NURS 250 Juratovac 2012 Case Study #3 Mrs.

A is a 71 year old Latina lady who was diagnosed this year with Type 2 Diabetes and was recently hospitalized for hyperglycemia. She also has had recent tooth extractions due to periodontal gum disease. She has lost nearly 30 pounds in the last few months without trying. She has also recently been seen in a gynecological practice for unexplained lower abdominal pain. She now lives alone, as her mother just died of breast cancer. She reports trouble staying asleep at night, trouble staying awake during the day, and when you ask about her energy, she emphasizes NADA! (which means no or none). She has been intermittently forgetting to take her evening dose of the new blood sugar pill. Food was always important, but lately she has little appetite. She doesnt cook any more since she only cooks for one, but canned soups and peanut butter crackers usually sound good to her. 1. Identify two age-related endocrine system changes. Why is this important to know for Mrs. As care? Type 2 Diabetes and trouble sleeping are two age-related endocrine system changes that Mrs. A has been experiencing. This is important to know for Mrs. As care because it helps us identify what medications will be necessary to treat her imbalanced hormone levels. 2. Identify two age-related changes in immune function. Why is this important to know for Mrs. As care? Periodontal gum disease and anorexia (loss of appetite) are two age-related immune function changes that Mrs. A has been experiencing. This is important to know for Mrs. As care because it will alert her health care providers to look out for more complications or infections in these areas of the body. Because we can relate these changes to age, we dont have to waste time worrying that Mrs. A has some other disease or reason for depleting her immune system. 3. Is there a connection between normal age-related changes, and risks for other conditions? Explain why or why not. There is a connection between normal age-related changes and risks for other conditions, but these two things are not synonymous. Normal age-related changes to a persons physiology are mostly impairing or deteriorating. These decreases in ones health can be associated with the risk factors for certain conditions or diseases. For example, it is normal for ones valve efficiency to decrease with age. This in combination with increased tortuosity and venous dilation can lead to impaired venous return from the lower extremities. However, people tend to blame many conditions on normal age-related changes unfairly. It is a common misconception that with age, it is normal for cardiac output to decline. In reality, decreased cardiac output is associated primarily with pathologic, not age-related, conditions.1
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Miller, C. A. (2012) Nursing for wellness in older adults (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

4. How will you assess Mrs. As understanding of her risk for other problems? Identify two assessment questions regarding specific prevention and screening for her. I will assess Mrs. As understanding of her risk for other problems by asking her why she should be aware of any changes in her optical ability and assessing her feet at the end of each day. These two assessments relate to possible risks of diabetic retinopathy and diabetic foot ulcers. If Mrs. A can tell me these possible complications are the reasons for being aware of her eyes and feet, I will conclude that she has an understanding. 5. Describe two interventions regarding Mrs. As medications and management of her diabetes. Two interventions regarding Mrs. As medications and management of her diabetes are to keep a diary of her glucose levels and use a diabetes meal plan that has been created with her healthcare provider. The meal plan would include making healthy food choices, limiting foods high in fat and salt, and eating foods with more fiber. Mrs. A should check her blood glucose level at least once a day and write down the level in her diary. When she makes appointments with her doctor she should bring the diary. These interventions will help remind Mrs. A how to reach her target glucose level, which will in turn reduce the risk for possible complications from diabetes. 6. Locate and identify one community resource in the Cleveland area that you recommend for Mrs. A, and explain why you believe this resource would be helpful to her. A community resource that I recommend for Mrs. A is the Cleveland Clinics new Diabetes Center. I believe this resource would be helpful to her because its goal is to get patients on the right track with their diabetes management before sending them back to their primary care physicians. The Diabetes Center also offers individual and group diabetes education classes year round. I think this would be a convenient and supportive system that Mrs. A could utilize as a tool for managing her diabetes.

Annotated Reference Database used: Google Scholar Keywords: recent research article normal aging diabetes APA Citation: Amati, F. & Dube, J. (2009) Physical inactivity and obesity underlie the insulin resistance of aging. American diabetes association: diabetes care, volume 32, pages 1547-1549. There is a common misconception that aging is the primary risk factor for the onset of type 2 diabetes. However, there are many research studies that conclude lifestyle factors such as lack of physical activity and obesity are the true main causes for insulin resistance, and therefore, type 2 diabetes. This study of young and old athletes, normal-weight, and obese subjects is one of the research studies that counter the age-related fallacy. It showed that regardless of age, athletes were more insulin sensitive than normal-weight subjects who were in turn more sensitive than obese subjects. I would recommend this article to a colleague because it is a supported and interesting study that combats a theory most people believe mistakenly. Other Sources Used for Case Study Cleveland clinic diabetes center. Retrieved from http://my.clevelandclinic.org/endocrinology/our-departments/diabetes-center.aspx. Miller, C. A. (2012) Nursing for wellness in older adults (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.