Running Head: MOLLY’S CASE 1

Molly’s Case

Name

Name of institution
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Chronic disorders like hypertension, diabetes mellitus, arthritis and COPD are the main

source of disturbance and physical ailment among the old age people. Diabetes is a growing

phenomenon among older adults that is asserting burden on the economy and health around

the globe.Munshi et al., (2016) had claimed that diabetes is a common issue among old age

people. Moreover, its prevalence is growing in long term care facilities (LTC). Along with

this, diabetes is also associated with the significant disease burden and higher costs (p.308).

On the other hand, COPD (chronic obstructive pulmonary disease) is another problem of old

age. Fried, Fragoso, &Rabow (2012) have explained that COPD is a common disease in

elderly patients. Moreover, it is putting more burdens by enhancing the mortality, morbidity

and health care utilizations. However, COPD is highly challenging among old age people and

it is affecting both patients and care givers (p.2). Diabetes mellitus is caused by the

destruction of normal Beta cells of pancreas which are producing insulin. Insulin is a

hormone that helps in maintaining the normal glucose levels in the body. On the other hand,

COPD is including two diseases in it; chronic bronchitis and emphysema. Chronic bronchitis

is associated with the excessive secretions and air way obstructions. Moreover, emphysema is

associated with the air sacs. Air sacs lose their elasticity thus increasing the air trapping in the

lungs.

In the given scenario, Molly is the patient who is GP nurse (general practice). She has

spent her life in this profession and now she is suffering from a number of problems. These

problems include DM, Hypertension, Arthritis and COPD. She came in hospital with the

active complain of Shortness of breath and difficulty in breathing. Moreover, she came to

hospital with COPD exacerbations. Effing et al., (2014) had explained that a COPD

exacerbation is a problem of respiratory healthy. This is indeed associated with the acute

deterioration in respiratory health. Moreover, it is the main leading cause that can lead

towards the worsening of the quality of life among old age patients (p.1598). The same
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situation was with Molly; she was with COPD exacerbation and admitted for its treatment.

For the treatment of this situation she was given medications. These medications included

prednisone (steroids) and Inhalators (bronchodilators). It is common in that the patients who

are using prednisone may face fluctuations in the blood glucose levels. In fact, prednisone is

commonly, prescribed medication which can be used for a short period of time. However, its

use can disturb the blood glucose levels, particularly in those patients who are known case of

diabetes. The Molly’s situation actually aggrandizes the same. Prednisone is used to treat a

number of issues such as, inflammatory conditions, allergic reactions and asthma.

Furthermore, it can be cleared that the patients who are using prednisolone for the

treatment of COPD exacerbations can cause increased blood pressures. The patients who are

with diabetes and are suffering from diabetes they should be educated that this medication

can increase the blood glucose levels. Hyperglycemia among diabetic patients occurs in

midday and midnight. However, this should also be kept in consideration that these increased

blood glucose levels can lead to increase the mortality, morbidity and length of stay in the

hospitals during COPD exacerbation. The patients should be educated about checking the

blood glucose levels regularly during the treatment with prednisolone. Effing et al., stated

that while taking prednisolone the patients should be educated to check their blood glucose

levels for four times (before breakfast, lunch, dinner, and bed time) (2014, p.1601). Thus, the

health care providers and patient will be able to know any changes in the blood glucose

levels. Therefore, the blood glucose levels should be checked on regular basis if the patient is

diabetic and is on steroidal therapy. Moreover, adjustment techniques are necessary to be

used and stated to the patient. As molly is a retired nurse and she knows a lot thus, it will be

easy to tell her about the plan and get her involved in the care and treatment plan. Similarly,

the treatment options also include the use of fast acting diabetic medications which can

control the glucose during the prednisolone therapy.

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The nurse should also educate the patient that the steroidal therapy is for short time and it

will help to control the symptoms related to COPD. However, this will be stopped and after

that the glucose levels will be in the normal range. Moreover, the patient should be on insulin

therapy during COPD exacerbation due to the steroidal therapy and dose should be adjusted

by the endocrinologist. Molly is using metformin that is also very important and active in the

management of hyperglycemia in the patient with prednisolone.

On the basis of above discussion Molly can be given nursing care according to her

present condition. She is on prednisone and her blood glucose levels are increased thus, there

is a need of proper blood glucose levels checkups. This should be done after 6 hours and

particularly in morning and at bed time. Assist the patient during walking and help the

patient while going to the washroom and removing from the bed. Check the signs of

shortness of breath and difficult breathing. Provide comfortable position to the patient. In

COPD patient feels comfortable while sitting and breathes well in sitting position. Therefore,

provide support in this position and focus on the joints of the patients as these can hurt the

patient due to arthritis. Provide support on the bed as patient is weak and can be a victim of

fall. Provide oxygen as per requirements and also titrate the oxygen. Titration is necessary as

it prevents from the accumulation of gases and respiratory acidosis. Provide inhalers to the

patient and teach about the proper method of using inhaler.

