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Case Study: Chronicity and Disability Essay

Type 2 diabetes mellitus is a major disease which affects many people in the world and has no specific cure and requires a highly demanding self-management regimen (Bayat et al., 2013). However, managing this condition presents a significant challenge to individuals with an intellectual disability such as Down syndrome. In this paper, I will consider the health challenges in caring for patients like the one in the case study (who I will refer to as Joe) as well as how his chronic disability impact his ability to manage his type 2 diabetes symptoms considering he has a moderate intellectual disability. I will then use the ICF model to discuss how the patient’s participation and activity are affected by his chronic illness of type 2 diabetes and intellectual disability. Finally, I will come up with a strategy to help the patient manage his type 2 diabetes symptoms.

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According to Bayat et al. (2013), diabetes affects more than 180 million individuals across the world and remains a major and increasing health problem with the numbers of the affected expected to double by 2030. There is an increased prevalence of diabetes across the world leading to premature mortality and morbidity. Type 2 diabetes forms the bulk of diabetes mellitus cases. Defects in insulin sensitivity and insulin secretion are characteristic of type 2 diabetes mellitus. Type 2 diabetes has been linked to morbidity and premature mortality that is related to kidney disease, cardiovascular disease, nerve disease, et cetera (Taggart, Coates & Truesdale-Kennedy, 2013).The management of type 2 diabetes mellitus is aimed at preventing the incidence as well as the progression of complications related to diabetes such as cardiovascular complications, kidney failure, nerve damage, amputation, et cetera.

From the patient information provided, it is clear that Joe is suffering from two serious chronic health issues (type 2 diabetes mellitus and Down syndrome) which have caused a moderate intellectual disability. According to Taggart, Truesdale-Kennedy & Scott (2015), intellectual disability refers to a disability that leads to a notable limitation in an individual’s intellectual functioning as well as adaptive behavior related to everyday practical and social skills. Intellectual disability may lead to acquired disability which may be worsened by type 2 diabetes. In fact, individuals with Down syndrome have a high prevalence of diabetes mellitus. According to Kota, Kota, Jammula & Tripathy (2013), Down syndrome is a chromosomal disorder that causes mental retardation. Down syndrome is associated with insulin resistance which is the most predominant pathological factor in type 2 diabetes mellitus. It is theorized that individuals with Down syndrome are more likely to be obese or overweight and with large fat stores in the abdomen all of which are considered as type 2 diabetes risk factors (Kota, Kota, Jammula & Tripathy, 2013).

Evidence from research indicates that the best health outcomes for patient with type 2 diabetes mellitus are achieved through education that enhances self-management regarding diet, weight control and physical activity. Just as Taggart, Truesdale-Kennedy & Scott (2015) indicates, such is difficult to achieve when dealing with individuals with intellectual disability. For them, it becomes hard to modify their lives and be able to learn new skills for self-management. In fact, Taggart, Truesdale-Kennedy & Scott (2015) points out that failure of the nurse to detect the disability may make it impossible to reach the desired health outcomes.

Several challenges can lead to poor outcomes when caring for a patient such as Joe, and these are related to cognitive impairment. Failure to recognize early symptoms and seek medical attention in time, mismanagement of medication and failure to adhere to the recommended intervention, weight and lifestyle mismanagement are some of the challenges as outlined by Taggart, Truesdale-Kennedy & Scott (2015). An intellectual disability to a patient suffering from type 2 diabetes mellitus is a critical challenge as it may bar them from effective self-management to monitor and prevent the exacerbation of their condition. This is because such patients may not be able to comply with dietary restrictions or physical activity programs that they have been advised to undertake. As such, it becomes hard to manage their weight and cannot take timely actions when symptoms arise. Therefore, if such patients do not receive the necessary support in a caring home or a community group home, they may find it hard to engage in health affirming activities that may improve their condition (Taggart, Truesdale-Kennedy & Scott, 2015).

Alford, Remedios Webb & Ewen (2013) refer to the ICF Model as an international framework that focuses on primary health in terms of the impact of a disease on functioning rather than the cause of the disease. The world Health Organization designed this framework to determine the link between disability and health and how it affects the individual in terms of participation restrictions, functional impairment and activity limitation (Brunani et al., 2015). Joe has type 2 diabetes mellitus, down syndrome and a moderate intellectual disability all of which limit his emotional, intellectual and physical ability. As such, Joe’s activity is limited as the impairment bars him from performing as he used to before the condition. Such limitation is also evident in his ability to perform domestic tasks or engage in social or job-related tasks. Such limitations vividly explain how intellectual disability and chronic illness has disabled him.

