Case Study: Management of Type 2 Diabetes Mellitus in an Older Adult

Introduction (Patient and Problem)

The patient is a 62-year-old female, Mrs. Smith, who presents to the outpatient clinic with complaints of increased thirst, frequent urination, and fatigue. She has been experiencing these symptoms for the past three months and has noticed a significant weight loss of about 15 pounds. Upon assessment, she was diagnosed with Type 2 Diabetes Mellitus (T2DM). As a nurse, my primary focus should be on educating Mrs. Smith about diabetes management, including lifestyle modifications such as dietary changes and physical activity, as well as the importance of medication adherence.

Pathophysiology

Type 2 Diabetes Mellitus is characterized by insulin resistance, where the body’s cells become less responsive to insulin, along with a relative deficiency in insulin production. Symptoms of T2DM include polyuria (increased urination), polydipsia (increased thirst), polyphagia (increased hunger), fatigue, and blurred vision. The underlying causes of T2DM are complex but often include a combination of genetic predisposition, obesity, physical inactivity, and poor dietary habits. Elevated blood glucose levels result from insufficient insulin action and can lead to long-term complications affecting the cardiovascular system, kidneys, eyes, and nerves.

History

Mrs. Smith has a medical history significant for hypertension and hyperlipidemia. She was diagnosed with hypertension five years ago and is currently taking Lisinopril 20 mg daily. Additionally, she has been prescribed Atorvastatin 10 mg daily for cholesterol management. There is no history of major surgeries, but she has previously undergone lifestyle modifications including dietary counseling without sustained results. Her family history includes diabetes in her mother and cardiovascular disease in her father.

Nursing Physical Assessment

Upon assessment, Mrs. Smith’s vital signs are as follows:

– Blood Pressure: 135/85 mmHg
– Heart Rate: 78 beats per minute
– Respiratory Rate: 16 breaths per minute
– Temperature: 98.6°F
– Weight: 180 pounds (BMI: 30.3, indicating obesity)
– Blood Glucose Level: 250 mg/dL (random)
– Bowel sounds: Present in all quadrants

Her ambulation is slightly affected due to fatigue, but she is able to walk short distances without assistance.

Related Treatments

Mrs. Smith is currently receiving education on managing her diabetes, which includes:

– Dietary modifications aimed at reducing carbohydrate intake and increasing fiber consumption.
– Encouragement to engage in regular physical activity (at least 150 minutes of moderate exercise per week).
– Monitoring blood glucose levels at home.
– Initiation of Metformin 500 mg twice daily to help control blood sugar levels.

Nursing Diagnosis & Patient Goal

The primary nursing diagnosis for Mrs. Smith is “Ineffective Health Management related to lack of knowledge about diabetes management.” The goal for Mrs. Smith is to achieve better glycemic control as evidenced by a target HbA1c level of less than 7% within three months and improved understanding of lifestyle changes necessary for managing her condition.

Nursing Interventions

To accomplish these goals, the following nursing interventions will be implemented:

1. Education: Provide comprehensive teaching about diabetes management, including understanding blood glucose monitoring techniques and recognizing symptoms of hypo/hyperglycemia (American Diabetes Association, 2020).
2. Nutritional Counseling: Collaborate with a registered dietitian to develop a personalized meal plan focusing on balanced nutrition and portion control (Wylie-Rosett et al., 2019).
3. Encouragement of Physical Activity: Support the patient in setting realistic goals for physical activity and provide resources for local exercise programs or community resources.
4. Regular Follow-ups: Schedule regular follow-up appointments to monitor blood glucose levels and adjust medications as necessary.

Evaluation

Following the nursing interventions, Mrs. Smith demonstrated significant improvement in her understanding of diabetes management. After one month, her blood glucose levels decreased to an average of 150 mg/dL, and she reported increased energy levels and adherence to her diet and exercise plan. A follow-up HbA1c test showed a decrease from 9% to 7.5%, indicating better glycemic control.

Recommendations

For continued recovery and improvement, it is recommended that Mrs. Smith:

1. Continue regular follow-ups with her healthcare provider to monitor her diabetes management.
2. Engage in ongoing education about diabetes care through community resources or support groups.
3. Maintain a consistent exercise routine and adhere to dietary recommendations while monitoring her blood sugar levels regularly.

As her nurse, I will also continue to provide support and encouragement throughout her journey in managing Type 2 Diabetes Mellitus effectively.

References

American Diabetes Association. (2020). Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Supplement 1), S1-S232.

Wylie-Rosett, J., Segal-Isaacson, C., & Sweeney, L. (2019). The Role of Diet in the Management of Type 2 Diabetes: A Review of Current Evidence. Nutrition Reviews, 77(5), 377-393.