Type 2 Diabetes Leg Ulcer Case Study

This essay will focus on Molly who is an 82-year-old female who has type II diabetes and has developed a leg ulcer. This essay will primarily focus on Molly’s leg ulcer. It will also discuss how primary health care (PHC) relates to the patient, how it can assist Molly with her health problems, providing her sufficient information and adequate care. Two principals will be discussed from the Wellness Model, these include ‘positivity is empowerment’ and ‘wellness is an active process’ and how it relates to Molly’s situation. A learning program will also be presented; this will discuss two teaching methods in regards to the leg ulcer and new skills and behaviors that can benefit Molly. It will also discuss what other health professionals can be included in her care and resources that can support her learning. The essay will also discuss the support that can be given to her husband after she has passed away.

The leg ulcer that Molly has developed can impact on her life dramatically, it may cause Molly to feel self-conscious, it can force Molly to socially isolate herself from the community and spend her time indoors. It may also affect her health, due to the leg ulcer; she will be unable to mobilize independently due to pain, increasing the risk of more pressure ulcers. Primary healthcare (PHC) is essential care that is made to be accessible to all people. It is based on various factors such as practical, scientifically, technology and socially acceptable methods. It requires the full participation of individuals and it is important that primary healthcare is affordable to maintain self-reliance and self-determination (Koutoukidis, Stainton, & Hughson, 2013). Primary health care has an important aspect to Molly’s health, it can assist Molly’s developed leg ulcer. PHC will provide her with the sufficient information and adequate care that she will need to manage the leg ulcer. It is very important for Molly to receive the appropriate care that she requires as it will allow her to understand her condition (Koutoukidis, Stainton, & Hughson, 2013). Molly is financially stable, as she has been seeking medical treatment, where she has to treatment for her leg ulcer. The local GP has also recommended for Molly that she should sit with her leg up to promote healing. PHC will also allow Molly to contribute in decision-making, this will permit her to have a say in the care she will receive, and make her feel in control of the situation and to maintain her independence (Koutoukidis, Stainton, & Hughson, 2013).

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Wellness is defined as having maximum health, it relates to an individual making a decision that contributes in improving their health and gives an opportunity for them to be able to live to their full potential (Koutoukidis, Stainton, & Hughson, 2013). Wellness is identified to be ‘holistic’, and includes 6 dimensions, social, occupational, spiritual, physical, intellectual and emotional wellness (Southern New Hampshire University, 2015). Using the wellness model, we are able to support Molly by helping her make positive changes that improve her level of health. By promoting one of the principles ‘Wellness is an active process,’ Molly will be provided with assistance and education that will expand her knowledge, permitting her to learn more about how to manage her leg ulcer, and learn different ways in handling her health concerns, increasing her independence (Southern New Hampshire University, 2015). Another principle that we can promote for Molly is ‘Positivity is empowerment’. This principle takes into consideration ones feelings, meaning that having a negative attitude can affect the health outcome, whereas, having a positive attitude can help the patient feel empowered and in control of a situation (Southern New Hampshire University, 2015). Promoting the principle ‘Positivity is empowerment’ for Molly will motivate her into making significant changes in her health without having the need to doubt herself in her decisions. Positivity has a great effect to how Molly perceives her situation whereas; having a negative effect can bring her down and impact on her healing (Southern New Hampshire University, 2015). Health care providers will also be there to support Molly in anything that she will need and reassure her if things don’t go to plan.

Within Australia, the incidence of diabetes amongst the adults is 4%, this rate has risen from 1.5% since 1989 (Australian Institute of Health and Welfare, 2015). There are two main issues that are related to insulin in type 2 diabetes, the inability of the body to secrete insulin and insulin resistance. Normally, insulin would bind to receptors on cell surfaces and initiates a reaction that is involved in glucose metabolism. However, in type 2 diabetes, this process is impeded, which leads insulin less effective at stimulating glucose uptake by the tissues and the release of glucose in the liver (Farrell & Dempsey, 2011).A factor that may have caused Molly’s leg ulcer is the loss of sensory due to neuropathy. Pain and temperature are the first sensations that are affected by neuropathy, this makes it difficult for the patient to feel tissue damage, inflammation, or injury (Meiner, 2014). Molly’s eyesight may be deteriorating due to diabetic retinopathy (DR). This is mainly caused because of micro vascular damage that diabetes inflicts in the body. Hyperglycemia damages the retinal vasculature and the progression of retinopathy is caused by the severity and duration of high blood sugars (Shah, 2008).

Both a physiotherapist and a dietician would be recommended to assist Molly on her health issue. The physiotherapist would be involved in renewing her mobility and relieve any pain that she may be feeling, a dietician will be able to introduce Molly to a new healthy eating diet (Funnel, Koutoukidis, & Lawrence, 2009). Eating healthier can promote wound healing, as her blood sugar levels will be manageable increasing the blood supply to her feet (Diabetes Australia, 2015). Molly can be taught how to look after her leg ulcer by demonstrating how to treat and prevent infections. A way we can teach her is by using very simple verbal discussion and demonstrations so that she is able to understand. If she is unable to understand what is discussed, she can be provided with information sheets or pamphlets with large writing and pictures showing her instructions. By doing this it will help Molly understand on how to keep her ulcer clean and prevent further infections. This is a very important skill to have if she is unable to access a clinical facility, Molly will be able to change her dressing on her own or with the help of her husband (The State of Queensland, 2012). A community program that Molly can be introduced to is The Leg Ulcer Prevention Program, which is available for people who are receiving care for leg ulcers. This program assists people to better care for their ulcer, by helping them manage chronic disease risk factors, promote wound healing and the reoccurrence of leg ulcers. This program also helps patients with treatment and helps them take ownership of their leg ulcer and self-care activities (Kapp, Miller, & Donohue, 2010). An additional program that can be used to support Molly’s learning program is a pamphlet called ‘The Care of Venous Leg Ulcers’ this pamphlet is able to explain how essential it is to manage a leg ulcer and it clarifies how to care for it on a daily basis. This pamphlet must also be altered to meet Molly’s needs such as enlarging that word size so that she will be able to read more clearly (AWMA, 2012).

