Nursing Management for Chronic Diabetes


NursingManagement for Chronic Diabetes

August12, 2014.

Diabetesis a serious chronic disease that results from lack of enough insulinin the body. Type 2 diabetes has been found to affect people abovethirty five years who have an intellectual disability problemalthough the prevalence rate is low. Diabetes leads to long-termailments that sometimes predispose the patient to healthcomplications in their lifespan. Patients with diabetes andintellectual disability are faced with serious self-care managementproblems and require assistance to enable them effectively engage intheir daily activities. The goal of effective care management fordiabetic patients with intellectual disability should be promotingself-care management and reduce the burden of ailment from thepatient. Patients with diabetes and with intellectual disabilitiesare incapable of self-care management. As such, they need anappropriate healthcare approach that involves the support of theircommunity, family members and the healthcare providers. The followingis a report based on a nursing management of a patient with moderateintellectual disability and chronic type 2 diabetic.

Healthchallenges of the man across his lifespan

Managementof type 2 diabetes requires adopting a change in lifestyle and copingwith psychological and medical condition of the disease. This meansthat, a diabetic patient with intellectual disability face greatchallenges in managing their condition. In particular, diabetesmanagement requires adequate knowledge about the disease, medicationand routine lifestyle change. This may be a challenge forintellectual disabled man as he cannot learn or make individualchoices on engagement activities to participate in. Patient withdiabetes require information on food intake and their general healthcondition and this may not be possible to the moderately disabledman. In this case, the man will depend on the support of care membersin his life span (Stucki,Reinhardt, Grimby&amp Melvin, 2007).

Potentialimpact of health challenges on the health and wellbeing of the man

Extremecases of type 2 diabetes lead to disability and inactivity that arisefrom injured and disabled limbs and this makes patients less activeand interactive in their social life (Shaw&amp Chisholm, 2003).In some cases, the patient might suffer from extreme depressions anddementia if nobody is around to give them social and psychologicalsupport. In addition, the patients hygiene deteriorates as they areunable to wash and bath unless with some assistance (Tuomilehto,Lindstrom, Eriksson, 2001).In general, the patient the quality of life is greatly affected asthey face stress, depression, coping and other personality disordersif social support from their significant others is lacking.

ICFModel: how intellectual disability and diabetesaffect the patientactivity and participation in care management

Intellectualdisability and diabetes increase the complexity of care managementfor the patient. The man has a limitation in that he cannoteffectively participate in self-care management practice due to hisintellectual disability. It is difficult for him to learn importanthealth information on lifestyle changes, diet and exercises needed.In addition, due to his intellectual disability the victim becomesless reciprocative to assistive efforts from the community, familymembers and the health care givers. In this case, lack ofcommunication and mobility affects care given as individualsassisting the patient fail tounderstand the patient condition comprehensively.

Accordingto the ICF model, care management for such patients requires aconsideration of three levels of the patient in order to assess theright approach of assisting the patient (Hurst,2003).The first level is identifying the patient body functioning and thehealth of various parts. This is followed by designating the bodyfunctioning with patient’s condition. Lastly, it is important todesignate the functioning of the patient body with thesocial-environment(Lennox, Diggens &amp Ugoni, 1997).The man intellectual disability affects his participation inself-care management and learning from the social environment.Therefore, social, personal and environment factors need to beconsidered when planning the care intervention approach to assist him(Stucki,Reinhardt, Grimby &amp Melvin, 2007).According to the ICF framework of diabetes management for patientswith moderate intellectual disability, the focus should start withthe conceptualization of the care management approach effective forthe individual patient. This is followed by conducting an assessmentof the patient body functions and ability to adapt to theintervention strategy conceptualized(Hurst, 2003).

Intervention/strategyfor managing diabetes across the man lifespan

Inthe care management approach for the man with type 2 diabetes andmoderate intellectual disability, the most prevalent and effectivemode of intervention is facilitating his lifestyle change. Thisinvolves assisting the man in the choice of the right food andassisting him with regular exercises. Studies indicate that, type 2diabetics can be prevented or delayed through good nutrition andconstant exercises. Intensive body activity reduces diabetes healthrelated risks to a significant level. Empirical evidence on theimpact of dietary changes in alleviating the problem of type 2diabetes is relative. However, there exists reliable evidence that anabsolute change in lifestyle that includes diet changes and regularbody exercises reduces diabetes complications significantly(Williams, 2008).

