Adult Health Promotion, Case Study Example

Concept Map

The patient is a 46 year old married male of Hawaiian/Chinese decent. He is commented to be a reliable historian. His current complaints include pain in his heart as well as his legs. Presently, the patient states that he had no problems with any pain until around a month before his physical exam when he noticed he would develop a swelling at the legs if he remained seated for long periods of time. The swelling of the legs stops after a while of elevating his legs. Additionally, he also feels that he is weaker than normal, getting more tired that often. The patient’s history includes the usual childhood illnesses. Also, he has been diagnosed with Diabetes Type 2, during the age of 38 years old, and this is poorly controlled. He claims to maintain a diet and in takes Metformin ER 1,000mg extended release tablet qd with evening meal. The patient also has HTN which he takes Diltiazem 60mg BID and 25 mg BID for. The patient takes multivitamins every day. He also was told that he has a heart murmur years back which was noted during a physical exam for him to participate in sports. The patient claims he has no food or drug allergies.

Family History and Physical Check up    

The patient has no history of any respiratory, renal, endocrine, or neurologic or psychiatric disorders. There is family history on his HTN and Diabetes type 2, which is found on the maternal side. His mother is still alive and is presently living with his family, his father is deceased and the cause of death is unknown. The patient lives in Hawaii on a half-acre of coffee land in Miloli’I with his wife, mother two daughters, one grandson. His mother lives with them because her husband had recently just passed away. Their family has also assumed care for a 5 year old hanai son. The family make their living on a small farm which consists of a few animals. The patient works all day on his farm and assumes a night shift at the airport. He comes home tired and elevates his legs after a long day’s work. He worries that he needs to work more as the primary wage-earner for his family.

The patient claims he has no history of illicit drug use, he drinks one or two beers during the weekends, two cups of coffee ever morning and smokes one pack of cigarettes a day; this habit has been going on for the past thirty years. He enjoys eating local food and does not follow a strict diet for his diabetes because he claims that he has to purchase food from work.

The patient considers himself to be in good health, and does not believe that his diabetes or his smoking habits are a problem. He weighs 212 lbs and is 5’6” in height. He eats three meals a day and claims to restrict sugar in his diet, however he does not follow any food pyramid or ADA diet plans. He claims that the cuts on his legs do take a while to heal. He experiences general body weaknesses, but no specific muscle or joint pains. He wears reading glasses and denies any blurring in his vision, diplopia, photophobia, glaucoma, discharge or trauma. However, the patient has not had an eye exam in a long time. He claims that he has no hearing loss, the patient occasionally gets sinus congestion when the fog gets really bad. The patient claims that he does not have any chest pains or palpitations. However, over the past month, he has decreased tolerance in exercise. He only takes his medication for HTN when he remembers, and his feet get swollen when he consumes foods which are high in sodium. He has had a heart murmur since childhood.

Focus area

With the patient’s medical history, there are three areas of concern which should be studied deeper. The patient is of Hawaiian decent, and according to Diabetes.org (2010) Native Hawaiians have a higher risk in developing Diabetes Type 2. He has a family history of Diabetes type 2, HTN as well as a heart murmur. The patient complains of feeling tired and weaker than usual, and he also has been experiencing the swelling of his legs. Additionally, he has not had an eye check up in a while, and may not have noticed any slight changes in vision; this pertaining to his diabetes (Campbell & White, 2006). The patient also states that he has noticed that sores and cuts on his feet do take quite some time to heal. The patient is a regular smoker and does not keep a strict diet according to his diabetes, he eats a lot of local food, which is known to be high in sodium as well as in glucose; this may account for the swelling in his legs. Also, the patient’s stress is at a high, feeling that he needs to provide for his large family by working two jobs. He does not get to rest, and it can be assumed that he does not take the time in taking care of his own health. Being the only male old enough to work in the household, he has taken on the role of being the provider to an extreme, this may account for his tiredness as well.

The focus areas which are of high concern to the patient are the following:

1. Health behaviors: the individual should assume a healthier lifestyle and follow a strict eating habit for his diabetes, possibly cut-down or even quit smoking
2. Health Care Knowledge: because of the patient’s family history, he needs to monitor his illnesses
3. Stimulation: the patient needs to be motivated in keeping his habits healthy, this can be done in the form of a social group or a support group; this may also alleviate his stress at work

Implementation Plan

This two week teaching plan is aimed to educate the patient which is aimed at promoting health with a stable blood sugar. The patient is aware that he has diabetes type 2, however he does not seem to know the implications of the disease, and needs to be have better awareness for it so that he can take action in his own hands. By strictly following this teaching plan, we hope to achieve the patients understanding for her need for a comprehensive treatment approach – an education towards diabetes, a regulated diet and lifestyle changes as well as long-term and short term goals for her condition.

The teaching plan is designed to educate patients who need to know more about their diabetes. It explains the patients need for ongoing management towards treatment and lifestyle by over viewing the general concepts of diabetes.

1. Week 1
2. Day 1- General overview: What is diabetes type 2? (1-1.5 hours)
3. Day 2 – Blood glucose monitoring (1 hour)
4. Day 3 – Blood glucose levels (1.5 hours)
5. Day 4 – Treatment : Pills vs. Insulin (2 hours)
6. Day 5 – Possible complications (2 hours)
7. Day 6 – Skin and foot care (1 hour)
8. Day 7 – Exercise (1.5 hours)
9. Week 2
10. Day 1 – Diet (1 hour)
11. Day 2 – Diet (1 hour)
12. Day 3 – Coping with diabetes emotionally (2 hours)
13. Day 4 – Lifestyle changes (1 hour)
14. Day 5 – Genetics of Diabetes (1 – 2 hours)
15. Day 6 – Questions and answers (1 – 2 hours)
16. Day 7 – Review general concepts (2 hours)

The patient’s short term goal is to learn more about his diabetes type 2; this should take him about two weeks. His long term goal is to adjust his diet and incorporate exercise in his routine as much as possible (“Type 2 diabetes and exercise”, 2010). He needs to understand that his diabetes should be taken seriously, and that he may suffer complications in the near future, as he is already showing signs of it with his complaints. He should learn more about monitoring his blood sugar, and the first change which is needed is to know more about his diabetes (“Monitoring your blood sugar”, 2008)

Evaluation

The patient will be monitored weekly, checking if he has any improvements in his weight, also in his blood sugar level. His feet will be checked regularly for any sores, also his eyes will be examined to determine if there is any blurring.

Reflection

I believe that this exercise has led me to learn more about diabetes type 2 and its implications. It is the main area of concern with the patient and needed to be focused on; the patient did not seem to take this illness very seriously. Next time, I would probably learn more about the patient’s background sociologically, this seems to have many implications in one’s health and eating habits; I believe that this is the genesis of the problem with this particular patient.

References

Campbell, R.K., & White, J.R. (2006). Insulin in type 2 diabetes. Journal of the American Pharmacists Association, 42(4),

Monitoring your blood sugar. (2008). Retrieved from http://www.health.com/health/condition-article/0,,20188369,00.html

Type 2. (2010). Retrieved from http://www.diabetes.org/diabetes-basics/type-2/

Type 2 diabetes and exercise. (2010). Retrieved from http://diabetes.webmd.com/guide/exercise-guidelines