Nursing for Down Syndrome

Down syndrome is also known as trisomy 21, is a genetic disorder caused by the disjunction of the chromosome and addition of a copy to the 21^st chromosome pair. One of the main characteristics of such individuals with Down syndrome is an intellectual disability. Such individuals have a poor immune system and normally they have elevated the risk of several health problems that can be life-threatening. According to Deacon & Edirippulige (2015), Type 1 diabetes is an autoimmune disease that has a usual association with the Down’s syndrome. Therefore, improving the care for a patient with chronic illnesses becomes the greatest challenge in the nursing practice. The challenge of addressing the requirements of the community which involves patients with multi-morbidities has led to the development of interventions that can focus more on the patient rather than the specific disease. In this essay, the various health issues experienced by a man with Down’s syndrome and Type 1 diabetes will be discussed, and the various nursing intervention related to is health issues will be highlighted (Rönö et al., 2014).

According to the case study the 45 years man, was an individual with Down syndrome and was also suffering from Type 1 diabetes and mental disability. According to Deacon & Edirippulige (2015), adults with Down syndrome experience increased the risk of various illnesses such as thyroid disease, depression, diabetes, obsessive-compulsive, hearing loss and Alzheimer’s disease. In this case, as reported the man with Down syndrome and suffering from diabetes Type 1 would be at the risk of different health challenges such as hyperthyroidism, dermatomyositis, autoimmune hemolytic anemia, rheumatoid arthritis, multiple sclerosis, polyarteritis nodosa, Sjogren’s syndrome and systemic lupus erythematosus across his life span. In addition to this due to the presence of diabetes, the man might develop obesity in the future (Parrini et al., 2014),

Literature review suggests that around 13 to 34% of the Down’s syndrome patient’s thyroid auto-antibodies were observed. Therefore, as a patient of Down’s syndrome the man is prone to the risk of hypo as well hyperthyroidism. A recent study discussed by East et al. (2016), reveals that hypothyroidism in adults with Down syndrome has differed between 3% to 54%. Addition to this cardiac disease accounts for around 47% of the Down syndrome adults. Down syndrome also makes an individual’s sensory organs at high risk. On considering the example from the case study the man with Down syndrome might develop cataract producing impaired vision or he might develop a risk for conductive hearing loss. Moreover, during his life span he might be at an elevated risk for sleep apnea, osteoarthritis, osteoporosis and celiac disease (Epstein, 2013). 

As stated by Necchi et al. (2015), the several risk factors associated with this man might cause a negative impact on his mental and emotional well-being. As the man ill grow old, he might experience common mental health disorders such as depression, obsessive compulsion disorder, anxiety and behavioral disorder. The behavioral disorder might develop from his mental imbalance. Moreover, societal discrimination and financial loss due to treatment of diabetes Type 1 may affect on the psychological well-being of the man. This might also lead to increased risk of dementia (Scott et al., 2014).

According to Deckers et al., (2016), The “World Health Organization” has developed a model related to human functioning, health, and disability in its “International Classification of Functioning, Disability, and Health (ICF) in order to use it as the international standard to illustrate and evaluate health and the various disabilities associated with it. As stated by Mayer?Davis et al. (2015), the ICF is constructed to allow the dimension and also the impact of the interface of both one’s disability and health. According to Deacon & Edirippulige (2015), There are 3 key domains which allow practitioners to understand the degree of an individual’s disability. The three main domains are functional impairment, activity restriction and participation restrictions. The 45 years man has Down syndrome and Type 1 diabetes impairing his physical, logical and emotional capacity. Such a condition causes activity restraints for him since he is from the birth not been able to perform to his pre-impaired state. Thus, it reflects the fact that the man is less probable to contribute in a series of social, domestic and work activities. The amalgamation of these 3 factors explains how the man with Down syndrome becomes disabled by diabetes and moderate mental disability (Look AHEAD Research Group, 2013).  

The man’s surroundings from the beginning of his cognitive impairment is a community group home whose staff conducts a disability specific day program five days a week. As discussed by Katz et al. (2014), in such an environment which consists of patients with various impairments, proper treatment and care are not possible with less number of staffs. Moreover, since the man was suffering from Down syndrome his cognitive disability might make tasks difficult due to disorganized thinking, formulating and obtaining goals and problem solving. Thus, his participation which would have been beneficial as an indirect and healthy treatment of diabetes might be his health and well being constrained. The most effective way to enhance the man’s participation and to improve his activity status is efficient self management and patient centered care (Heller et al., 2014).

There are few interventions that can be employed in order to reduce the risks associated with diabetes mellitus. According to Deacon & Edirippulige (2015), Insulin therapy is the key prevention method for Type 1 Diabetes mellitus. Most of the patient with Type 1 diabetes requires two to more insulin injections daily, and the doses are adjusted based on the self-monitoring of the patient’s blood glucose level (BSL).  The American Diabetes Association (ADA) emphasize on the age of the patient as one of the considerations in laying a foundation of the glycemic goals (Katz et al. (2014).

