Managing type 2 diabetes in an elderly patient with multiple comorbidities
This nursing case study explores challenges in managing care for a 75-year-old male patient diagnosed with Type 2 diabetes, hypertension, and stage 3 chronic kidney disease (CKD). The essay writer discusses some of the key nursing interventions that address glucose monitoring, medication management, and the complexities of polypharmacy. The provided care focused on the simplification of his medication regime to avoid drug interactions, adjustment of insulin and blood pressure medications, and addressing complications related to CKD. Also, it was deemed impossible to exclude the family of the patient from participation in the enhancement of medication adherence and making necessary lifestyle changes. Thus, this sample paper identifies that treatment for elderly patients with several comorbid conditions needs to be undertaken in a strategic and holistic manner.
November 15, 2024
* The sample essays are for browsing purposes only and are not to be submitted as original work to avoid issues with plagiarism.
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Case Study: Managing Type 2 Diabetes in an Elderly Patient with Multiple Comorbidities
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Case Study: Managing Type 2 Diabetes in an Elderly Patient with Multiple Comorbidities
Type-2 diabetes management, especially in elderly patients, is quite challenging in the
presence of other comorbid conditions such as hypertension and CKD. Thus, increased age is
linked to increased vulnerability to various complications as a result of physiological changes,
which are further aggravated by chronic conditions. The nursing case study here is representative
of a 75-year-old gentleman with T2D, hypertension, and stage 3 CKD, representing some of the
key nursing interventions in monitoring his glucose level, management of medication, patient
education, and complications of polypharmacy. The history of the patient, clinical presentation,
and nursing interventions done in this study delineate the complex nature of managing an elderly
patient having multiple health issues. This case study highlights that there should be a holistic
approach to the management of such patients, with coordination of care, prioritizing medication
safety, and ensuring patient understanding of and adherence to medication.
Patient History
The patient is a 75-year-old male with the background of a prolonged history of
uncontrolled hyperglycemia and gradual decline in renal function. His medical history includes
the following conditions:
â—ŹType 2 Diabetes, diagnosed 10 years ago, with recent poor control as evidenced by
elevated HbA1c levels.
â—ŹHypertension, diagnosed 15 years ago, with inconsistent adherence to medications.
â—ŹChronic Kidney Disease (Stage 3), diagnosed 5 years ago, marked by gradually
declining renal function, with elevated serum creatinine levels.
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â—ŹHyperlipidemia is managed with statin therapy.
â—ŹOsteoarthritis, which limits mobility and exacerbates his health complications.
Currently, some of the medications that the patient takes include:
â—ŹMetformin 500 mg twice daily
â—ŹLisinopril 10 mg daily
â—ŹAmlodipine 5 mg daily
â—ŹSimvastatin 20 mg at night
â—ŹFurosemide 40 mg daily to manage fluid retention due to CKD
The patient is a non-smoker but he hardly exercises at all due to osteoarthritis. Overall,
his dietary plan could have been adequate for his type 2 diabetes; however, the client finally
faced some issues, mostly because he mentioned that his appetite had been poor, and meal
preparation was an issue since he spends most of his time seated.
Diagnosis and Assessment
Upon admission, the patient presented with the following clinical findings:
â—ŹBlood Pressure: 165/90 mmHg, indicating poorly controlled hypertension.
â—ŹBlood Glucose: 18 mmol/L, reflecting poorly controlled diabetes.
â—ŹSerum Creatinine: 1.8 mg/dL, indicating deteriorating renal function.
â—ŹUrine Output: 600 mL/day, below normal, suggesting potential fluid retention or kidney
dysfunction.
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â—ŹBody Weight: 68 kg, with a 5 kg weight loss over the past three months.
These findings indicated that the patient required intensive management to stabilize his
condition. The nursing assessment showed concerns about the patient's medication adherence,
cognitive decline due to aging, and a lack of understanding regarding his disease processes. It
was also indicated to involve his family in his care to properly manage his complex needs.
Nursing Interventions
There is a multidimensional process involved in the management of elderly patients with
diabetes and CKD. Some concerns to focus on are blood glucose management, hypertension
management, teaching to the patient, and polypharmacy. In this case, blood glucose needed to be
monitored every four hours, for which a large-print glucose meter was given by the nurse to the
patient, keeping his visual impairment in mind (Ahn, Yang, & Park, 2024). The family was able
to become more involved in the process. Because of the deterioration in renal function,
metformin was stopped to avoid the possibility of lactic acidosis and was replaced with insulin,
whose dosing frequency was changed according to glucose readings. It was also important to
manage hypertension in order not to increase the risk of cardiovascular events and further renal
impairment. Blood pressure was followed to maintain the values within the target limit of 140/90
mmHg by modifying drugs accordingly. The dosage of lisinopril was reduced and continued to
minimize complications related to CKD. Amlodipine was adjusted downward to establish control
of blood pressure without additional concern of fluid retention. The nurse continually assessed
hypotension/dizziness related to medication adjustment, keeping the blood pressure within stable
limits (Chimirri, et al., 2013).
