Epilepsy and Type 2 Diabetes Mellitus: Case Study

Epilepsy and Type 2 Diabetes Mellitus Case StudyPeople with chronic and complex shapes are usually characterized by complex causality, multiple risk factors, a long latency period, a prolonged course of illness that back tooth non been cured, and functional impairment (Wilkes, Cioffi, Warne, Harrison, Vonu-Boriceanu, 2008). These sight are oft treated by primary care master keys such as the community care. Community care plays a key role in our health arranging it can avoid diligent readmission to the hospital, bring down healthcare costs, and make patients feel more comfortable when they have treatment at home (Wilkes et al., 2008). In the side study, Jessica is suffering epilepsy and Type 2 Diabetes Mellitus, which affects her daily life and her self-care behaviour. As a community care registered nurse (RN), I will promote Jessicas experience round her chronic illness and health history, perform nurse assessments, and support her and her family with regard to her cont inuing nursing care. My primary goal is to meliorate Jessicas health condition and help her maintain her normal daily social and career life style (Lubkin Learsen, 2013).As an RN, on the first day visit with Jessica. At the beginning, I will establish therapeutic relationship with her by communication and also observing her facial expression, body language and listening voice tone. Arnold Boggs (2011) give tongue to the foundation of nursing skills are approaching to therapeutic relationships and good communication in nursing practice and identifies trust, respect and honesty which are guiding professional actions. Meanwhile, her health history necessitates to be obtained by using oral communication skills, such an interview with her and her partner, without any judgment and by using unrestricted short questions (Lubkin Learsen, 2013). In addition, the RN deprivation perform a physical examination that includes general observation and checking BP, pulse, temperature, BGL, he ight, and weight. The information obtained during this phase contributes to an overview that identifies Jessicas topical and quondam(prenominal) health order and provides a baseline assessment to evaluate future changes (Brown et al., 2014). It is important for the RN to indicate Jessicas past and present medical conditions and treatments, which can create a suitable care throw and provide unique care. Ekman et al. (2011) believe all care providers should create personalized nursing care to people with chronic illness and help them to achieve their individual goals.The investigate shows epilepsy is the most common serious chronic neurological disorder of young people, with public mis registering inducing fear and social stigma, which leading to prejudice and discrimination in school, workplace, and community (Coker, Bhargava, Fitzgerald, Doherty, 2011). As a RN should educate Jessica by explaining the pathophysiology of epilepsy for example, McCance, Heuther, Brashers, Rote (2014) state that seizures are the abnormal discharge of electrical activity within the brain the epilepsy is repeated recurrence of seizure activity which results from underlying disorder of the Centre steel System (CNS) (pp. 679). In the past, Jessicas seizures have been infrequent, brief, and often well controlled by medication. However, she may also suffer from greater degrees of depression, anxiety, and be prone to the social and vocational limitations that the illness usually brings (Coker et al., 2011). Furthermore, there are many risk factors that can cause breakthrough seizures these include diet, medication pulling out, and alcohol consumption. Jessica may not aware(p) of such factors due to a lack of specific knowledge (Coker et al., 2011). At the moment, Jessica is starting to withdraw from her anticonvulsant medications and avoiding her GPs advice by continuing to make her car she also went to a dance club and drank alcohol. All of these affect her health conditions .Jessica also has Type 2 diabetes, a common chronic multisystem sickness related to abnormal or impaired insulin production, with high risk of macrovascular and microvascular complications that lead to illness or disability and death (Hicks, 2008). There is no specific research on the association of epilepsy and Type 2 diabetes, but studies have found that seizures can occur during diabetic ketoacidosis when the body cannot get enough insulin meanwhile, in many cases, epilepsy-related seizures may be mistaken for the symptoms of hypoglycaemia (Schober Holl, 2011). The aim of treatment is to control her blood glucose level (BGL) between 4 to 7 mmol/L, which reduces the risk of diabetes