Context of Diabetes Mellitus

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Holistic Assessment:
Part I (300 words)
Choose one of the case profiles and explain what components/tools you would include to best apply a holistic assessment. Based on the information provided and/or speculative finding (per your holistic assessment), write 1-3 sentence assessment statement. An assessment provides a summary of pertinent assessment findings that will guide a Patient Care Plan.
An example of an assessment statement:
74 years old female who has lived with diabetes for 15 years. Microvascular complication include; bilateral retinopathy and mixed neuropathy. Pertinent issue: poor family and community support systems. She is at risk for falls, and is scoring high on Geriatric Depression Scale.
Part II (500 words)
Based on the “assessment statement” from part I, highlight how potential nursing practice strategy(s)/ intervention may best meet and addresses the pertinent needs and issue of the case profile. Refer to credible research resources to substantiate your choice of approach/es.
Case Profile: Jim
Representing prominent population: Rural Australia males living with DM and chronic complications.
Jim is a 55 years old male living at rural Australia. Jim is six months right below knee amputation (BKA) and left lateral foot ulcer. HbA1C% of 12%. “I don’t think I can take this anymore”.
Past medical history:
> Type 2 Diabetes for 20 years
> Hypertension (30 years)
> Systolic heart failure for 3 years (ejection fraction 35%, NYHA class 2)
> Chronic renal failure stage 3
Social and Patient Narrative:
> For the past 10 years Jim has had to leave his farming to an employee.
> He is dependent on commonwealth disability payments. His wife Jessie ( 21 years) continues to work full time as an office manager.
> Jim is a non-smoker for 10 years, and drinks ETOH “3-4” beers a night.
> He is attempting to walk for 45 minutes 3x week but since his left foot blister and infection he has had stop.
> Jim is able to drive his car and participates in household duties. Hobbies he loves to work with his hands and has been making wood projects in his spare time.
> He is a father of 2 adult sons who are living interstate. He has an estranged relationship with his sons and his “sole” companion is his wife Jessie.
> He does not have a religious/ spiritual belief system but states ‘fishing” is his religion.
> He expresses feelings of despondency and frustration with his deteriorating health over the past year. “I don’t know if I can take too much more of all this”.
> He states that he is having many sleepless nights with periods of excessive sleep.
> He has had to relinquish his private health insurance and finds co-payments for office visits and medications adding up. He and his wife have had to rethink their retirement dreams and plans.
Medications:
Atorvastatin 40mg nocte
Metformin XR 1000mg daily
Lantus 40 units SC nocte
Humalog 5 units SC ac
Lisinopril 10mg mane
Gabapentin 600mg nocte
Ibuprofen 400mg bd
Ephalexin 500mg tds x 10 days
Diagnostic reports
BP 140/90
HbA1C 10.5%
Creatinine (H 150)
eGFR 43 (Stage 3 moderately reduced kidney function)
Lipid Panel wnl
ALT (H 94)
GGT (H 72)

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