Whenplanning for type 2 diabetes care management approach, an integratedapproach would be used in which case the patients family, thecommunity and the nurses are engaged (Stucki, Reinhardt, Grimby&ampMelvin, 2007). The aim is to get theirs collaboration in assistingthe man have good daily dietary intakes and exercises. Initially,with the support of the community the man would be assisted withhealthy diets that are aimed at checking sugar levels. A diet planwould be made and explained to the community health staff workers aswell as the family members. This would be followed with resistancetraining for the patient, the support staffs and the family members.The objective of this dietary strategy is to promote weight loss andbring down sugar levels (Lennox, Diggens &amp Ugoni, 1997).

Thedietary plan would reflect a medical plan in which different type offoods and daily nutritional intake would be drawn and explained tothe community support staff, the family and other care-givers. Thedietary plan would not be enough without daily body exercises thismeans the patient would be assisted in daily aerobic and resistanttraining in order to enhance greater glucose intake in the bodymuscles (Williams, 2008). Assisted aerobic and exercises trainingduration would be planned to match daily calorie intake. Inparticular, mild intensity exercises such as yoga, running and gymactivity would be encouraged. However, the support team and thecommunity would be encouraged to combine and use a variety ofexercises and diet to motivate the patient stick to therehabilitation plan. Lifestyle change that involve exercising andgood dietary intakes has previously proved positive in theimprovement of patient care management for type 2 diabetes (Stucki,Reinhardt, Grimby &amp Melvin, 2007).

Studiesindicate that, people with disability and chronic diseases needscommunity support as an important aspect in addressing the mainproblem. As such, in the care management of the type 2 diabeticpatient an all-inclusive approach will be encouraged in which thefamily members, friends and the general community members would beencouraged to interact and show love to the patient (Lennox, Diggens&amp Ugoni, 1997). The overall goal is to alleviate possible stress,depression and promote coping and adaptation to lifestyle change onthe patient. People who are close to the patient have a great impactin encouraging the patient to undertake the care management plangiven. Furthermore, the integration of the social and the environmentthrough diet and exercises encourages lifestyle change (Stucki,Reinhardt, Grimby&amp Melvin, 2007). The support of the communityand the professional care givers determines how fast the patientrecovers from their health conditions.

Researchstudies indicate that, severe complications of diabetes areexacerbated by the psychological condition of the patients (Williams,2008). In this light, patients with intellectual disability requireadequate social support as well as engaging them in dialogues. Thisis important as it make the patients feel loved, strengthen theircoping mechanism and increase their confidence (Stucki, Reinhardt,Grimby&amp Melvin, 2007). Furthermore, it is only through increasedinteractions that the patients build on their knowledge on theirhealth condition and what is expected. The man would become moreactive and effectively participate in his care management.Furthermore, interactions and social support will help the man regainhis confidence, positively influence his attitude and provide moreopportunity for learning and development (Lennox, Diggens &ampUgoni, 1997).


Theoverall goal of effective care management for diabetic patients withintellectual disability should be promoting self-care management andreduce the burden of ailment from the patient. Diabetesis a serious chronic ailment in the modern age that requires supportfrom the larger community in enhancing the patient rehabilitation andrecovery especially for patients with intellectual disability. Thecare managers, family members and the support staffs need to takeresponsibility of assisting the patient adapt, cope and understandthe care management approach given by a nurse. In particular, type 2diabetic care plan for a patient with intellectual disability needsto embrace an integrative approach in which a dietary and exerciseplan is taught to care-givers, support staffs and the individual.

Regularexercises and good dietary intake are the hallmark approaches thatlead to effective prevention and ‘cure’ of type 2 diabetes. Inthis case, despite the patient being intellectually disabled, throughan integrated approach and efforts of the community members thepatient could effectively be assisted with good nutritional intakeand daily exercises in alleviating his critical condition and improvehis well been. People who are close to the patient have a greatimpact in encouraging the patient to undertake the care managementplan given. Increased interactions that the patients build on theirknowledge on their health condition and what is expected. The manwould become more active and effectively participate in his caremanagement.Therefore, social, personal and environment factors need to beconsidered when planning the care intervention approach to assistingpatients with type 2 diabetes.


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