Diabetes Case Study


Assessment 1 Semester 1, 2013 Clients Situation This assessment consists of a 1400 word written discussion that requires you, the student, to identify and prioritise the clinical issues within the scenario below. For your top three (3) issues describe and justify the nursing actions /care that should be initiated. In addition identify and discuss one (1) issue relevant to “Community”. The development of a concept map is also mandatory and additional to the 1400 words. Refer to the NRSG366 Unit Outline where the Assessment Information and Marking Criteria are located. James Silva is a 46 year old Indigenous man who lives in a capital city near you. James lives with his wife and 4 children; Karen who is 13 years old, John who is 8 years old, Peter who is 6 years old and Janet who is 3 years old. James is an elder of his community and works part time as a self-employed accountant. Clinical History James developed Chronic Renal Failure three years ago as a result of his diabetes mellitus and is being treated with haemodialysis. His obesity since the age of 24 consequently led to James being diagnosed with Type 2 (non-insulin dependent) diabetes 10 years ago. James attends a local hospital satellite unit where he dialyses for 3-4 hours three time a week (Monday, Wednesday and Friday mornings). His haemodialysis access site is an arterio-venous fistula on his right forearm. Two months ago he developed a diabetic foot ulcer on his left outer ankle bone which is being dressed when he attends dialysis, by the dialysis nurse, with hydrogel. James’s current medical diagnoses are: ? Renal failure ? Haemodialysis ? Diabetes mellitus ? Early stage diabetic retinopathy (both eyes) ? Diabetic neuropathy (both feet)
It is Friday and when James turns up for dialysis he states he isn’t feeling too well. You take a blood sugar level which is 20 mmol/L and when you weigh him you find he has gained two kilograms since Wednesday

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