Hypoglycaemia In Elderly Patients Essay

Question:

Discuss the Case Study of Patient Ann Lenska.

Answer:

Introduction

The essay provides an overview of hypoglycaemia case study. Hypoglycaemia is characterised by low glucose level in the body. Care management is important in ensuring that there is normal regulation of the blood glucose in the body. Hence the application of self management process and utilization of education strategies for managing and coping with the condition is essential. The essay provides a preview of a case study of hypoglycaemia patient and the role of education practices in minimising on the potential health risks associated.

Patient Overview

This is a case study of patient Ann Lenska, a 68 year old woman suffering right lower leg ulcer. Her previous condition indicates that she has been having history of hypertension and type II diabetes which needs management of oral hypoglycaemia. Patient Ann lives alone and often relies on her neighbour to keep her company and to shop for her needs. Her state of health is improving as her right leg ulcer has been dressed twice by the community nurse.

The patient has not been taking her meals well since her neighbour left. The state of living she is, is not conducive and she has been wearing torn shoes. Her medical condition is not positive; her medical history shows that she often forgets to take her medications.

During nursing visit the patient is not feeling well as the nurse comes to see her at home. At this stage the visiting nurse offers therapeutic management for hypoglycaemia and her state of health normalizes which eventually leads to her blood sugar level improving to 6.2 mmol/L. Currently her vital signs indicate that, her temperature is 36.5 degrees Celsius, her blood pressure is 160/90 mmHg, while her pulse is 84 beats /min while her respiratory rate is stable. She is taking Metformin at 1g PO daily and Metoprolol at 25 mg.

Potential Health Concerns

Diabetes has proved to be a serious medical condition which affects majority of the population. It requires continuous attention for self care management among the patients. Hypoglycaemia is a disease that requires prompt attention and recognition and treatment to avert organ and brain damage. Potential health concerns which are obtained from this case study are the;

Occurrence of Vascular disease

Potential health outcome which can be encountered by the patient is acute vascular event which can be angina, myocardial infarction and the cerebral vascular diseases, (Shafiee et al., 2012). With this occurrence there increased risks associated with death and other complications aligned in the micro vascular. Studies have attributed episodes of hypoglycaemia and vascular occurrence. And further repeated episodes of the hypoglycaemia in this patient can promote macro vascular disease and accelerate the risks of atherosclerosis as supported by the studies, (Adler et al., 2009). The sypatho adrenal stimulation in this patient can have an effect on the release of hypoglycaemia which causes hemodynamic changes which involves activation of the white blood cell and inflammation of mediators and cytokines. Patient Ann could experience changes in the blood flow, with localized vasoconstriction, which leads to increase risks of intravascular coagulation and damage to the endothelial cells.

Chronic hypoglycaemia for the patient could be a driver atherosclerosis with recurrent exposure contributing to aggravating micro and macro vascular complications later, (Desouza et al., 2010). Further extreme hypoglycaemia could trigger sudden death for this patient through the action of inducing ischemic and electrocardiographic changes which predisposes the patient to state of ventricular arrhythmias.

Hypoglycaemia causing brain damage

Evidence based practice has linked hypoglycaemia with brain damage. Prolonged exposure to severe hypoglycaemia could have clinical factors which affect could affect cognition later in the years. Development of hypoglycaemia early in life increases the risks of neuro dys function neuro cognitive score for this patent. The metabolic changes which are linked to diabetes have an impact on the brain effects which lead to increased dementia and other related conditions. Thus this prolong occurrence of the diabetes may be a recipe for brain dysfunction later in the years.

Studies have shown that severe hypoglycaemia can have an impact on the on the cortex and hippocampus of the damage regions which are closely related to seizure activities, (Alagiakrishnana & Mereu et al., 2010). Further to expound is that the exposure of the patient not taking meals correctly, could lead to acute interruption of the glucose supply which can be a factor in brain failure.

Thus brain damage is serious cause for this patient; as it can aggravate sever neuro cognitive dysfunction of the brain. Further apart from increasing the risks for dementia, sever hypoglycaemia could cause cerebrallar ataxia, (Cryer, 2007).

