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The chronic illnesses and functional disabilities are health defects that are life long in terms of its effects or outcomes, therefore, presence of any functional disability along with the chronic conditions require a very critical management (Ogden, 2012). The occurrence of moderate intellectual disability due to Down’s syndrome along with chronic condition of Diabetes Mellitus type-2 in the case study patient (man 45years age) indicates his critical situation that requires a specific nursing management process.
As a community nurse, the present condition of this study patient is been analysed and his on-going management processes are examined to develop a specific intervention or strategy that will provide a lifelong management of his critical condition.
Reviewing the health challenges and their impact on health across man’s lifespan due to Down syndrome, moderate intellectual disability and Diabetes Mellitus type-2According to studies of Loane et al. (2013) the complications or health challenges of Down syndrome involves heart problems, leukaemia, infections, sleep apnea, obesity, thyroid, vision and hearing defects, sleep disorder and dementia. Heslop et al. (2014) indicated that Down’s syndrome being a genetic defect also possesses potential risk for attention deficit, behavioural disorder and autism-spectrum disorder, especially in young people. It was experimentally proven that defected immune system is a major health effect of Down’s syndrome which makes a person disposed to respiratory infections and leukaemia. This leukaemia can develop into any kind of cancer risking the life of vulnerable. Further, Loane et al. (2013) indicated that dementia after 50 years of age is another health hazard of Down’s syndrome that results in increased seizures and Alzheimer’s disease risk.
According to studies of Heslop et al. (2014) people with Down’s syndrome have a great tendency to develop obesity that harms their physical and mental health. Further, 80% of Down’s syndrome patient face lifelong hearing and vision loss. Bigby, Frawley & Ramcharan (2014) opine moderate intellectual disability being one of the health defects if Down’s syndrome also causes major health hazards. As the study patient is facing moderate intellectual disability he has a huge risk of reduced life expectancy (Ogden, 2012). In this study, it is also indicated that People with Down’s syndrome risk for Alzheimer dementia development that reduces the mortality and morbidity. Loane et al. (2013) supported by indicating that a high risk of short life expectancy occurs in people showing less mobility, unable of self-management. Further, Heslop et al. (2014) studies describe that intellectual disability risk for lifelong sensory loss, sleep problems, neurological defects, fracture risk, epilepsy and endocrine disorder. The people with ID suffer from severe constipation and respiratory infections that can require proper care and management throughout life. Bigby, Frawley & Ramcharan (2014) indicated that people with a moderate intellectual disability also have a low IQ level throughout life that risk to learning disability, verbal aggression, serious tantrums.
Further, understanding the potential health risks of diabetes mellitus type-2 on the lifespan of vulnerable, studies of Scirica et al. (2013) indicated that DM-2 risk for stroke, nerve damage, retinopathy, and kidney damages. The nerve damages and retinopathy can lead to lifelong sensory loss. Further, general foot problems like ulcer, small cuts, nicks, and infection are common health challenges that heal very slowly or even don't heal in severe conditions. The suffers from DM-2 can also face sexual dysfunctions like erection problems, vaginal dryness, pain during sex, reduced sex drive as major lifelong complications that impact the sex life of vulnerable (American Diabetes Association, 2013).
The ICF Model describing the potential impact of man’s activity and participation across his lifespanThe ICF model generally known as International Classification of Functioning, Disability and Health is a framework describing health and other health related conditions at the individual, social and institutional levels. This framework consists different domains whose impact is determined in health condition as per environmental factors to capture their level of capacity and performance. These domains vary in the three frameworks for individual, social and institutional ICF model (Kongstvedt, 2012).
The below provided is general structure of individual ICF model that is used to determine the potential impact of man’s activity and participation across his lifespan.
Figure 1: Individual ICF model
(Source: Kongstvedt, 2012, p.90)
The ICF model describing condition of study patient is provided below:
Using the ICF model, the body functions and structure were determined using Developmental Behaviour Checklist that indicated the obese condition, retarded verbal skills and low mobility that can severely affect the health condition of the patient. Sperl-Hillen (2014) indicated that patient with diabetes mellitus type -2 need to perform active mobility for better self-management. Further, the activity and participation measures indicated that patient is actively involved in community life and daily disability specific program for his moderate intellectual disability. But, showed less self-care and communication. The lack of self-care lead to the development of health challenges related to Down’s syndrome and chronic illness (Bouchard, Blair & Haskell, 2012).
The environmental factors identified were lacking family support and only availability of community support. The lack of family support can worsen the mental disabilities of this patient and presence of only community support indicates a lack of care and support. The personal details of patient indicate that he is reaching his late adulthood. The lack of self-care can worsen the present condition of the patient. Scirica et al. (2013) indicated that most of the risk factors of chronic condition show their impact with increasing age. Therefore, in present case lack of proper management can lead to high risk of health hazards related to Down’s syndrome and Diabetes mellitus type-2.
Identifying x1 intervention/strategy for ensuring optimal health and wellbeing across man’s lifespanThe below provided nursing intervention/strategy is planned for the management of Diabetes Mellitus type-2 chronic condition of study patient.
Intervention name and description – 300 (goals and rationale)
Intervention Name- Diabetes Self-Management Education and Support (DSME/DSMS)
This intervention was studied from the peer-reviewed journal of Powers et al. (2015) where the diabetes self-management education and support intervention was described to overcome the clinical hazards of Diabetes mellitus type -2 conditions in the vulnerable patient. American Diabetes Association reviewed this research, therefore, it can be considered as a reliable and authentic intervention strategy where DSME involves technique of providing self-management skills and behaviours to the vulnerable patient and DSMS program provided to community care providers who will help in providing support and facility to develop this self-management skills and behaviours.
