Question

case study
Julie is 45 year old mother and lives on a cropping farm, run as a family business, with her husband and his brother. Julie has three children same, aged 14; Katie, aged 12 and James aged 8.The two older children attend boarding school and return home for holidays. James is at home and attends the local primary school 50 km away.
Both Julie's boys have type 1 diabetes that she manages.
Julie has lived with her diabetes for 37 years and has many comorbidities due her both her diabetes and celiac disease. which she developed as a teenager. Julie has stage 3 chronic kidney disease, poor eyesight and osteoporosis. She is currently tryinģ to give up smoking after having smoked since of 16.
Julie currently sees her endocrinologist in large metropolitan hospital every three-month at outpatient clinic. It take her five hours to drive by car to the appointment in the city a journey that she takes with her husband. Her nephrologist is based at the regional hospital about 2 hours drive from home.Julie engages with a diabetes educator via phone and face to face monthly . The local hospital is 50 km away and is small, rural hospital. with a locum doctor and regular nursing staff, who cover the acute inpatient ward, and community registered nurse. She attends a community chronic diseases self management program at the local church hall run by the community registered nurse once a week in town and does her weekly groceries. Julie has expressed to the diabetes educator that she need more assistance with managing her own condition. She is concerned that her son who have type 1 diabetes, may end up with the same comorbidities as her because she has an autoimmune chronic condition

Question
identify 5 evidence based nursing intervention that are appropriate to implement in planning the patient's nursing care and provide a clear rationale for each intervention

Answer 1

1. Proper counseling to maintain a healthy nutritious diet and suggestion to consult a good nutritionist

Rationale:

In this condition, Julie's overall food intake is the first and most prominent factor that is affecting her health. She has diabetes (glucose problem), celiac disease (gluten problem) , poor eyesight (deficiency of vitamin A), osteoporosis (need of calcium and vitamin D) and well as kidney problem. That is why she needs to be educated about how her conditions can become worst with time if she does not changes her eating habit.

2. Strict advice to avoid all foods and beverages that contains gluten including wheat, barley, rye and oats

Rationale:

Celiac disease is an autoimmune disorder and the only possible cure for this problem is to strictly follow a gluten-free diet. A diet free from gluten can healp her to reduce the existing symptoms, heal the intestinal damage that has already been done and most importantly prevent future damage.

3. Medical management of osteoporosis accompanied by regular exercise and fall prevention program

Rationale:

Early medical intervention for this condition will significantly help in reducing as well as preventing the continuous bone loss and will help in relieving pain. A proper care plan will include bisphosphonates, estrogen therapy, raloxifene, salmon calcitonin, and the anabolic agent teriparatide. A fall prevention program will help in preventing fall and the risk of additional fractures which is very common in this condition. Regular physical activity and exercise can help with Julie's fragility, body positioning, muscle strengthening and ambulation.

4. Medication on time

Rationale:

Stage 3 chronic kidney disease is not curable and one can only prevent it from further progression. The kidney has been damaged already but Julie can significantly prevent the ongoing damage by taking medicines on time which will generally include angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. She also has to take good care of her diabetes as well as maintain an optimal blood pressure to achieve this goal.

5. Therapies and programs for Tobacco and Alcohal Prevention

Rationale:

Alcohal and smoking are two things that are highly responsible for her condition. So, it is very important for her to say no to both of them on an immediate basis. Bupropion which is a non-nicotine therapy and nicotine replacement therapies like gum, patch, nasal spray, inhaler can actually help Julie to achieve this goal.