Case Study Report : Co-morbidities - Nursing Assessment

Nursing Case Study Assignment

Case Scenario/ Task

The written assessment tasks for this subject require you to submit a Case Study Report in which you explore the potential impact of chronic and complex conditions on the patient.

In addition to a brief introduction and conclusion, PART A of your report should include:

• • A discussion of the pathophysiology and related clinical manifestations of EACH diagnosed chronic illnessthat the patient is presenting with in the case study
  • A discussion of the chronicity and complexity of the patient's condition, including the identification of two (2) possible interactions between the patient's co-morbidities and a discussion of how these conditions will impact the patient and her family. You will need to consider the pathophysiology, clinical manifestations and the medication the patient is taking in this part of the report.

Introduction

Australia is the country, which highly culturally and linguistically diverse. Though this diversity brings many positive changes to the society, by increasing the societal richness, but it also brings barriers among good health. There have been many Italian immigrants in Australia, who have been living there since many years. It has also been noticed that prevalence of type 2 diabetes is very high in Italian migrants.

Paper reviews the case study of Luigi, who is a 77 year old Italian man, living in Australia since 40 years. Luigi suffers from type 2 diabetes. This paper will present the Pathophysiology of the chronic condition in the case of Luigi. The paper also aims to present the co-morbidity, Chronicity and Complexity of the conditions associated with the patient. Diabetes would reach the epidemic proposition in the coming future. Some research studies have shown that the incidences of the type 2 diabetes have increased in the Italian migrants of Australia.

In comparison to Australian born people, Italian migrants are more prone to this illness. Many factors are responsible for this, such as immigration factors, genetic factors, socio-culture factors and also socio-economic factors. Type 2 diabetes and other chronic illness are due to the changed physical activities and eating habits of these people (Chen, Magliano, & Zimmet, 2012). Thus, paper will focus on understanding the Pathophysiology of the chronic condition and complexity of the co-morbidities associated with the health of Luigi

Pathophysiology of Type 2 Diabetes

Many research studies have shown that type 2 diabetes is more prevalent in the overseas-born people than Australian-born. The culturally and linguistically diverse groups also display some other risks including diabetes, such as, obesity, cardiovascular diseases, high blood pressure and ageing. The health related issues of the migrants are increased due to factors like, immigration, genetic factors, socio cultural and socio economic factors. Luigi, who is a retired 77 year old Italian-Australian is suffering from Type 2 diabetes. This type of diabetes is called as non-insulin dependent diabetes. This kind of diabetes was historically found in the middle aged or older people. But, this disease could also be found in young adults and children. This type of diabetes does not require insulin for survival (Colagiuri et al, 2015, p. 8).

Diabetes is considered as a group of metabolic disorders, which is differentiated by the condition of chronic hyperglycemic that results in insufficient action of the insulin. It is also associated with abnormalities in fat metabolism and carbohydrate. The factors involved in causing the disease are both genetic as well as environmental. The main pathophysiological factor associated with Type 2 diabetes is increased insulin resistance and decreased secretion of insulin. The factors responsible for causing this disease also affect the beta cell function and tissue (liver, muscle, pancreas, and adipose tissue). Mainly the pancreatic beta cell display progression over time. Though there has been a debate over the reduced insulin sensitivity and beta cell dysfunction, still it is the generally accepted Pathophysiology accepted for diabetes. It is also accepted that both of these reasons play very important role in causing the disease.

The Pathophysiology of type 2 diabetes involves genetic as well environmental factors. In the genetic factors, the involved pathogenesis to be involved is genetic abnormality of the molecules, which are related to regulatory system of the glucose metabolism. The genetic abnormalities are found in the “glucose-stimulated insulin secretion of pancreatic cells and the molecules comprising the molecular mechanism for insulin action” (Kohei, 2010). The environmental factors involve obesity, insufficient consumption of energy, drinking alcohol and smoking.

