Nursing And Health Sciences

The given case study is about Mr. John who has Down’s syndrome and Type 2 diabetes. The patient also suffers from a chronic illness that is Diabetes Mellitus. Down’s syndrome is a genetic disorder that results due to an error in the process of cell division, which is known as “nondisjunction” that leads to the formation of three copies of chromosome 21. The primary aim of treatment for individuals with Down’s syndrome is based on the intellectual and physical needs together with personal strengths and limitations (Foley et al., 2014). This essay will analyze health challenges that the patient may face due to his health condition and disability. It will interpret the how the health challenges may affect the health and wellbeing of the patient. Using the ICF model, it will discuss patients social participation is restricted by cognitive impairment and type 2 diabetes. Finally the essay will explain the interventiosn that nurse take to improve diet and physical activity in patients and promote positive health outcome in patient.

According to Escorpizo et al. (2013), Down’s syndrome is the most common genetic birth defect and results in mental retardation. It is a recognized fact that the individuals suffering from this syndrome posse an increased occurrence of autoimmune disorders that affects the endocrine as well as the non-endocrine organs (Foley et al., 2014). The cases of Down’s syndrome are associated with diabetes mellitus. The individuals suffering from Down’s syndrome have characteristic features and levels of intellectual disability. They face a number of challenges associated with health and development. The individuals suffering from Down’s syndrome has impaired facial features like small ears, flat face, small mouth and slanting eyes. They have abnormal thinking pattern and memory. Their intelligence level is below average. The patient is having two chronic health issues; Down’s syndrome and Diabetes mellitus. According to Rouquette et al. (2015) a number of individuals suffering from Down’s syndrome experience lesser secretion of insulin, mitochondrial dysfunction and enhanced oxidative stress in the beta cells of the pancreas that produces insulin. Type 2 diabetes mellitus is a metabolic disorder, which is characterized by insulin resistance, elevated blood sugar levels together with the lack of insulin. The common symptoms include unexplained weight loss, frequent urination and increased thirst. The other symptoms may also comprise feeling of tiredness and increased hunger. The research literature evidently reports enhanced outcomes of health when diabetes mellitus is managed in the community via education supporting for and improving the behaviors of self-care (Gulanick & Myers, 2013).  Nonetheless, it is not easy to be successful when an individual has an intellectual disability. Not only the individuals attempted for readjusting to a new life living with a disability, but also approaching to the terms by means of learning new routines and skills for managing their chronic illness (Escorpizo et al., 2013).

The International Classification of Functioning, Disability and Health (ICF) is a framework of World Health Organization (WHO), and measures health and disability at the individual as well as the population levels (Rouquette et al., 2015).  It is designed for enabling the measurement as well as impact of the interaction of health as well as disability in an individual. Health practitioner measures interaction of health by analyzing disability functions like functional impairment, activity limitation and activity restriction. Mr. John is a patient with diabetes and he has increased risk of mobility disorder, limited ability to perform daily task and intellectual dysfunction. As Mr. John is also a patient with Down’s syndrome and he may face health and development of challenges. Such patients require a lot of support and they may not be able to live an independent life. He may face delay in development and difficulties in learning. They lose the confidence to participate in social activities because of speech impairment and inability to speak clearly (Corry et al., 2013).  Among all the factors, one factor has been reported as an environmental barrier which is social attitudes. As the Mr. John is living in a community, he may face challenges due to the attitude of other people who do not understand what it means to have Down’s syndrome.  People do not see them as individual but a person with Down’s syndrome who has same complications. But, there is large variation in individuals with Down’s syndrome and they may face their own unique disability, strength and weakness. These effects together with the symptoms of Down’s syndrome signify that the potential activity of the patient is limited severely, denoting the participation of the patient in the activities that will directly as well as indirectly benefit the heath and well being of the patient in the given case scenario (Butcher et al., 2013). 

A nurse can utilize various strategies to assist John in managing diabetes. One strategy is proper physical activity and diet management plan for patients. According to Ley et al., (2014), evidence based clinical trials has highlighted the importance of nutrients and food modification on the prevention Type 2 Diabetes. It showed that observing the quality of food like amount of carbohydrate consumed is more important than the quantity of macronutrients. The nurse could adopt strategies to encourage John to diet rich foods like vegetable, legumes, and nuts and discourage him from eating refined grains, red or processed meats and sugar-sweetened beverages. Diet changes will help in reducing the risk of the disease and improve glucose level in Mr. John. It will also be important for nurse to teach her self-management intervention to control Mr. John’s diabetes. Self-management intervention is required for effective diet control and monitoring of blood glucose level. Nurse will play a role in educating Mr. John about how to maintain diabetes specific quality of life. Increasing physical activity has the greatest potential to improve metabolic control (Heinrich et al., 2015). Weigh loss intervention is also important for Mr. John as it will lead to improvement in glycaemic control, minimize risk factors for cardiovascular disease, quality of life and obesity related illness. The nurse can also utilize technologies like mobile phones, text messages, website and computer-based learning technology to educate and enhance physical activity learning in Mr. John. Reinforcement strategies like phone calls and email counseling is effective for behavioral change in Mr. John. They should educate the patient regarding self-management and should provide a structured education for type 2 diabetes (Pal et al., 2013). Regarding diet and lifestyle, they should tell the patient to consume a healthy diet and should perform physical exercises. A combination of aerobics and exercise may prove to be more efficient for managing the blood glucose levels in comparison to one type of exercise alone. Aerobic exercises improve the uptake of blood glucose levels by means of a greater action of insulin and are also independent of the alterations in aerobic capacity or mass of the muscles (Gregg et al., 2012). The care provider’s of the patient should be involved in providing education to the patient regarding the importance of physical activity and diet. In addition, the nurses must ensure that the care provider is informed properly since the self-management of the patient will be dependent on the awareness and knowledge of the caregiver regarding Down’s syndrome associated with type 2 diabetes (Scheen, 2014).  The patient in the given case scenario is vital for the accomplishment of this plan and therefore he must also be integrated. Gulanick & Myers (2013), suggested relating the patient since they emphasize only individuals who are learned properly are best positioned for participating in the activities of self-care (Wu et al., 2013).  Some other researchers recommended utilizing basic language to a suitable level. The tools such as visual aids can assist this procedure. For instance, making a diet plan, which comprises the figure of brain, pictures in which the individuals are eating healthy foods and performing exercises,  a figure of a doctor and hospital may strengthen the association between the efficient interventions/strategies and Down’s syndrome associated with diabetes (Steinsbekk et al., 2012).  These interventions/strategies are predominantly important for the patient as his intellectual disability will affect his ability of understanding and retaining these details. A number other strategies can be put into practice for assisting the patient such as making a diet chart, maintain a food dairy, performing different new exercises effectively (Heinrich, Schaper  & de Vries, 2015).

In the end, it can be concluded that it is apparent that considering the relation between intellectual disability and chronic illness is necessary for the nurses for informing their practice. The dilemma, which is faced, by the patient and his care provider in such an environment involves the balancing of needs for the promotion of involvement, but with the recognition of the patient’s activity restrictions currently that he exists with a chronic illness and a disability. It exerts an effect on the on the daily activities of the patient in the given case scenario. The analysis of case study highlighted that nurse should not also understand the interaction of other factors such as environmental and social barrier to judge the level of severity of disease. Understanding of the health challenges that can limit patients daily life activities will help in planning effective therapeutic intervention for patient with diabetes and cognitive impairment.

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