The purpose of this clinical rotation is to communicate with, assess and educate an older adult client about a medical condition (type 2 diabetes). The assessment report covers functional and physiological changes that place the older adult at greater risk for decline in health and quality of life and medical condition being experienced. In addition, it presents pathophysiology of the medical condition and potential nursing diagnosis (NANDA approved) outcomes and interventions for the older adult, as well as client education on health promotion and disease prevention.
The number of seniors (persons aged 65 years and over) in America has increased significantly, and this trend has attracted the attention of various stakeholders, including healthcare professionals and policymakers. Providing care to older adults can be a complex affair and needs specialized knowledge for effective outcomes.
Functional and Physiological Changes
Aging is associated with the impairment of functional and physiological changes in older adults (Amarya, Singh, & Sabharwal, 2015). Such changes tend to affect functional capabilities of each body system. Heart performance deteriorates due to cardiovascular changes. Musculoskeletal changes may critically transform the posture, general appearance, and/or function of older adults and vision and hearing impairments (sensory changes) may occur. Further, functions of the liver (gastrointestinal (GI) changes), lungs (respirator changes), and kidney (renal and urologic changes) may decline. Integumentary changes affect skin, hair, and nails. Body composition also is altered because of changes in fat mass, while heat stress and hypothermia may also be experienced. Further, nutritional and sleep changes may be observed in seniors. These changes negatively affect their general well-being and functional abilities. It is imperative to note that chronic health conditions, such as cardiovascular diseases, diabetes, may occur due to normal age-related changes.
Client Medical Condition
RXC is a 70-year-old male patient with type 2 diabetes first diagnosed a year ago. RXC has also gained weight considerably and has hypothyroidism. He has a past of alcohol consumption and cigarette smoking, but he quitted these habits about a year ago. RXC is physically inactive, feels dizzy and light headache in the morning. He also reported anxiety about the future and his independence.
Pathophysiology of the Medical Condition
Type 2 diabetes is progressively linked to several body organs and tissues that play a role in elevating blood glucose levels. Muscle tissues in the body may fail to take up glucose for energy requirements and become resistant to insulin while fat cells enhance the breakdown of fats and other lipids that result in insulin resistance and deposits of body fats. The liver stores large volumes of glucose and it may compensate for low levels of glucose and increase production. In the pancreas, beta cells fail to produce insulin whereas alpha cells enhance the generation of glucagon hormone to change stored glycogen into glucose (Spencer, 2010). When the kidney enhances reabsorption of glucose, organs that keep the excess glucose are eventually damaged.
Type 2 diabetes is a disorder caused by multiple factors related to impaired insulin production, resistance, and environmental factors, such as obesity, poor diets, aging, physical inactivity, and stress. Under regular physiological condition, glucose is controlled and maintained with narrow margins with relevant tissues and organs. However, these functions are impaired in type 2 diabetes with outcome of pathological impairments involving insulin production through beta cell dysfunction and abnormal insulin activities due to insulin resistance (Ozougwu, Obimba, Belonwu, & Unakalamba, 2013).
Clinical manifestation of type 2 diabetes involves diabetic nephropathy, which is a clinical symptom associated with hypertension, albuminuria, obesity, albuminuria, and progressive renal insufficiency. Diabetic nephropathy is responsible for most cases of end-stage renal disease (ESRD) (Baynest, 2015).
A Potential Nursing Diagnosis Outcomes and Interventions
Assessment will focus on rest, circulation, elimination, ego integrity, food/fluid intake, pain/comfort, and learning about family history.
Nursing diagnosis outcomes will include osmotic diuresis (hyperglycemia), physical weakness, immobilization neuropathy, high glucose levels, reduction in leukocyte function, poor nutrition intake, and knowledge deficit.
Nursing intervention and implementation plan for RXC would target fluid deficit to enhance fluid balance. Body weight will be reduced to reach the normal laboratory value with no signs malnutrition while intervention will ensure that infection does not occur. The intervention will also address fatigue and knowledge deficit observed.
Client Education on Health Promotion and Disease Prevention
RXC will be provided with relevant information on type 2 diabetes management and control (Adams, 2010). Regular physical activities, healthy diets, risk factors, adherence to medications, and reading about best practices will be effective for RXC. In addition, RXC will be trained to focus on long-term management and regular reviews of the condition.
Adams, R. J. (2010). Improving health outcomes with better patient understanding and education. Risk Management & Healthcare Policy, 3, 61–72. Web.
Amarya, S., Singh, K., & Sabharwal, M. (2015). Changes during aging and their association with malnutrition. Journal of Clinical Gerontology and Geriatrics, 6(3), 78–84. Web.
Baynest, H. W. (2015). Classification, pathophysiology, diagnosis and management of diabetes mellitus. Journal of Diabetes & Metabolism, 6(5), 541. Web.
Ozougwu, J. C., Obimba, K. C., Belonwu, C. D., & Unakalamba, C. B. (2013). Thepathogenesis and pathophysiology of type 1 andtype 2 diabetes mellitus. Journal of Physiology and Pathophysiology, 4(4), 46-57. Web.
Spencer, J. (2010). Type 2 diabetes and hypertension in older adults: a case study. Nursing Standard, 24(32), 35-39.