Management Plan For A Patient With Diabetic Neuropathy And Multiple Co-morbidities

ANZPAC podiatry Competency standard 6

Developing a patient/client – focussed management plan

This reflection is about developing a management and education plan for a patient or client from a targeted group or individual. This includes children, people requiring supported care such as those with a mental illness, disabled or the aged. The management plan needs to include evidence of consideration for cultural backgrounds, beliefs, cultural attitudes to health and well-being, extended family and carer impact.

Select a client/patient from one of these groups that you have seen on placement or may have come in contact with Outline your client/patient’s case, management and education plan.

Your management plan should reflect the patients/clients/carer's needs, use of appropriate language, and understanding of cultural awareness and should support predicted outcomes

Patient's Medical History

The following reflection is based on the case study of a 47-year old male (Max) who is presented to the external clinical for routine skin, nail and wound care. His medical history highlights R/1^st amputation, type-2 diabetes mellitus, diabetic neuropathy, high blood pressure, high level of blood cholesterol, high basal metabolic rate (BMI) along with L/1^st plantar and anxiety. He was a chain smoker for the past 20 years and has metatarsophalangeal joint (MPJ) injuries on L/1^st plantar. His current medication includes metformin for diabetes management, Atorvastatin for reduction in the blood cholesterol level and Atenolol for treating hypertension. The self-reflection drafted over this patient will be guided by the competency standard 6 of ANZPAC (Australian and New Zealand Podiatry Accreditation Council) guidelines, which promotes the development of management plan and education of the service users with the person centre approach. Under this approach, the age, culture, mental health and other contextual settings are taken into consideration (ANZPAC, 2009).

During conversation, Max reported that he is truck driver by profession and used to indulge in high levels of smoking and high consumption of food while driving. Max also reported that he stays with his partner however, his partner is unwell and is unable to perform the daily living activity. Thus, I assumed that Max is forced to complete majority of the household work. During consultation, I noted that Max left eye is bloodshot red and it appeared to me that Max has developed conjunctivitis. However, when I enquired the patient that if he is taking any medical support and thereby, he mentioned that it would go eventually”. Moreover, I also noticed that the patient is not maintaining proper self-hygiene. During conversation, I also realized that Max was not aware about his health and lacks proper health awareness in spite of having history of hospitalization. Max also highlighted that he either stays bare footed or wear slippers and is not taking adequate food as he lacks clear ideas on that ground. Max also reported that he forget to apply dressing after every two days.

It is very difficult to establish concrete goals for Max is difficult to establish for Max as he seemed to be apathetic to the suggestions provided to him. However, he agreed that he was better off when the wound was closed and highlighted that he wants to prevent bilateral amputation of his 1^st digit. Additionally Max also stated that he is willing to visit a private podiatrist once the L/1^st wound is in-tact.

Patient Goals and Objectives

The patient centered goal will be directed towards effective wound management (L/1^st plantar mtpj wound moderate exudates). According to Mat Saad, Khoo and Halim (2013), effective management of wound requires replacement of dressing after every two days along with the use of proper antibiotics. Patient centered goal for effective wound management of Max will be education and awareness about wound management and proper antibiotic prescription in order to prevention the spread of infection through the exudates of the wound.

Another short-term goal is proper education of the patient about the about the severity of the conjunctivitis and immediate referral to the patients to an ophthalmologist. I will mainly educate patients regarding how conjunctivitis is contiguous disease and if not treated might infect his family members and in his case might result to blindness.

Max is unaware about the importance of basic hygiene. According to Yazdanpanah, Nasiri and Adarvishi (2015), maintenance of basic health and hygiene is important for proper improvement of the health-related quality of life along with effective management of wound. Though Max is apathetic about the suggestion provided however, Freeman et al. (2014) suggest that proper health-related awareness is effective for apathetic patient. Here Max will be educated that lack of health hygiene might make his family vulnerable towards developing infectious disease.

Proper education about dietary plan helps in the improvement of health related quality of life. In case of Max he must be educated regarding how nutritional diet plan helps to increase the overall health status along with the improvement of diseased condition. The diet plan of Max must be diabetic with restricted intake of sugar and carbohydrate along with reduction in the intake of cholesterol (since Max has high level of blood cholesterol). I will mainly take help from professional dietician in order to frame the diet plan for Max. Another rationale for the effective diet management is, it will promote reduction in the BMI and this will promote fast healing of wound (Wukich et al., 2013).

While in conversation with Max, I noticed that he mostly, remain depressed and suffers from anxiety. According to Robson et al. (2013) proper counseling with the mental health nurse helps to analyze the root cause of depression and anxiety and thereby helping to draft an effective person-centered care plan. I will mainly ask the physicians to refer Max to a professional mental health nurse or a psychiatrist. Recovery from depression and anxiety will help Max to adhere to regime of replacement of wound dressing, proper health hygiene and consumption of nutritional food.

References

Australian and New Zealand Podiatry Accreditation Council. (2009). Podiatry Competency Standards for Australia and New Zealand . Access date: 5^th October 2018. Retrieved from: https://www.anzpac.org.au/files/Podiatry%20Competency%20Standards%20for%20Australia%20and%20New%20Zealand%20(Final).pdf

Freeman, M. C., Stocks, M. E., Cumming, O., Jeandron, A., Higgins, J. P., Wolf, J., ... & Curtis, V. (2014). Systematic review: hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Tropical Medicine & International Health, 19(8), 906-916.

Mat Saad, A. Z., Khoo, T. L., & Halim, A. S. (2013). Wound bed preparation for chronic diabetic foot ulcers. ISRN endocrinology, 2013.

Robson, D., Haddad, M., Gray, R., & Gournay, K. (2013). Mental health nursing and physical health care: A cross?sectional study of nurses' attitudes, practice, and perceived training needs for the physical health care of people with severe mental illness. International Journal of Mental Health Nursing, 22(5), 409-417.

Wukich, D. K., Armstrong, D. G., Attinger, C. E., Boulton, A. J., Burns, P. R., Frykberg, R. G., ... & Pinzur, M. S. (2013). Inpatient management of diabetic foot disorders: a clinical guide. Diabetes care, 36(9), 2862-2871.

Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management of diabetic foot ulcer. World journal of diabetes, 6(1), 37.