Tell the patient about the side effects and disease process. Try to involve the patient in

the decision making process. Ask molly about the preferences and some important points

related to the treatment process. Get opinions of the patient related to the disease, disease

process, monitoring, medication and treatment methods. Involvement of the patient in the

treatment and care is considered important now a days. It is important as the patient is a

person and he has a right to give opinions and she/he should be listened properly and

involved.
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Medications contain both effects and side effects in the treatment. Thus, the use of the

medications and the reason of their use should be explained to the patient. This will help the

patient to reduce their anxiety related to the medications and what is going with them after

the use of the medications. For instance, Molly is using steroids to manage COPD

exacerbation but due to this medication her sugar levels are increasing. Although, she is

diabetic yet her sugar levels are not being controlled. This makes her worried; therefore, she

should be explained about the medications and their effects. Metformin is helping in

maintaining the glucose levels however, the short term use of prednisone is affecting the

blood glucose levels of the patient.

On the other hand, molly is using the medications for the treatment of hypertension

and arthritis. These two problems are with her and she takes medication for the management

of blood pressure and joint pain. So, all these reasons should be explained to the patient. This

will help the patient in reducing her/his anxiety. All the effects and side effects should be

explained to the patient clearly. Because, the rules of the good communication include; the

proper information provision to the patient.

As molly is knowledgeable and knows much about medications, techniques and

effects and side effects of the medication. The ever changing environment of the globe is

demanding for cost effective, innovative and evidenced based efforts for promotion of health

and wellbeing among old age people. It is also a point to remember that the old age people in

old homes, homes and in community centers feel isolated from the outer community.

According to Edvardsson et al., (2017), aged care has negative societal images in a number of

different countries. Moreover, these negative consequences have a great impact on the staff

job satisfaction at old homes (p.2). Every person in this world is unique and diverse by

his/her beliefs, values and performance. Therefore, a nurse must recognize those diversities

and must know about the stigmas, labels and differences which are related to the old age.
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Zhao et al., (2016) has explained that “Person-centered care is a holistic approach

which is concerned with the delivery of respectful and individualized care. Furthermore, it

provides negotiations and care offering choices that empowered the older people to be

involved in the health care decisions. In general, the patient centered care is based on four

characteristics; holistic, individualized, respectful and empowering (p.399). Maslow stated

that the person centered care is getting popularity around the globe. However, the main goal

of person centered care to improve the outcomes and care for people of all ages with diseases,

conditions and care needs (2013).

To explain this further, Hafskjold at al., (2015) has explained that the person

centeredness is a growing idea among healthcare professionals. This is actually an ethical

idea that the patient should be treated as a person. It is further elaborated that the patient

should be viewed for their social context and respected in person’s own care. On the other

hand, there are some traits of healthcare providers which influence the care and

communication. These traits include empathy, mindfulness and emotional intelligence (p.2).

The nurses are the front force in the healthcare provider’s team. Undoubtedly, the

nurses use their clinical skills (clinical judgment and decision making) to help the older

people to improve their health and to manage with the health problems and to achieve the

best quality of life regardless of their disease and problem type. According to Dambha-Miller

et al., (2016), patient centered care (PCC) is considered as a corner stone in health care

general practices. Thus, it can help in reducing the risk factor levels of various problems

among older people. Adding to this view, PCC is helpful in understanding the health beliefs

of the individual, patient preferences and mutual management of plans. Hence, these can

influence positively the health behaviors of the individuals such as, diet, physical activities,

smoking and alcohol intake (p.2).

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Bölenius et al., (2017) had found that person centered care focuses on older people’s

expressed needs, care planning and delivery of interventions. Furthermore, together with a

health care professional the psychological, functional and physical needs of the older people

are fulfilled (p.2).Thus, it helps in improving care, interpersonal relationships, and

involvement of the person in management and treatment plans and ultimately affects the

health and disability in a positive way. Furthermore, Zhao et al., had explained that PCC is a

selection and delivery of the interventions in a respectful way which are based on the needs,

preferences and values of the individuals (2016, p.399). Not to mention, person centered care

is a broad term that covers many areas of empowering, needs and preferences of the

individuals and older age people particularly.

Self care management plan of the patient (Molly) should involve the patient in the

management process. Ask the patient about the disease and give information about the

present management pathways of the disease. Although Molly is active and keeps herself up-

to-date regarding disease management still as a patient she needs information, education,

support and future planning for the management of the disease at home. Furthermore, she is

from another area and she is retired, her husband is not with her, her children left her alone

and she even don’t have driver’s license with her. Therefore, she is mentally disturbed and

needs emotional support along with medical treatment. Furthermore, molly is also excited to

get a tele health system of disease management.

