity), educating the patient of effective diabetes self-management (e.g. insulin injections, diabetic diet), planning and implementing interventions related to the current health needs, coordinating the care across all settings, and finally evaluating expected outcomes(e.g. prevention of infection, few or no hypo or hyperglycemic episodes), and effectiveness of interventions.

Two disciplines that are a very important part of the healthcare team for Mrs. MH are physical therapy and social services. Physical therapy is crucial for the rehabilitation of the patient given that mobility has been impaired by the non-healing wound on her foot. Social services are also a very important part of the care given that her support systems are very limited.

The current plan of care of Mrs. MH is adequate given that all her health needs are being addressed and interventions are being implemented to assist those needs. These needs being related to wound care, diabetes self-management and patient education related to nutrition and insulin treatment, and safety amongst the home environment. Support Systems

“Support systems include people, groups, and organizations with which one associates in order to accomplish goals or to achieve some purpose” (Roy & Andrews, 1999, p.476). Upon assessment of the support systems available to Mrs. MH it was identified that she has very limited resources. She reported having a son who visits her once a week and does the grocery shopping for her. However the patient stated “He is a very busy man and he does what he can for me, but he can’t always be there”. Besides her son she did not identified any other source of support such as belonging to a church or having any friends. She expressed “Sometimes a neighbor would come by for minute to say hello, but otherwise I don’t socialize very much”. The patient also reported being a widower for four years now.

Steps which could be considered in augmenting the support resources for Mrs. MH are encouraging participation in senior activities within the community, and perhaps searching...

References: AmericanNurses Association, (2003). Scope and Standards of Diabetes Nursing Practice.
Maryland: Nurses Books
Bellenir, K. (1999). Diabetes Sourcebook. Michigan: Omnigraphics Inc.
Lewis, S., Heitkemper, M., Dirksen, S., O’Brien, P., Bucher, L. (2007). Medical Surgical
Nursing: Assessment and Management of Clinical Problems. Missouri: Mosby Elsevier.
Roy , C. & Andrews, H. (1999). Roy Adaptation Model. Connecticut: Appleton & Lange.
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