Obesity

According to the study of Kohei (2010), “Type 2 diabetes is caused by a combination of genetic factors related to impaired insulin secretion and insulin resistance and environmental factors such as obesity, overeating, lack of exercise, and stress, as well as aging” (p. 41). It is thus, a multifactorial disorder, which involves varied environmental factors as well as multiple genes. Development of the Type 2 diabetes is mainly associated with genetic factors. The most important environmental factor is obesity. Due to lack of the physical activities and exercises, the muscle mass decreases, this on the other hand induces insulin resistance. Such clinical manifestation is mainly seen in the middle aged and older people. In the case of Luigi, he has been over weight, and do not pay attention towards his diet and sugar intake. His diet is changed; particularly intake of the fat is increased, he might also consume more of the simple sugar and reduced the dietary fiber in his diet (Brooks, 2013). All these factors contribute to obesity and decrease in the glucose tolerance. According to a study, “even mild obesity (BMI 25) can cause a 4- to 5-fold increase in the risk of developing diabetes, if it is accompanied by the increase in visceral fat mass” (Kohei, 2010, p. 42). Majority of the patients suffering from diabetes. The pathophysiological conditions associated with Type 2 diabetes are impaired insulin secretion and insulin resistance.

Chronic Kidney Disease

According to the current medical reports of Luigi, he has been diagnosed with Chronic renal failure, which is a kidney disease. Diabetes is also associated with the kidney problems, as the high level of glucose can damage the blood-filtering capillaries of the kidney. This result in the condition called as diabetic nephropathy. The manifestations of the diabetic kidney disorder range from “asymptomatic leakage of protein into the urine (microalbuminuria, macroalbuminuria and proteinuria) to end-stage kidney disease, which requires treatment with kidney dialysis or a kidney transplant” (Lin et al, 2015, p. 20). Thus, reason of protein and glucose in the urine of Luigi is this disease. According to the reports, 16% of the adult Australians population has displayed the evidences of kidney damage (failure), where the function of kidney is reduced and protein is passed through urine. Diabetes is related to co-morbidity of the chronic dysfunctions.

Eye Diseases

Diabetic retinopathy is the complication of microvascular tissue. Due to diabetes capillaries of retina are damaged and cause eye sight problems. The individuals suffering from diabetes are also exposed to higher risk of eye diseases. The prevalence of this kind of eye disease is higher in the people diagnosed with Type 2 diabetes (Ruta et al, 2013, p. 389). Some of the eye diseases related to diabetes is diabetic retinopathy, glaucoma, and cataract. These are the major manifestation associated with the vision impairment and blurred vision. In the case of Luigi, any of such eye disease caused due to changes in the glucose level, could be the reason behind his blurred vision.

Peripheral neuropathy

Peripheral neuropathy is the manifestation of the peripheral nerve dysfunction. This is seen in the people suffering from diabetes. This condition is responsible in causing the damage to the nerves of feet, legs and toes. Peripheral neuropathy is of two types: Sensory neuropathy and Motor neuropathy. In the case of Luigi, motor neuropathy is associated with his condition. In this diseases the nerves are affected, which carry the signals to the muscles to move. It leads to loss of control over the movement. Motor neuropathy thus leads to unexplained ankle oedema (General practice management of type 2 diabetes, 2014).

Co-Morbidity In the Case of Type 2 Diabetes

Co-morbidity is the existence of the disorders or the diseases that co-occur with the primary disease. The primary problem of diabetes is associated with co-morbidities. Co-morbidity or multi morbidity can have severe effect on the patient’s physical, balancing and self care abilities. For the high quality management of the diabetes, the co-existing physical conditions and complex disorder cannot be avoided. The socio-economic status of the patients, as well as age is also associated with these factors (Gray, Davies, & Khunti, 2014, p. 120).

Diabetes is associated with at least one co-morbidity disorder. These co-morbidities may not be related to diabetes, but their treatment is very important for glycaemic control. In the case of Luigi, the co-morbidities are chronic renal failure, motor neuropathy, eye disease and obesity. He is the patient of Type 2 Diabetes, and co-morbidities associated with his condition can lead to complete physical disability or cognitive impairment. Most common co-morbidities associated with Type 2 Diabetes are painful conditions (acute as well as chronic), which in the case of Luigi is the motor neuropathy; Renal impairment (present in Luigi as chronic renal disease); being over-weight or obesity; and many macrovascular diseases (Gray, Davies, & Khunti, 2014, p. 122).