Hospital information technology is the best way to help the patients. It is helpful in

provision of patient centered care. Cliff (2012) stated that the HIT is having a tremendous

potential to enable, support, and enhance patient centered care. Infect, the proper HIT

system is essential element of health care system that is designed to meet the patient’s needs,

preferences at right time, for right reasons and at right cost. Thus, HIT is to enhance the

effectiveness of the health care strategies, to improve patient care and improve proper
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communication among patient and health care professional. This ultimately, improves the

patient care and promotes better care (p.302). Thus, the role of tele health is increasing day

by day and patients are getting benefits at their door steps. Furthermore, the patients are

getting more and more better options for care and health related issues. Snyder, Wu, Miller,

Jensen, Bantug & Wolff (2011) has explained that the informatics in the health care setups

can improve the patient care. Eventually the patient cantered care can be improved in the

health care settings b the use of the important information technologies (p. 2).

The old age patients suffer from number of comorbids in the elder age and they have a

lot of complications due to these diseases. Diabetes, COPD, Hypertension and osteoporosis

are some of the problems which are being faced by the patients. However, nurses cane play

important role while caring these patients in the health care settings. Moreover, the patients

always in need of social, psychological and physical support from the health care

professionals at all the stages. Patient either educated or not always need information and

support to reduce their anxiety and depression regarding their health and disease. Health

informatics and HIT are technologies which are providing the patients with more benefits and

effectiveness.
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References

Bölenius, K., Lämås, K., Sandman, P., &Edvardsson, D. (2017). Effects and meanings of a

person-centred and health-promoting intervention in home care services - a study

protocol of a non-randomised controlled trial. BMC Geriatrics, 17(1), 1-9.

doi:10.1186/s12877-017-0445-0

Cliff, B. (2012). Using Technology to Enhance Patient-Centered Care. Journal of

Healthcare Management, 57(5), 301-303.

Dambha-Miller, H., Cooper, A. J., Simmons, R. K., Kinmonth, A. L., & Griffin, S. J. (2016).

Patient-centred care, health behaviours and cardiovascular risk factor levels in people

with recently diagnosed type 2 diabetes: 5-year follow-up of the ADDITION-Plus

trial cohort. BMJ Open,6(1), 1-8. doi:10.1136/bmjopen-2015-008931

Edvardsson, D., Sjögren, K., Lood, Q., Bergland, Å.,Kirkevold, M., & Sandman, P. (2017).

A person-centred and thriving-promoting intervention in nursing homes - study

protocol for the U-Age nursing home multi-centre, non-equivalent controlled group

before-after trial. BMC Geriatrics, 17(1), 1-9. doi:10.1186/s12877-016-0404-1

Effing, T. W., Lenferink, A., Buckman, J., Spicer, D., Cafarella, P. A., Burt, M. G., …

Bassett, K. L. (2014). Development of a self-treatment approach for patients with

COPD and comorbidities: an ongoing learning process. Journal of Thorac

Diseases, 6(11), 1597-1605. doi:10.3978/j.issn.2072-1439.2014.11.14

Fried, T. R., Fragoso, C. A., &Rabow, M. W. (2012).Caring for the Older Person with

Chronic Obstructive Pulmonary Disease. JAMA, 308(12), 1254.

doi:10.1001/jama.2012.12422

Hafskjold, L., Sundler, A. J., Holmstrom, I. K., Sundling, V., Van Dulmen, S., &Eide, H.

(2015). A cross-sectional study on person-centred communication in the care of older

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people: the COMHOME study protocol. BMJ Open, 5(4), e007864-e007864.

doi:10.1136/bmjopen-2015-007864

Munshi, M. N., Florez, H., Huang, E. S., Kalyani, R. R., Mupanomunda, M., Pandya, N., …

Haas, L. B. (2016). Management of Diabetes in Long-term Care and Skilled Nursing

Facilities: A Position Statement of the American Diabetes Association. Diabetes

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Snyder, C. F., Wu, A. W., Miller, R. S., Jensen, R. E., Bantug, E. T., & Wolff, A. C. (2011).

The Role of Informatics in Promoting Patient Centered Care. Cancer Journal, 17(4),

211-218. doi:10.1097/PPO.0b013e318225ff89

Zhao, J., Gao, S., Wang, J., Liu, X., &Hao, Y. (2016). Differentiation between two

healthcare concepts: Person-centered and patient-centered care. International Journal

of Nursing Sciences, 3(4), 398-402. doi:10.1016/j.ijnss.2016.08.009