Nursing Assignment Sample: Essay on Type 2 Diabetes Case Study of John

1. Introduction

A 50 years old man named John has recently been diagnosed with Type 2 diabetes, it is commonly known as a chronic metabolic disorder which requires much improvement in lifestyle. On top of feeling under the weather, he has hypertension and obesity, which heighten his risk for additional problems. John, however, is not compliant with prescribed oral medications for the use of Metformin for glycaemic control and Atorvastatin for cholesterol management, lacking adherence to medical advice relating to weight management and alcohol intake (Bailey, 2024).

In addition, John has recently suffered job loss due to organisational cutbacks piling up financial and emotional stress. His unemployment means that his household is already under economic strain. John has led a socially active lifestyle, eating out and drinking with friends, making the changes he now needs in diet and lifestyle more than tricky. The diabetic ulcer on his right heel is a significant concern in John’s health status. The signs of infection from this wound have increased; there is more redness, pain, depth, and yellow discharge (Li et al., 2021). With diabetic ulcers being of such severe potential, especially for the threat of infection, delayed healing and even amputation in more serious cases, immediate medical and nursing intervention is essential.

2. Application of Anatomy and Physiology in John’s Care

In John’s case, it is essential to understand the relationship between normal and abnormal anatomy and physiology. With a recent diagnosis of diabetes and a history of hypertension and obesity, those are physiological challenges that affect his health in a whole range of ways (Jia & Sowers, 2021). At the moment, he presents with a condition which demands close attention to the prevention of complications, especially his diabetic ulcer, which has demonstrated deterioration.

Type 2 diabetes mellitus is a clinical condition referred to as insulin resistance with impaired capacity to regulate blood sugar. In a healthy individual, the purpose of insulin is to transport glucose into cells for proper energy processing (Małkowska, 2024). In John’s case, though, his body’s cells have become less responsive to insulin, so his blood glucose is persistently high. It is a prevalent condition that is associated with widespread complications (damage to blood vessels, increased risk of cardiovascular disease, and poor wound healing). Diabetic neuropathy is also a result of inadequate glucose control, which damages the nerves, making them unresponsive and causing decreased sensation, particularly in the lower extremities (Bodman & Varacallo, 2024). Since John has no early pain with his ulcer and it is progressing, it is most likely that neuropathy contributes. Additionally, the prolonged hyperglycaemia provides a pristine setting for bacterial growth, increasing the likelihood of infection and making wound care more arduous.

Another critical issue that needs to be considered in John’s case is his hypertension. This results in high blood pressure, which puts extreme stress on blood vessels, which causes the endothelium to become dysfunctional and tend to develop atherosclerosis (Bodman & Varacallo, 2024). Diabetics, particularly those with additional hypertension, suffer from impaired blood circulation, including the extremities, which significantly prevents their diabetic ulcers from healing (Selvarajah et al., 2019). Poor blood flow deprives the wound site of oxygen and essential nutrients, slowing tissue repair and leading to infection. Moreover, lifestyle factors, like drinking alcohol and consuming a diet rich in fats, can also worsen hypertension and add to the likelihood of John experiencing cardiovascular events like a heart attack or stroke.

John’s health challenges have much to do with obesity. Having a high amount of excess adipose tissue further worsens his diabetes progression and leads to an increased risk for uncontrolled hyperglycemia. This weight is additional to the heart, putting strain on the cardiovascular system, so the blood pressure is elevated, and more complications follow (Tackling & Borhade, 2023). In addition, obesity also puts pressure on the lower extremities, particularly the feet, and increased mechanical stress on the skin increases the risk of ulcers forming. For John, it is a challenging combination of low blood circulation, high glucose levels, and pressure points from the associated obesity.

A diabetic ulcer is one that you must pay close attention to immediately. Such an infection must be immediately resolved as it suggests yellow discharge. Several physiological factors contribute to poor wound healing in diabetic patients, including peripheral neuropathy, peripheral arterial disease and immune dysfunction (Patel et al., 2019). Sensory reduction caused by neuropathy means that foot injuries are less apparent and present earlier than detected. Lack of blood flow (diminished) due to the disease results in poor oxygen delivery and nutrient supply to the affected tissue (Burtscher et al., 2023). Prolonged hyperglycemia also weakens immune function and dampens the body’s ability to battle infections.

3. Psychosocial Factors Influencing John’s Health and Wellbeing

Psychosocial implications associated with John’s diagnosis of Type 2 diabetes, his recent job loss, financial stress as well as problems related to the change of lifestyle are essential and need to be considered during his nursing care (Paduch et al., 2017). His ability to manage his condition is dependent on how well he plays his physical and psychological well-being off each other. Psychosocial factors, including emotional distress, social support, lifestyle habits and economic stability, greatly influence his overall health outcomes.