According to Heller et al. (2014), the successful management plan for an individual with diabetes depends on the relationship established between the patient and the nurse. As a community nurse, the first intervention that one should use is the initial health assessment and the lifestyle of the 45 years man referring to his medical history.  Once the details of the physical condition of the patient are completed insulin therapy should be administered to the patient. As stated by Rönö et al. (2014), depending on the patient’s condition the recommendation of the dose daily needs to be given and applied. As stated by Deacon & Edirippulige (2015), this type of multiple daily injections includes a combination of a long active insulin like Lantus or Levemir which comes in contact with Apidra, Novolog and Humolog. Depending on the result of the fasting plasma glucose level the duration and time of walking should be advised. These strategies are specifically important for the 45 years man as his reduction in the blood sugar level can impact on many of his physical disabilities (Katz et al. (2014).

Other strategies that can be implemented to assist the 45 years man include mediations such as Pramlintide. This injection can reduce the movement of the food through one’s stomach in order to curb the increase in the blood sugar. So as a nurse, this medicine can be given to the man to control his blood sugar level. As discussed by Rönö et al., (2014), the second medicine that can be given is known as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) as prescribed by the doctor. These medicines help to maintain the function of the kidney. These can only be applied if is blood pressure reaches above 140/80 ((Rönö et al., 2014).

It can be thus concluded that consideration of the relations between the disability and the chronic illness is significant for nurses in order to put into practice more informative data. Based on this case where a 45 years man with Down syndrome is affected by diabetes mellitus Type 1, it can be said that the nurse cannot simply just simply focus on a particular disease. Rather a nursing practitioner requires appreciating the association between the functional impairment, participation restrictions and activity limitations. The ICF which is constructed to allow the dimension and also the impact of the interface of both one’s health and disability reflects better understanding of the man's impairment. Thus, his participation which would have been beneficial as an indirect and healthy treatment of diabetes might be his health and well being constrained. The most effective way to enhance the man’s participation and to improve his activity status is efficient self management and patient centered care. Using the 45 years man case prescribed insulin therapy; this essay has demonstrated how understanding of certain factors can notify nurses’ practice through adaptation of strategies can lead to a improved chance of effective treatment.

References:

Deacon, A. J., & Edirippulige, S. (2015). Using mobile technology to motivate adolescents with type 1 diabetes mellitus: A systematic review of recent literature. Journal of telemedicine and telecare, 1357633X15605223.

Deckers, S. R., Van Zaalen, Y., Stoep, J., Van Balkom, H., & Verhoeven, L. (2016). Communication performance of children with Down Syndrome: An ICF-CY based multiple case study. Child Language Teaching and Therapy, 0265659016630775.

East, A., Goodlett, C. R., Stringer, M., Podila, H., Dalman, N., & Roper, R. J. (2016). Deficits in a Radial-Arm Maze Spatial Pattern Separation Task and Cell Proliferation in a Mouse Model for Down Syndrome.

Epstein, C. J. (2013). of Down Syndrome. Molecular Genetic Medicine, 2, 105.

Heller, S., Lawton, J., Amiel, S., Cooke, D., Mansell, P., Brennan, A., ... & Basarir, H. (2014). Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes.

Katz, M. L., Volkening, L. K., Butler, D. A., Anderson, B. J., & Laffel, L. M. (2014). Family?based psychoeducation and care ambassador intervention to improve glycemic control in youth with type 1 diabetes: a randomized trial.Pediatric diabetes, 15(2), 142-150.

Look AHEAD Research Group. (2013). Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N engl J med, 2013(369), 145-154.

Mayer?Davis, E. J., Seid, M., Crandell, J., Dolan, L., Lagarde, W. H., Letourneau, L., ... & Thomas, J. (2015). Flexible Lifestyles for Youth (FL3X) behavioural intervention for at?risk adolescents with Type 1 diabetes: a randomized pilot and feasibility trial. Diabetic Medicine, 32(6), 829-833.

Necchi, D., Pinto, A., Tillhon, M., Dutto, I., Serafini, M. M., Lanni, C., ... & Prosperi, E. (2015). Defective DNA repair and increased chromatin binding of DNA repair factors in Down syndrome fibroblasts. Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis, 780, 15-23.

Parrini, M., Ghezzi, D., Deidda, G., Medrihan, L., Benfenati, F., Baldelli, P., ... & Contestabile, A. (2014). Physical exercise rescues adult neurogenesis, synaptic plasticity and memory in down syndrome mice. In 9th FENS Forum of Neuroscience (No. EPFL-CONF-210214).

Rönö, K., Stach-Lempinen, B., Klemetti, M. M., Kaaja, R. J., Pöyhönen-Alho, M., Eriksson, J. G., & Koivusalo, S. B. (2014). Prevention of gestational diabetes through lifestyle intervention: study design and methods of a Finnish randomized controlled multicenter trial (RADIEL). BMC pregnancy and childbirth, 14(1), 1.

Scott, M., Foley, K. R., Bourke, J., Leonard, H., & Girdler, S. (2014). “I have a good life”: the meaning of well-being from the perspective of young adults with Down syndrome. Disability and rehabilitation, 36(15), 1290-1298.

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