complications (Hicks, 2008). Currently, Jessicas BGL shows12.9 mmol/L because of poorly controlled diet and excessive weight, which presents a greater great risk of cardiovascular, kidney, and metabolic diseases.After explaining the two chronic diseases to Jessica, during the time as an RN, I will pe rform a nursing assessment that includes a neurological observation assessment, nutritional assessment include regular BGL checks, behavioural assessment, and psychological assessment. neurological observation is the collection of information on a patients central nervous system and neurological status, incorporates monitoring of the patients level of consciousness, pupil reply and motor function, and observation of vital signs (Brown et al., 2014). It is important to monitor Jessicas neuron function due to frequent seizures, especially after being hospitalized with tonic-clonic coma and unconsciousness. fixing BGL checks will help with her awareness of her glucose level and encourage regular administration of her hyperglucagonemia medication. The aim of intervention for Jessica is to control her high BGL and assess her normal diet, which can reduce diabetes complications so that she can achieve the quality of life she desires. Research has found that to control chronic complicati ons from diabetes, a patient needs good self-care behaviours for example hefty diet, regular exercises, weight loss, taking medications as prescribed, blood sugar monitoring, and good support from family (Huang, Hung, Stocker, Lin, 2013). Behavioural assessment can help monitor her health condition and achieve goal setting, problem-solving, and medication adherence. The nurse can provide an accessible, relaxed milieu to help Jessica focus on what she can do rather than what she cannot do, and act as a channel for her and her partner to discuss their fears and anxieties associated with her chronic illness (Welsh, 2008). She also told her GP that she did not need any more prescriptions for her anticonvulsant medication. Studies show that withdrawal from epilepsy medication has significant implications for lifestyle and circumstance, and that the patient should stop driving (Coker et al, 2011). As the result, as an RN I need to consider Jessicas dilemma conservatively as it impacts her independence regarding transport and that, in turn, impacts her employment and income, self-esteem, and quality of life. The nursing intervention can include broader aspects of care including assessing Jessicas needs, providing advice on associated topics to help her get wind her condition and the attention plan, and asking her partner to join her care (Welsh, 2008). For example, her partner, Martin, should be aware of her health condition including driving, potential pregnancy, alcohol use, employment restrictions, and other guard duty issues. On the point of RN also provide referrals to other professionals such as dietitian, social workers, counselling services, and family support groups. The role of the community RN is not only managing a patients chronic illness, but also to seek more assistance or research to improve the effectiveness of patient cares (Chen et al., 2012).The research shows that education in combination with psychological intervention can support medicat ion adherence (Dean, Walters, Hall, 2010). In Jessicas case, the RN needs to understand the negative impact that psychological issues can have on her lifestyle and chronic disease management, for example the chronic disease may cause her anxiety, and depression. As the result, we might arrange for Jessica to attend some group meeting or study conference about young people with chronic diseases. The fundamental nursing requirements are skills in communication, listening, counselling, and teaching to support the patient and her family (Welsh, 2008).There are two priorities for the RNs come in-up with Jessica. As we noticed that before the current seizure, Jessica had weened herself off her anticonvulsant medications because she wanted to become pregnant and is perpetually in noncompliance with regard to her diabetes. The aim of the community service nursing intervention is to improve Jessicas quality of life through needs-led primary health care with a person-centred approach to her individual needs and create a treatment plan that will improve health outcomes (Ekman et al, 2011). As Jessica is of child-bearing age with epilepsy, she merits unique consideration. Because withdrawal her antiepileptic drugs will increase seizure frequency, as an RN will need to be informed when Jessica contemplates pregnancy and refer her to a specialist before conception. Meanwhile, an occupational therapist