A primary concern is the impact of John’s job loss. Indigenous employment gives a sense of financial security and a meaning, purpose, and habit of mind. Emotional distress, reduction of self-esteem and increased anxiety about his future are likely to follow the loss of his job as a delivery driver in Barnsley (Beaton et al., 2022). Unemployment may also put a financial strain on him, which makes it challenging to afford healthier food choices, schedule medical appointments or stay on medicine. Stress related to job loss can also contribute to poor glucose control by triggering hormonal responses and increasing blood sugar (Merabet et al., 2022). Therefore, his health is only going to become worse if he is not able to manage stress effectively.

A second obstacle in adapting to his new lifestyle is John’s long-standing social habits, like frequenting restaurants and drinking alcohol with friends. These were probably essential parts of his social identity, and their reduction may leave him lonely or frustrated (Merabet et al., 2022). There will be social pressure to keep up with these habits, and his friends and partner will partake in it as it may be difficult for him to make even necessary dietary and lifestyle modifications. John may need the support of others to help him with motivation and to help him adhere to his diabetes management plan.

He also has a relationship with his husband of ten years, Barry, which is essential to his well-being. There is the question of whether Barry’s presence would be an emotional support and an added financial burden to their household since he is unemployed (Ingrosso et al., 2022). Furthermore, Barry’s ways of living may either facilitate or impede John’s capacity to perform well. The adjustment process may be even more difficult if Barry does not actively support John’s need for a healthier diet or reduced alcohol consumption. Partner involvement in healthcare lifestyle changes may be encouraged for John’s adherence to medical advice and to generate a more supportive home environment (Matthews et al., 2024).

The emotional stress of enduring a chronic illness is another key factor in John’s well-being. Type 2 diabetes is diagnosed new when it can cause psychological distress such as anxiety, depression and a sense of hopelessness (Matthews et al., 2024). For example, his diabetic ulcer may also be progressively worse and increase his understanding of vulnerability and fear of complications such as infection or amputation. These concerns might make him less willing to engage in such self-care activities sufficiently to attend to himself or seek medical help promptly.

John’s mental health may also be affected by stigma regarding diabetes and obesity. The public's view of diabetes tends to identify the condition with poor lifestyle, self-blame, and guilt. If John absorbs this set of values from society, he might have low self-worth and be unable to practice good health behaviours (Paduch et al., 2017). Moreover, if she has experienced discrimination or if interactions have been rude in a healthcare setting, she is less likely to go for regular medical care, which will, in turn, heighten the risk of complications.

John could cope with these challenges through psychological interventions, for instance, through the use of stress management peer support groups and cognitive behavioural therapy. Open communication about his feelings, concerns, and fears encourages emotional resilience and helps him navigate his transitions to a healthier lifestyle (Patel et al., 2019). John can also be empowered by education on diabetes self-management in a nonjudgmental and supportive way, which will help him to take control of his condition and minimise distressful feelings.

4. Pharmacological Interventions and Nursing Considerations

Pharmacological interventions to promote John’s cardiovascular health will include treating his Type 2 diabetes and hyperlipidaemia (Suman et al., 2023). With his medical history, prescribed medications, diabetic ulcer, and the parameters of a nursing plan of care is needed to address adherence, mitigate side effects and achieve optimal therapeutic outcomes.

The first-line medication for Type 2 diabetes is Metformin 500 mg twice daily, and John has been prescribed this (Baker et al., 2021). Metformin decreases hepatic glucose production, enhances insulin sensitivity, and enhances glucose uptake by peripheral tissues. It lowers blood glucose levels and reduces the chances of long-term diabetes complications. On the other hand, Metformin has the side effects of gastrointestinal distress, such as nausea, diarrhoea (Andreadi et al., 2023), and abdominal discomfort, which may be a barrier to John’s adherence. There is a good likelihood that addressing any side effects by making dietary adjustments and slowly ramping up the dose would increase John's compliance, as he is already under stress and struggling to adjust to lifestyle changes. Like all medications, metformin also has a risk for lactic acidosis, particularly among people with renal impairment (Baker et al., 2021). Thus, regular renal function monitoring is necessary to avoid complications.

The other central pharmacological intervention in John’s regimen is Atorvastatin 10 mg at night for cholesterol management. Atorvastatin is a statin drug that inhibits HMG-CoA reductase and reduces low-density lipoprotein (LDL) cholesterol and the risk of cardiovascular events (Ray, 2024). Control of John’s cholesterol to prevent further vascular complications is given to his history of hypertension and obesity. Despite this, some people have problems with statins, muscle pain, fatigue, and rhabdomyolysis (Pergolizzi et al., 2020). John should be told to inform the doctor if he experiences any unexplained muscle weakness or pain that may be an adverse effect and requires dose adjustment or another form of treatment.

