Background Cristobel is a 68-year-old woman who has been recently diagnosed with metabolic syndrome.
Cristobel is married with 3 adult children, and she looks after her daughters’ children during the week while they go out to work. English is not her first language as she was born in the Philippines. Food plays a big part in the family’s life, with gatherings and celebrations with extended family occurring frequently. Cristobel was diagnosed with Type II diabetes and hypertension six months ago. Cristobel is 158cm tall and weighed 85kg at the time she was diagnosed.
Phase One – Chronic Care
Cristobel is attending a clinic appointment with her diabetes nurse for the first time since her diagnosis. She has missed the last two scheduled appointments, and has presented with her blood glucose diary only partially filled out, reporting that she hasn’t been filling it in because “her eyes are no good these days”. Cristobel reports that she is still not sure about how to use the blood glucose machine or what types of food she should be eating. Cristobel states that she would like to be able to be more active with her grandchildren but gets chest pain when she gets out of breath, so she prioritises her housework and then rests. She reports that she takes her prescribed medication most of the time, but she does forget sometimes when she gets busy.
On examination:
• Blood pressure: 150/95 mmHg
• Fasting blood glucose level: 7.8 mmol/L
• HbA1C: 8.9% (reference range 4.0-6.0%).
• Total cholesterol is 6.1 mmol (≤5.5 mmol/L) and is comprised of HDL cholesterol 0.9 (≥1.2 mmol/L) and LDL cholesterol 5.2 mmol/L (≤3.0 mmol/L). Her triglycerides are 2.9 mmol/L (≤2.0 mmol/L).
• Waist circumference: 96cm You have chosen a highly relevant and accurate problem which would be considered a priority in this situation.
All relevant assessment data has been identified and described correctly. The pathophysiology is described in depth with all aspects relevant to the case covered. You have applied evidence from a wide range of current and highly relevant literature and comprehensively justified your choice of priority problem. You have presented a strong, reasoned and well written case for your choices based on this evidence.
1- Identify one (1) priority problem and justify your choice by linking to the relevant assessment data and pathophysiology.
2-Identify one (1) other nursing assessment you think would be necessary and provide a rationale for your choice.
3- Identify two (2) interventions to address your priority problems and provide a rationale for the choice of each intervention.
B. You must discuss at least ONE (1) nurse-initiated intervention per problem in your essay. If your other chosen intervention is collaborative with members of the multidisciplinary team, then you must focus on the requirements of the nursing role in that intervention.
4-Demonstrate how you would evaluate the effectiveness of your chosen interventions. Your plan contains two interventions which are deemed safe and appropriate with high correlation to best practice. You have supported your choice of interventions with a comprehensive range of strong evidence. There is a comprehensive focus on the nursing role in the interventions. There are no missing evaluation criteria.