Posted: March 31st, 2023

Nursing Care Plan for Mr. John Snow: Managing Diabetes and Hyperlipidemia

Nursing FINAL ASSESSMENT #2: CARE FOR THE ELDERLY LEVEL 3 ASSIGNMENT BRIEF Instructions: Read the assignment brief and complete the instructions.

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This assessment counts towards 50% of your final grade. Total marks available for this assessment: 20 marks. Pass Mark: 50% (10 marks). Assessment Brief:

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As a new care giver in the community, you were asked to take responsibility for caring for a sixty seven (67) year old male patient, Mr. John Snow, who was recently discharged from Georgetown Public Hospital Co-operation. He was suffering from Diabetes and Hyperlipidaemia for the past seven years but was unable to control same. He recently developed a diabetic foot ulcer and was admitted for management with intravenous medications and insulin to control his condition. After five (5) days of being an impatient he was discharged with medications for seven days as follows :

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1. Clindamycin 300mg po QID 2. Flagyl 500mg po BD 3. Metformin 500mg po TID 4. Daonil 5mg po OD 5. Asprin 81mg po OD

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6. Ramipril 5mg po OD 7. Atrovastation 10mg po Nocte 8. Vitamin C 1gm po OD 9. BCO 1 tab po OD 10. Diclofenac 50mg PO PRN pain

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11. Omeprazole 20mg po OD The patient also requires daily cleaning and dressing of the wound with normal saline and iodine. Mr Snow is often non-compliant with his treatment regime and normally eats whatever he desires. He is usually a late sleeper and lacks physical activity and exercise. Mr Snow was warned of his carefree behaviour and if he continues he can actually lose the affected limb. Mr Snow is living alone with his son visiting twice a month and usually buys his meals as he doesn’t know how to cook. Mr Snow’s son can afford to employ a home care provider is willing to adjust his father’s lifestyle to achieve better health. As the care provider, kindly evaluate the client’s condition and with the support of his family and the instructions of the health care provider, develop a care plan to suit Mr Snow’s condition and his needs for the seven days.

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Note the following: His Glucose and blood pressure level reading for the last five days are as follows: · Day 1: 365 mg/dl, 130/85 mm/hg · Day 2: 395 mg/dl, 128/79 mm/hg

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· Day 3: 289 mg/dl, 139/89 mm/hg · Day 4: 343 mg/dl, 145/92 mm/hg · Day 5: 271 mg/dl, 140/90 mm/hg · Cholesterol : 367mg/dl

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Assessment Criteria: Your Care Plan must include but not limited to the following: A) Background Information and General Overview of the Patient (4 marks) B) The Patient’s Diagnosis (4 marks)

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C) Goals and Outcomes (4 marks) D) Intervention Strategies (4 marks) E) Evaluation (Short Term & Long Term) (4 marks) End of Assessment

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____________________________________________ Nursing Care Plan for Mr. John Snow: Managing Diabetes and Hyperlipidemia A) Background Information and General Overview of the Patient Mr. John Snow, a sixty-seven-year-old male, has recently been discharged from Georgetown Public Hospital Co-operation. He has been grappling with uncontrolled Diabetes and Hyperlipidemia for the past seven years. Despite his medical history, he has faced challenges in managing these conditions effectively. His recent hospitalization was prompted by the development of a diabetic foot ulcer, necessitating intravenous medications and insulin therapy. Mr. Snow's compliance with treatment has been inconsistent, compounded by his inclination to indulge in unrestricted dietary choices and his sedentary lifestyle. He lives alone and his son, though supportive, visits only twice a month. B) The Patient’s Diagnosis

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Mr. Snow's primary diagnoses encompass Diabetes and Hyperlipidemia. The former is characterized by elevated glucose levels that require stringent management to prevent complications such as diabetic foot ulcers, as in his case. Hyperlipidemia, on the other hand, refers to elevated levels of lipids, particularly cholesterol, which increases the risk of cardiovascular diseases. C) Goals and Outcomes The overarching goal of Mr. Snow's care plan is to enhance his quality of life and mitigate the potential consequences of his uncontrolled Diabetes and Hyperlipidemia. Short-term objectives include reducing blood glucose levels within an acceptable range and stabilizing blood pressure readings. Long-term goals encompass preventing further complications such as infections, promoting wound healing, and fostering a sustainable lifestyle change that supports overall health. D) Intervention Strategies Medication Management: Strict adherence to the prescribed medication regimen is paramount. A combination of Clindamycin, Flagyl, Metformin, Daonil, Aspirin, Ramipril, Atorvastatin, Vitamin C, BCO, Diclofenac, and Omeprazole is critical for managing his conditions. Each medication serves a specific purpose, either addressing infection, regulating blood glucose, controlling blood pressure, or supporting pain management.

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Dietary Modifications: Collaboratively working with a dietitian, Mr. Snow should follow a tailored diet plan that aligns with his health needs. A diet rich in whole grains, lean proteins, fruits, and vegetables while minimizing sugary and high-fat foods is essential. Monitoring carbohydrate intake can help regulate blood glucose levels. Wound Care: Mr. Snow's foot ulcer necessitates daily cleaning and dressing with normal saline and iodine. Proper wound care minimizes infection risk and accelerates healing. Physical Activity: Encouraging Mr. Snow to engage in regular physical activity, even low-intensity exercises, is crucial. This can aid in improving insulin sensitivity, regulating blood glucose levels, and enhancing overall cardiovascular health. Education and Support: Providing Mr. Snow with comprehensive education about his conditions, potential complications, and the importance of adhering to the care plan is crucial. His son's involvement can serve as a motivational factor, and involving a home care provider can ensure consistent support. E) Evaluation (Short Term & Long Term)

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Short-term evaluation will involve tracking Mr. Snow's blood glucose levels, blood pressure readings, wound healing progress, and adherence to the medication regimen and dietary plan. Adjustments to medication dosages or interventions can be made as necessary. Long-term evaluation will focus on sustained improvements in blood glucose control, cholesterol levels, wound healing, and overall lifestyle. It will also consider any reduction in the risk of complications associated with Diabetes and Hyperlipidemia. In summary, Mr. Snow's care plan is tailored to his specific medical history and lifestyle. It combines pharmacological interventions, dietary modifications, wound care, and lifestyle changes to address his Diabetes and Hyperlipidemia comprehensively. Regular monitoring and evaluation will be essential to ensure the plan's effectiveness and make necessary adjustments. With the collaboration of healthcare providers, family support, and Mr. Snow's commitment, the aim is to enhance his well-being and prevent further health complications. References: American Diabetes Association. (2019). Standards of medical care in diabetes—2019. Diabetes Care, 42(Supplement 1), S1-S193.

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Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., ... & Smith, S. C. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 73(24), e285-e350. Strain, W. D., Cos X, Hirst M, et al. (2016). Time to do more: addressing clinical inertia in the management of type 2 diabetes mellitus. Diabetes Research and Clinical Practice, 121, 1-11. Stratton, I. M., Adler, A. I., Neil, H. A., Matthews, D. R., Manley, S. E., Cull, C. A., ... & Holman, R. R. (2000). Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ, 321(7258), 405-412.

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