John requires strict blood glucose control to heal wounds and preserve infection risk. If his blood sugar levels are poorly controlled even though he is on metformin, further pharmacological interventions, including SGLT2 inhibitors or GLP-1 receptor agonists, could be considered (Wilcox et al., 2020). Given John’s obesity, these agents could provide cardiovascular benefits and weight loss. Although they are prescribed cautiously, taking into account any contraindications and patient-specific factors, they are not always practical.

Another important aspect of John’s care is pain management, especially his diabetic ulcer. If he has pain related to the ulcer, which is severe according to him, he will probably be recommended some analgesics, such as paracetamol or non-opioid pain relievers. However, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be done cautiously as they affect renal function and worsen cardiovascular risks in diabetic patients (Drożdżal et al., 2021).

The signs of worsened ulceration, such as yellow discharge, present a concern for infection control. Antibiotic therapy is indicated based on wound culture results of confirmed bacterial infection. Diabetic foot infections are treated with empirical antibiotics, such as flucloxacillin or co-amoxiclav, but treatment should be individualised according to bacterial sensitivity and local antimicrobial guidelines (Drożdżal et al., 2021).

5. Wound Management and Preventative Care for Diabetic Ulcers

Delayed healing due to impaired circulation, neuropathy, and high blood glucose levels is one of the most serious complications of Type 2 diabetes: diabetic ulcers (Andreadi et al., 2023). For John, the ulcer on his right heel has worsened, with a look of infection, yellow discharge and increased pain. Reduction of the risk of further complications, for example, deep tissue infection, osteomyelitis or even lower limb amputation, depends on effective wound management and preventative strategies.

John’s first step is a comprehensive wound assessment. The status of the ulcer, such as size, depth, exudate, and the condition of surrounding tissue, needs to be evaluated regularly, and variations in the progress of ulcer healing need to be monitored (Andreadi et al., 2023) The presence of yellow discharge infers infection, which can occur in that bacteria, a so manipulation of microbiological analysis to determine the causative bacteria causing the disease and the treatment with the appropriate antibiotics. It also should include an assessment of worsening conditions, including peripheral perfusion, sensation, and signs of systemic disease (Guo et al., 2024). Preventing infection related to wound care interventions should promote tissue regeneration and maintain an optimal healing environment.

Necrotic tissue needs to be removed, and the bacterial load needs to be decreased to facilitate granulation to form. Depending on the wound condition, mechanical, enzymatic, and autolytic debridement methods may be performed. Properly selecting wound dressing is also essential; hydrocolloid, alginate or foam dressings may absorb exudate and moisten the healing environment (Nowak et al., 2022). Topical antimicrobial dressings containing silver or iodine may be needed to keep bacteria under control if bacterial colonisation or infection persists.

John’s ulcer management needs to control his glycemic control. Diabetes poorly controlled reduces the immune system's ability to fight, and delivering oxygen to cells delays healing. Maintaining optimum blood glucose levels through medication adherence, diet, and behavioural modification is essential (Nowak et al., 2022). Long-term glucose control can be assessed using regular HbA1c monitoring, and daily checks of capillary blood glucose can be made to prevent wound deterioration caused by hyperglycaemia.

Another critical aspect of wound management is the addressing of circulatory issues. Peripheral arterial disease (PAD), which reduces blood supply to the lower extremities, often makes things worse for diabetic ulcers (Rümenapf et al., 2024). Compression therapy and vascular assessments may be necessary to ensure adequate circulation. Vascular interventions such as angioplasty may be considered if PAD is present to improve blood flow (Bethel & Annex, 2023). During sitting, especially in comfort chairs, nurses should help the patient do foot elevation to improve blood circulation and relieve the pressure on the ulcer site.

Conclusion and Recommendations

Johns’ case is fraught with complicated physiological, psychosocial and social challenges that necessitate a holistic, multidisciplinary approach to care. His recent diagnosis of Type 2 diabetes, history of hypertension, obesity, and progression of his diabetic ulcer has placed him at high risk of further comorbidities. His psychosocial circumstances, such as job loss, financial insecurity, and inability to adapt to life changes, also worsen his health condition. The nursing care of the individual involved must incorporate medical management, patient education, psychosocial support and preventative strategies to help in his all-round good health (Bethel & Annex, 2023).

Applying anatomy and physiology to how John is cared for shows the importance of describing how diabetes, hypertension, and obesity intersect to affect his health. Comprehensive diabetes management is essential because his metabolic dysfunction leads to insulin resistance, poor circulation, and delayed wound healing. Blood glucose levels are stabilised through healthcare pharmacological interventions such as Metformin and Atorvastatin, reducing CV risk. Further, non-adherence is a problem due to his current life stressors.

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References

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