Redmon et al. (2014) indicated that diabetes is a chronic condition that requires a highly compatible management and care process to minimise its effect on health. As diabetes is a bodily defect (imbalance of blood sugar) there is no cure for this disease, however, the only solution is to properly manage the diet and physical activities for quality life. In the provided study patient, there are defects in the daily activities, self-management and care process of the patient. Therefore, as a nurse, the intervention of providing DSME/S is developed to manage the on-going chronic condition of study patient.
According to Inzucchi et al. (2012) the DSME/S can only be provided by healthcare professional as per specific requirements of patient condition. The intervention involves a process to educate the patient about the self-management as per diabetic condition assessment followed by guiding the community care provider about the support they need to provide in self-management to the patient.
As per the details provided above about the study patient conditions in ICF model, it is confirmed that proper self-management is the first and foremost requirement of this patient. Therefore, intervention goal is to provide diabetes self-management education and support.
The DSME/S intervention is a formal outpatient program where the patient participates in an outpatient service provided by healthcare professional in a healthcare facility. Powers et al. (2015) indicated that DSME/S is now practised in medical homes, community care centres, pharmacies and other minor healthcare settings. Therefore, this intervention will be implemented in the community care centre of study patient. As a community professional nurse, the personalised and inclusive approach is used to address the necessities of the patient. The knowledge regarding clinical, behavioural, and psychological diabetes care will be delivered in intervention through describing strategies of self-management. A patient-centred care approach will be adapted to deliver education where implementation are constructed as per specific needs of study patient.
The Diabetes self-management education intervention involves educating patient about proper diet, exercise, medication and blood glucose self-monitoring process. the DSME program will guide about the self-care behaviours, collaborative team-work with the care team, improving life quality, physical activities and informed decision-making as per patient body type and health status.
As a patient-centered care approach is used, therefore, the education about mild physical activities likes walking slowly with a time interval; instrument playing, light bicycling etc. will be taught to enhance the mobility (Ogden, 2012). As patient suffers functional disorder therefore only mild physical exercises are recommended in intervention. Further, the patient will be guided about the nutrition therapy to manage the obese health condition. A proper seven days diet chart is provided in nutrition therapy that is required to be managed by the healthcare providers at the community centre (Bouchard, Blair & Haskell, 2012). Basically, nutrition therapy is also a part of DSMS as well. Further, the patient will be educated about self-care habits or behaviours. Powers et al. (2015) studied seven self-care behaviours that include medication complaints, risk reduction attitude, avoiding complex diet, practising mobility, developing coping skills, daily practising to monitor sugar, and stress managing practice. This DSME intervention will help the patient in practising self-management and improve their present health conditions.
Further, diabetes self-management support part of intervention will provide activities to support the patient in their self-management process. These activities will be taught to the care providers present at the community centre. The DSMS will involve educating about activities to provide psychological, clinical, behavioural and educational support to the patient.
The chronic condition like diabetes and genetic defects like Down’s syndrome are complex conditions that are not curable but require proper self-management and coping strategies to minimise their health hazards. The modifications in food, monitoring, medication and physical activities are processes of self-management that improve the diabetic condition. But, patient requires learning this self-management skills and processes. The DSME/S intervention provides an overall process to manage type-2 diabetes related issues and crucial support required for establishment of this self-management process. The DSME/S intervention detailed in the study is developed as per the present condition of study patient. This intervention is flexible to be modified as per patient requirements and hence delivers effective outcomes.
Bouchard, C., Blair, S. N., & Haskell, W. (Eds.). (2012). Physical activity and health. Human Kinetics.
Kongstvedt, P. R. (2012). Essentials of managed health care. Jones & Bartlett Publishers.
Ogden, J. (2012). Health psychology. McGraw-Hill Education (UK).
American Diabetes Association. (2013). Standards of medical care for patients with diabetes mellitus. Puerto Rico Health Sciences Journal, 20(2).
Bigby, C., Frawley, P., & Ramcharan, P. (2014). Conceptualizing inclusive research with people with intellectual disability. Journal of Applied Research in Intellectual Disabilities, 27(1), 3-12.
Heslop, P., Blair, P. S., Fleming, P., Hoghton, M., Marriott, A., & Russ, L. (2014). The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study. The Lancet,383(9920), 889-895.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... & Matthews, D. R. (2012). Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia, 55(6), 1577-1596.
Loane, M., Morris, J. K., Addor, M. C., Arriola, L., Budd, J., Doray, B., ... & Melve, K. K. (2013). Twenty-year trends in the prevalence of Down syndrome and other trisomies in Europe: impact of maternal age and prenatal screening. European Journal of Human Genetics, 21(1), 27-33.
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., ... & Vivian, E. (2015). Diabetes self-management education and support in type 2 diabetes a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 41(4), 417-430.
Redmon, B., Caccamo, D., Flavin, P., Michels, R., O’Connor, P., Roberts, J., ... & Sperl-Hillen, J. (2014). Diagnosis and management of type 2 diabetes mellitus in adults. Institute for Clinical Systems Improvement. Updated July.
Scirica, B. M., Bhatt, D. L., Braunwald, E., Steg, P. G., Davidson, J., Hirshberg, B., ... & Cavender, M. A. (2013). Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. New England Journal of Medicine, 369(14), 1317-1326.
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