Chronicity and Complexity

Chronicity is the term that refers to the condition of continuous and consistent illness. Diabetes is a chronic disease, which requires regular care (Upshur, & Tracy, 2008, p. 1655). Diabetes is a chronic and progressive problem that requires proper management. Prevention from the chronic disease is not yet found, but such patients need social, psychological, and emotional support from the care givers. Luigi is the patient of type 2 diabetes, which is chronic and progressive disease. With his uncontrollable eating habits, his condition is becoming more complex day by day.

The complexity of the type 2 diabetes is associated with the medical complications arising with co-morbidities. The patient of Type 2 diabetes takes multiple medications in order to control the co-morbidities. Multiple drug therapy creates complexity for the patient (Upshur, & Tracy, 2008, p. 1655). Type 2 diabetes in case of Luigi also includes the complex set of co-morbidities. The care of the patient also becomes complex, as more time is required for evaluation the conditions and treating them.

Impact of Chronic and Complex Conditions

In taking care of the older patients, it is important to focus on the complexities of the co-morbidities, I stead of just focusing on the primary disease. The chronic kidney disease requires attention as it increases the complexity of diabetes in the patient. Chronic renal failure in Luigi is associated with high level of glucose, high blood pressure and body mass (Colagiuri et al, 2015, p. 9). Uncontrolled Type 2 diabetes also leads to eye disorder. The patient could also lose the complete eye sight. The other complexity with the patient’s condition is that clinical practice guidelines may conflict with each other with one primary disease or with the co-morbidities. In the management of the chronic diseases such as Type 2 diabetes, it involves curative as well as preventive elements, thus complexity increases while treating single chronic disease- Type 2 diabetes or chronic renal failure (as in the case of Luigi).

It becomes complex for the healthcare providers to treat two different chronic disorders at same time. The signs and symptoms of the multiple chronic diseases interact; and it becomes difficult to separate the effect of medication. When several diseases are present in the same patient; management of the patient’s health condition becomes more complex (Upshur, & Tracy, 2008, p. 1656). The complexity of the co-morbidities and primary disease is navigated to patient, healthcare providers and the patient’s family. The care management becomes more complex and the ability to adhere to the clinical guidelines reduces. This on the other hand increases the risk of iatrogenesis (Twigg, & Wong, 2015).

Luigi has been retired since many years, due to which his physical activity has been reduced. He was also not doing any significant exercises and his uncontrolled eating habits have increased the burden of disease on him as well as on his family. The complexity could also be increased due to motor neuropathy and excess glucose. This could also lead to amputation of the feet, which will impact both patient as well as his family. According to the study of Lin et al (2015), “Multiple chronic co-morbidities (MCCs) are an issue of growing significance in diabetes because they are highly prevalent and can increase disease burden and costs” (p. 23)

Conclusion

The paper presents the thorough study of the case study of Luigi. He is a 77 year old retired man, and patient of uncontrolled Type 2 diabetes. His medical condition includes co-morbidities that increase the complexity of his condition. Paper also reviewed the Pathophysiology of the chronic and complex conditions associated with Type 2 diabetes. The chronic renal failure is also due to uncontrolled Type 2 diabetes in case of Luigi.

There has been a significant limitation to the current management strategies of the chronic disease management. The current clinical model should look for the cures of the co-morbidities and should eliminate reversible cause. The primary disease and complex co-morbidities associated with it require self care. However, for Luigi it is difficult as he also suffers from motor neuropathy. Thus, the main burden is on his family to take care of him. He requires proper access to medical care. The advanced practicing nurses are ideal for playing the integral role of medical management for the diabetes patients. The quality of the care can be improved with enhanced clinical skills and knowledge. The nurses should understand that confluent morbidity resembles to the palliative medication. Patient centered care and applying the theory of concordance are important for treating the patients with diabetes.