will assess any risks in her home environment a counselling service also be needed. From this point, the RN should consider the patients needs and communicate with a multidisciplinary team (Lubkin Larsen, 2013).We will need to motivate Jessica to take responsibility for her own self-care by using motivational interviewing and health coaching to incorporate behaviour change principles that promote healthy activities (Lubkin Larsen, 2013). For example, as an RN need to understand and explore Jessicas motivation for becoming pregnant and keep her current life routine by liste ning with empathy because her printing and methods may be different than they would be with a person who didnt have complex medical issues. This will empower Jessica, encouraging her hope and optimism to follow the current treatment plan as well as to consult other health professionals. The primary goal is to maintain good self-care attitudes that will alter Jessicas knowledge and apprehensiveness related to her ability to successfully cope with the disease in her normal life (Coker et al., 2011). A study by Soubhi et al. (2010) shows that rigid self-management programs are amongst the best evidence-based interventions for improving outcomes. Thus, promoting self-care will empower Jessica to make independent decisions. The result will be an improvement in her quality of life and a reduction of psychosocial problems.In conclusion, from a community nursing service perspective, the experience of care giving to Jessica with her chronic and complex conditions has been extensively add ressed. Meanwhile, an RN with an increased understanding of Jessicas experiences will gain greater insight into the care she needs to improve her health and provide more effective healthcare delivery in the community (Soubhi et al., 2010).ReferencesArnold, C. E., Boggs, U. K. (Eds.). (2011). Interpersonal Relationships Professional Communication Skills for Nurses (6th ed.). Missouri Elsevier.Brown, D., Edwards, H., Lewis, S. L., Heitkemper, M. M., Dirksen, S. R., OBrien, P. G., Bucher, L. (Eds.). (2014). Lewiss medical-surgical nursing assessment and management of clinical problems (4th ed.). Chatswood, Australia Elsevier.Coker, M. F., Bhargava, S., Fitzgerald, M., Doherty, P. C. (2011). What do people with epilepsy know about their condition? Evaluation of a subspecialty clinic population. Elsevier Ltd Seizure 20, 55-59. doi 10.1016/j.seizure.2010.10.007Chen, M. S., Creedy, D., Lin, S. H., Wollin, J. (2012). Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes A randomize controlled trial. Elsevier Ltd, International daybook of Nursing Studies, 49, 637644. doi10.1016/j.ijnurstu.2011.11.011Dean, J. A., Walters, J., Hall, A. (2010). A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness. Arch Dis Child, 95, 717723. doi10.1136/adc.2009.175125Ekman, I., Swedgerg, K., Taft, C., Lindseth, A., Norberg, A. Sunnerhagen, S. K. (2011). Person-centered care-ready for choice time. European Journal of Cardiovascular Nursing 10, 248251. doi 10.1016/j.ejcnurse.2011.06.008Huang, C. M., Hung, H. C., Stocker, J., Lin, C. L. (2012). Outcomes for type 2 diabetes mellitus patients with diverse regimens. Blackwell Publishing Journal of Clinical Nursing, 22, 1899-1906. doi 10.1111/jocn.12123Hicks, D. (2008). Recent developments in the management of type 2 diabetes. British Journal of Community Nursing, 6(11). doi http//dx.doi.org/10.12968/bj cn.2001.6.11.9458Lubkin, I., Larsen, P. (Eds) (2013). Chronic illness Impact and interventions (8th ed.). Burlington, MA Jones Bartlett.McCance, L. K., Heuther, E. S., Brashers, L. V., Rote, S. N. (Eds.). (2014). Pathophysiology The biologic basis for disease in adults and children (7th ed.). St. Louis, MO Elsevier.Schober, E. Holl, R. (2011). Epilepsy in children and adolescents with type 1 diabetes. Diabetes Voice 56(2), 43-44. Retrieved from https//www.idf.org/sites/default/files/attachments/DV_56-SI2_Schober-Holl.pdfSoubhi, H., Bayliss, A. H., Fortin, M., Hudon, C., Akker, V. D. M., Thivierge, R. Fleiszer, D. (2010).Learning and caring in communities of practice Using relationships and collective learning to improve primary care for patients with multimorbidity. memorial of Family Medicine, 8(2), 170-177. doi10.1370/afm.1056Welsh, M. (2008). The practice nurses role in the management of epilepsy. British Journal of Community Nursing, 6(3). Retrieved from http//www.ncbi.nlm .nih.gov/pubmed/11923723Wilkes, L., Cioffi, J., Warne, B., Harrison, K., Vonu-Boriceanu, O. (2008). Clients with chronic and complex conditions their experiences of community nursing services. Journal of Clinical Nursing, 17(7b), 160-168. doi10.1111/j.1365-2702.2008.02454.x