Patient Education Topics

This education management will be facilitated to the patient so as to minimise the consequences and to enhance the patient preventive ability. Evidence has linked blood glucose awareness training for the patient and behavioural therapy is essential for health and attitude change. There is need for this patient to achieve glycaemia control so as to provide care to herself.

Blood glucose monitoring

Teaching this patient on regular measurement of blood is the most essential and effective way of ensuring that the patient identify the asymptomatic symptoms. As much as it is commonly proffered for patient with type diabetes management, type II diabetes patients have found treatment with insulin as beneficial in ensuring regular monitoring and prevention of self management for hypoglycaemia.

As per recommended standards of care according to ADA, 2013, they recommend that self monitoring blood glucose be done at least 6-8 times per day for patients with multiple injections of insulin/ blood glucose monitoring can be implemented periodically or through the use of glucose monitoring, (Alberti et al., 2007).

Teaching the patients how to conduct self monitoring blood glucose can be beneficial in ensuring that that appropriate insulin management is addressed. Glucose monitoring also provides real time notification and alerts for changes in blood glucose values of the patient. Regular monitoring of blood glucose is effective in monitoring trends and identifying asymptomatic symptoms. This can be affected through periodic monitoring of the blood glucose levels so as to minimise risks associated with diabetes.

Diabetes self management

This aspect of patient education is aimed at empowering the patient on the basics of diabetes care, which is linked to health outcomes, (Norris et al., 2012). Studies done have shown having diabetes self management for education results in behaviour change for these patients. A patient with well informed knowledge of symptoms always know the risks associated with risks of hypoglycaemia, prevention and the course of treatment it takes. The need for education this patient for self care process is essential in ensuring that she manages her diabetic condition effectively.

With diabetes self management this patient will understand the importance of knowing her history, episodes experienced so that treatment care can be aligned effectively. These regimes include activities like basal bolus insulin, which use day time hypoglycaemia. Achieving glycaemia control for this patient through self management approach is key towards providing optimum care for the patient, (Boutati et al., 2009). Thus empowering the patient on early identification of symptom and the appropriate interventions measures is key towards ensuring good management of diabetes, (Khamseh et al., 2010).

Education Strategies

Practical learning sessions for the blood glucose monitoring

Blood glucose is the glucose levels in the blood which if often expressed by mill moles per litre. Blood monitoring is utilised to indicate if the blood glucose levels is within range of 4-7mmol/L. This monitoring is essential in ensuring that monitoring and managing of insulin is conducted swiftly.

Conduct of the training

For this activity or learning session to take place there is need to educate to educate the patient on how she can be able to monitor the blood glucose by herself and take appropriate steps of self management. As a nurse there is need to train this patient on how to do blood glucose monitoring by herself.

Blood glucose monitoring equipment

There is need for acquiring new tool for measuring and assessing the patient state. The equipment should be safe and easy to use while the patient is at home

Information guides

There is need to develop information guides, which gives basic and clear instructions on how to perform the tests at home. The pamphlet information guide is meant to ensure that information should be relevance and simple for the patient to understand.

The information guides contains a step wise criteria and guideline son how to conduct the test. There is need to give the patient blood glucose monitoring book for recording of the reading s regularly upon checking this will assist the patent on knowing when to call for help.

Education strategies on diabetes self management

There is need for educating the patient on how to manage hypoglycaemia condition though avenues of insulin therapy. The insulin therapy for this patient will involve the long acting basal insulin which usually mimics the 24 hour insulin secretion in the pancreas. Thus this will be offered through offering and training the patient on when to use the insulin therapy for management care.

There is need for a structured education model for these patients is evidence based and suits the need for the patient; it has specific aims which are to ensure that the patient achieve good levels of hypoglycaemia. The aims and objectives established should be to meet the person’s attitudes and beliefs and building on adequate knowledge for self management. Further the education should theory driven lest say on a behaviour change theory which is evidence based and resourceful effective and be supported by the available resources for the patient, (Barink et al., 2012).

Justification of the Strategies Used

The effect of benefits of conducting self management and blood glucose monitoring is meant to improve the knowledge of the patient on health beliefs and improve on her lifestyle behaviour towards effective care for the disease. appropriate education strategies improves patient outcomes in terms of weight management, haemoglobin levels and other psycho local changes like quality of life and level of depression which might arise from loneliness which the patients lives currently.

