Analysis of a Diabetic Patient, Research Paper Example

My clinical rotation was on a critical care unit. This is an RN-only unit, as the patients present with complex, multi-symptom diagnoses that require continual assessment and rapid action if the patient’s condition begins to deteriorate.  The patient on this unit upon whom I chose to do the SWOT analysis was middle-aged diabetic married male who, due to an unresolved foot injury, who was slated to undergoa below-the-knee amputation of his right leg and during the course of his stay was transferred from Unit 44 then back to this unit. Education and thorough discharge planning is especially important for this kind of patient, as studies have shown that in helping diabetics cope with their condition, the discharge nurse’s role should be multi-disciplinary, an encompass “health, community education, health systems management, patient care and improving quality of life” (Aalaa, 2012, p. 551). In other words, even if a patient’s education level about diabetes improves, it is not likely to translate into actually lifestyle choices without continued support. Because the discharge process on such a patient involves a number of issues, this sort of analysis enables the nurse to see the patient holistically and to anticipate patient and family needs upon discharge.

The Strengths

One of the main strengths of this particular patient wasthe good social support that he enjoyed. His wife had been his primary caregiver for the past four years now and often visits the unit to see him. He also had three grown children – one in Calgary, one in Nova Scotia and one in Newfoundland – who call frequently to keep in touch with their father.  Good family support is necessary for diabetes management, and this patient has that.  He will also need this support has he deals with any emotional issues which result from the lifestyle changes subsequent to an amputation, especially in regards to loss of function and independence. Also, patient is on Assured Income for the Severely Handicapped, so employment issues after the amputation will not be a problem.

The Weaknesses

One of the main weaknesses I see with this patient is the fact that he continued to smoke had, as yet, not expressed in interest in quitting. Smoking increasing the risk of complications from diabetes and slows wound healing, so this is particularly of concern since he will be undergoing amputation of his right leg and wound healing will have to be promoted (American Diabetes Association, 2014, p. 1). That said, however, it is always important to prioritize medical care and in the case of this patient, foot care is definitely the priority: the most common cause of diabetic admission to the hospital is, as is the case with this patient, related to foot problems such as infection or gangrene and even after amputation, there is a nearly 50% risk for re-amputation within 2 years of the original surgery (Aala, 2012, p. 553) and in this instance, that priority is clearly good foot care and post-surgical aftercare.  This segues into the next weakness I anticipate, which is the potential for postoperative complications for wound infection and failure to heal.  As this patient had already presented with issues of poor wound healing in the past, it is likely he has diabetic neuropathy and poor peripheral circulation which make him more vulnerable.

The Opportunities

Opportunities for education of the patient and family abound. Clearly, the top priority would be a thorough course in diabetic foot care and educating the patient and spouse extensively on postoperative incision care. Researchers have noted that this education aims to “reduce the risk of re-ulceration and infection after hospital discharge to the home, a rehabilitation unit or a long-term care facility” (Wukich, 2013, p.862) and that, since the patient has been admitted for foot issues to begin with, that this constitutes a “teachable moment.” I think it is good to emphasize to the patient that nearly 85% of further foot problems are preventable with appropriate care and education (Aala, 2012, p. 556).  I would also implement a basic education on the disease process itself, as well as day-to-day management issues including a diabetic diet, blood glucose monitoring and insulin administration.   This would include keep clean technique for wound treatment and also recognizing and reporting signs and symptoms of potential infection in the wound.

The Threats

One of the biggest threats to this patient upon his return to the home environment was economic. Due to the fact that he is having to be on AISH, there are financial constraints in the household that could possibly effect the quality of care which the patient receives after discharge. Consultation with the hospital social worker to set patient and family up with community resources would be an excellent way to help with the constraints.  The easing of these financial constraints would most likely have a positive effect on compliance with a healthy diet, and the regular use of medications, glucometer and related diabetic supplies, since economic hardship can be an enormous barrier to ongoing diabetic care. It will also help to ease some of the worry being experienced by the patient and his wife, and the easing of this situation should allow them to focus their energies on the adjustments that will have to be made after the amputation.

Conclusion

Discharge planning for a patient with complex medical problems is, in itself, a complicated matter.  However, looking at the patient and their family holistically and considering patient needs from a physical, emotional, and environmental viewpoint can go a long way to the formation of a discharge plan which will support the patient in the healing process and improve outcomes.

References

Aalaa, M. et. al. (2012). “Nurse’s Role in Diabetic Foot Prevention and Care: a Review”. Journal of Diabetes and Metabolic Disorders. 11(24) 231-259

“Living with Diabetes” American Diabetes Association.  2014. Web. 11 June 2014.

Wukich, D. (2013).  “Inpatient Management of Diabetic Food Disorders”.  Diabetes Care.  36(9) 862-871. Print