Grief is described as feelings experienced by an individual that accompany an unexpected or actual loss that may occur in life (Farrell & Dempsy, 2011).

Supporting the spouse in this grieving situation is important. Developing a therapeutic relationship between the enrolled nurse and spouse can allow the spouse to feel comfortable and encouraged to communicate their feelings and work through it. This will allow the spouse to express their feelings of loss, even anger (Funnel, Koutoukidis, & Lawrence, 2009). The nurse has to remember that if anger is shown, it is not towards them or anyone but a way of responding to the situation occurring. By encouraging the spouse to communicate and express their feelings of loss are important components of a nurse’s role. The nurse requires a caring, willingness to listen and an understanding empathic approach. If the nurse shows this, the person is more likely to feel comfortable to express their feelings if they feel the nurse is willing to listen to their concerns (Funnel, Koutoukidis, & Lawrence, 2009). In a grieving situation the nurse cannot grieve for a person; the nurse will acknowledge the loss, by facilitating the expression of feelings and thoughts and providing appropriate support as they move on the feelings of grieving. The nurse should respect the spouse if he is not willing to express his feelings of grief, although the nurse can make it clear that if he decides to do at a later opportunity it can be possible (Funnel, Koutoukidis, & Lawrence, 2009). A service that would be recommended for Pat is Reach Out. Reach out (http://au.reachout.com/working-through-grief#strategies%20<%22) is a service providing strategies and support to individuals who are going through grief, it will give Pat the reassurance that there are people out there, including his family who will be there to support him in this very difficult time.

In conclusion Molly was able to receive all the appropriate care the she needed to address her health issue but unfortunately has passed away. Pat is currently under care with the support of family members and health care providers.

References:

Australian Wound Management Association (AWMA). (2012). Care of Venous Leg Ulcers. Retrieved from AWMA: http://www.awma.com.au/publications/vlu_patient_info_a4_2012-08-21.pdf

Australian Institute of Health and Welfare. (2015). Diabetes. Retrieved from Authoritative information and statistics to promote better health and wellbeing: http://www.aihw.gov.au/diabetes/

Diabetes Australia. (2015). Diabetes and Your Feet. Retrieved from Diabetes Australia: https://www.diabetesaustralia.com.au/Living-with-Diabetes/Mind–Body/Diabetes–Your-Feet/

Farrell, M., & Dempsey, J. (2011). Smeltzer and Bare’s Textbook of Medical-Surgical Nursing, volume 1 & 2 (2nd Edition). Philadelphia: Lippincott Williams & Wilkins

Funnel, R., Koutoukidis, G., & Lawrence. (2009). Tabbner’s Nursing Care (5^th Edition). Australia: Elsevier

Kapp, S., Miller, C., & Donohue, L. (2010). The Leg Ulcer Prevention Program: nurse perspectives on a multimedia client education package for people with venous leg ulcers. Wound Practice & Research, 18(2), 91-99.

Koutoukidis, G., Stainton, K., & Hughson, J. (2013). Tabbner’s Nursing Care: Theory and Practice (6^th Edition). Australia: Elsevier.

Meiner, E. S. (2014). Gerontologic Nursing (5th Edition). Retrieved from https://books.google.com.au/books?id=V-4TBQAAQBAJ&pg=PA620&dq=the+relationship+between+leg+ulcers+and+diabetes&hl=en&sa=X&ei=TnMOVbq-MYKB8gW5r4HwAQ&ved=0CDYQ6AEwBTgK#v=onepage&q&f=false

Reach Out Australia. (2014). Working through grief. Retrieved from ReachOut.com: (http://au.reachout.com/working-through-grief#strategies%20<%22)

Shah, C. (2008). Diabetic retinopathy: A comprehensive review. Indian Journal Of Medical Sciences, 62(12), 500-519. Retrieved from http://go.galegroup.com.ezproxy.lib.monash.edu.au/ps/retrieve.do?sgHitCountType=None&sort=RELEVANCE&inPS=true&prodId=AONE&userGroupName=monash&tabID=T002&searchId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=AdvancedSearchForm&currentPosition=1&contentSet=GALE%7CA195127190&&docId=GALE|A195127190&docType=GALE&role <%22>=

Southern New Hampshire University (2015). Wellness Model. Retrieved from Southern New Hampshire University: http://www.snhu.edu/2354.asp

The State of Queensland. (2012). A way with words: A guideline for the portrayal of people with disability. Retrieved from https://www.qld.gov.au/disability/documents/community/way-with-words.pdf