This education management is geared to increase in knowledge and confidence level which leads of informed decisions with regard to self management of diabetes. Research on such trainings such as X-PERT Program among adults with type II diabetes has shown that self management is essential in ensuring that there is improved glycemic control, there is improved intake of food such as consumption of fruits and vegetables and increased enjoyment of foods and improved knowledge of self empowerment and self management with great skills which offers care for hypoglycaemia., (Deakin et al., 2006).

Research by Zareban et al., (2014), has shown that there are positive results of self care for diabetes glycaemia control. Diabetes being a lifelong diseases, it needs behaviour change behaviours which can be realize through self care management and education approaches. The impact of training to such patients has shown that self care programs are significant in ensuring that patients change their behaviour which translates to better care and minimising other complications associated with the disease.

Intervention education is essential in controlling blood sugar. Education component is key towards improving these management levels for this patient. Thus training based participation with the patients is key in ensuring that diabetes self care is achieved. Research done has shown training activities are essential in ensuring that behaviour patterns is crucial in ensuring that diabetes complications and mortality associated with the disease is minimised.

Conclusion

Thus self training is key in reducing and minimising the associated health risks of developing cardiovascular disease and brain state due to low levels of sugar in the blood. With effective health education on blood glucose and self monitoring aspects in disease management, these potential risks for the patient could be minimised. Self care is important in ensuring knowledge, attitude and self care importance which improves the glucose levels at all times. Involving the patient in these education strategies is geared towards health state of the disease.

References

Adler, G. K., Bonyhay, I., Failing, H., Waring, E., Dotson, S., & Freeman, R. (2009). Antecedent hypoglycemia impairs autonomic cardiovascular function. Diabetes, 58(2), 360-366.

Alagiakrishnan, K., & Mereu, L. (2010). Approach to managing hypoglycemia in elderly patients with diabetes. Postgraduate medicine, 122(3), 129-137.

Alberti, K. G. M. M., Zimmet, P., & Shaw, J. (2007). International Diabetes Federation: a consensus on Type 2 diabetes prevention. Diabetic Medicine, 24(5), 451-463

Boutati, E. I., & Raptis, S. A. (2009). Self-monitoring of blood glucose as part of the integral care of type 2 diabetes. Diabetes Care, 32(suppl 2), S205-S210.

Brink, S. J., Miller, M., & Moltz, K. C. (2012). Education and multidisciplinary team care concepts for pediatric and adolescent diabetes mellitus. Journal of Pediatric Endocrinology and Metabolism, 15(8), 1113-1130.

Cryer, P. E. (2007). Hypoglycemia, functional brain failure, and brain death. Journal of Clinical Investigation, 117(4), 868.

Deakin, T. A., Cade, J. E., Williams, R., & Greenwood, D. C. (2006). Structured patient education: the Diabetes X?PERT Programme makes a difference. Diabetic Medicine, 23(9), 944-954.

Desouza CV, Bolli GB, Fonseca V. Hypoglycemia, diabetes, and cardiovascular events. Diabetes Care. 2010;33:1389–94.

Khamseh, M. E., Ansari, M., Malek, M., Shafiee, G., & Baradaran, H. (2011). Effects of a structured self-monitoring of blood glucose method on patient self-management behavior and metabolic outcomes in type 2 diabetes mellitus. Journal of diabetes science and technology, 5(2), 388-393.

Norris, S. L., Lau, J., Smith, S. J., Schmid, C. H., & Engelgau, M. M. (2012). Self-management education for adults with type 2 diabetes. Diabetes care, 25(7), 1159-1171.

Shafiee, G., Mohajeri-Tehrani, M., Pajouhi, M., & Larijani, B. (2012). The importance of hypoglycemia in diabetic patients. Journal of diabetes & Metabolic disorders, 11(1), 17.

Zareban, I., Karimy, M., Niknami, S., Haidarnia, A., & Rakhshani, F. (2014). The effect of self-care education program on reducing HbA1c levels in patients with type 2 diabetes. Journal of education and health promotion, 3.

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