Patient Education and Diet Management
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In the care plan, patient education was an important concern because knowledge of his
disease and respective treatments is vital for effective self-management (Carmago-Plazas,
Robertson, & Alvarado, 2023). He was taught about renal-friendly, low-sodium, and
low-carbohydrate diet modalities that have been helpful not only in maintaining his blood
pressure within normal limits but also in managing his blood glucose levels as well. A dietitian
collaborated with him on developing a meal plan, knowing his appetite was now poor, and his
physical limitations might make meal preparation challenging. He was encouraged to eat more
nutrient-dense meals, with an emphasis on fresh vegetables, lean proteins, and low glycemic
index foods for overall health support. Given the patient's osteoarthritis that limits his mobility,
light exercises were still advocated such as chair exercises and short walks to assist in improving
circulation and maintaining weight (Kong, Wang, & Zhang, 2022). Joint protection strategies
were also given by the nurse to limit discomfort and enable the patient to continue some form of
physical activity. One of the most important parts of patient education was medication
adherence. She explained the need for adherence to prescription, as this will lead to worsening of
hypertension, uncontrollable blood glucose, and further renal deterioration. The nurse discussed
all these matters with him and his family so that they were aware of all issues regarding the
treatment.
Polypharmacy or multiple drugs taken played a huge role in managing this patient.
Because elderly patients have many chronic conditions, careful medication management is
required due to the increased drug interactions and side effects. The current medications of the
patient were reviewed to simplify the regimen in order to eliminate those that are not necessary
and lessen the likelihood of adverse effects. For instance, the risk for electrolyte imbalance was
precipitated with the administration of the diuretic furosemide, while insulin adjustment was
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done to avoid hypoglycemia. The nurse was observant of these changes during this period.
Follow-up laboratory tests on the medications were done at regular intervals, receiving renal
function, electrolytes, and blood sugar were to ensure the effectiveness and safety of medication
without compromising kidney or other organ functions.
Challenges and Complications
This patient had many problematic aspects of care, where every single treatment he
received required special attention, constant reevaluation, and follow-up. One of the major
complications was polypharmacy, the ever-present concern for drug interaction and serious side
effects, which were putting the health of a patient in jeopardy. Drugs had to be reviewed
regularly for modification where necessary to make the treatment safe and effective. The
management of CKD was even more challenging because it included the monitoring of his
diabetes and hypertension, frequent medication changes, and continuous tests regarding renal
function. Moreover, mobility problems and mental deterioration made it too hard for him to
follow the care program. Considering this, the care team included the patient's family in the
process. The family members were educated on the patient's care plan related to medication
management and encouragement of nutrition and exercise for the patient (Busebaia, Thompson,
Fairbrother, & Ali, 2023). The impact, thus, of this involvement included the following: the
patient was compliant with prescribed medications; he was better educated about the proposed
treatment and care goals for him.
Conclusion
In conclusion, this case study has revolved around the areas of difficulty in managing the
care of an elderly patient with Type 2 diabetes, hypertension, and chronic renal disease.
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Observation of general health status, medications, patient education, and issues related to
polypharmacy supported nursing staff in addressing the specific needs of this patient. The
patient's family was also included in the plan for increasing his compliance with the medication
regimen and enhancing his awareness of the treatment process. Consequently, to accommodate
the increasing elderly populace, there is likely to be a high demand for increased specialization in
handling these intricate, multifaceted diseases to meet the quality healthcare demands of older
persons.
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References
Ahn, J., Yang, Y., & Park, G. (2024). Advancing elderly diabetes care: exploring the usability
and acceptance of continuous glucose monitoring. Geriatric Nursing, 59(1), 15-25.
Busebaia, T., Thompson, J., Fairbrother, H., & Ali, P. (2023). The role of family in supporting
adherence to diabetes self-care management practices: An umbrella review. Journal of
Advanced Nursing, 79(10), 3652-3677.
Carmago-Plazas, P., Robertson, M., & Alvarado, B. (2023). Diabetes self-management education
(DSME) for older persons in Western countries: A scoping review. PLoS One, 18(8),
e0288797.
Chimirri, S., Aiello, R., Mazzitello, C., Mumoli, L., Palleria, C., & Citraro, R. (2013).
Vertigo/dizziness as a Drugs’ adverse reaction. Journal of Pharmacology and
Pharmacotherapeutics, 4(1), 104-109.
Kong, H., Wang, X., & Zhang, X. (2022). Exercise for osteoarthritis: a literature review of
pathology and mechanism. Frontiers in Aging Neuroscience, 14(1), 854026.
November 15, 2024
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Academic level:
Undergraduate 3-4
Type of paper:
Case study
Discipline:
Nursing
Citation:
APA
Pages:
4 (1328 words)
Spacing:
Double
* The sample essays are for browsing purposes only and are not to be submitted as original work to avoid issues with plagiarism.