Joe has been living in a community group home which is a disability specific home. According to Ervin, Williams & Merrick (2014), patients like Joe should have access to comprehensive, quality, affordable and appropriate care as per their needs which maximize health, function, and well-being while still increasing community participation and independence. The aim of the caregivers is to promote positive outcomes and participation while keeping in mind the limitations vested upon him by the chronic illness and intellectual disability. Joe’s condition limits his ability to perform domestic chores, joining community groups or going to pick medications. This is because his intellectual disability leads to disorganized thinking and makes it hard to formulate and achieve goals or adhere to a program. Such effects, when combined with symptoms of type 2 diabetes mellitus, indicate a limitation to his abilities to participate in various activities that may benefit his health and wellbeing. As such, the only way a nurse or a care provider can be able to enhance his participation effectively is by enhancing self-management of type 2 diabetes mellitus.

Individuals suffering from type 2 diabetes have insulin insensitivity leading to the buildup of sugars in the bloodstream. However, it is possible to reverse the condition by making lifestyle changes that can help reduce blood sugar. As such, the primary aim in the management of type 2 diabetes mellitus is to control blood sugar and lipid levels, and blood pressure through specific lifestyle behaviors, for instance, increasing physical activity, regular monitoring of weight and adhering to particular dietary regimens (Brundisin et al., 2015). Such is important because it can delay or prevent the incidence of complications associated with diabetes. Although Joe lives in a community group home, it is a concern that he may not be able to engage in physical activity and adhere to dietary regulation as recommended and this is likely to worsen his chronic illness and its compounding with down syndrome may lead to the exacerbation od his disability.

Several strategies can be used to ensure that Joe sticks to the recommended diet and physical activity program and be able to monitor his weight closely. Taggart, Truesdale-Kennedy & Scott (2015) indicates that patient education is key in patients with intellectual disabilities as it can help them become aware of type 2 diabetes mellitus risk factors and therefore modify their lifestyles. Patient education can be achieved through communication with the patient and through the use of user-friendly literature that a care provider can give the patient to supplement the explanations. At this point, Taggart, Truesdale-Kennedy & Scott (2015) reiterates the need to involve the patients family members and caregivers as it ensures that the patient with an intellectual disability feels supported and motivated to modify their lifestyle behaviors. Family members and caregivers can achieve that function through fostering a culture of physical activity and healthy eating.

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It is impossible to take care of a patient like Joe without him being at the center of any program because the patient views might be instrumental in the care provider coming up with strategies that the patient understands easily (Brundisin et al., 2015). It is important to use simple language supported by visual aids to help the patients easily recognize key aspects of what is expected of them. On diet control, Nyenwe, Jerkins, Umpierrez & Kitabchi (2011) indicate that the patient can be provided with a list of low sugar, low-fat foods and a list of foods that the patient should avoid. On physical activity, Nyenwe, Jerkins, Umpierrez & Kitabchi, (2011), describes how it leads to increased insulin sensitivity and glucose uptake and reduction in obesity. The authors suggest that the patient can be provided with a chart of various forms of exercise and their estimated energy expenditure. Taggart, Truesdale-Kennedy & Scott (2015) stresses that a well-structured education program helps the patient to improve their skills, knowledge, and confidence which then imparts on them the ability to take control of their condition and embrace effective self-management.

To conclude, I reiterate the critical nature of the need for the nurse to understand the link between a disability and a chronic illness as a guide to their practice. It is important that the nurse does not only concentrate on the chronic condition but has to acknowledge first how that condition is related to intellectual disability regarding participation restrictions and activity limitations. I have used Joe as a case study to illustrate how such understanding is critical in informing nursing practice to come up with strategies that are most likely to help him modify his lifestyle, manage his weight and engage in physical activity.

References: Case Study: Joe’s Chronicity and Disability Essay

Alford, V., Remedios, L., Webb, G., & Ewen, S. (2013). The use of the international classification of functioning, disability and health (ICF) in indigenous healthcare: a systematic literature review. International Journal For Equity In Health, 12(1), 32. http://dx.doi.org/10.1186/1475-9276-12-32

Bayat, F., Shojaeezadeh, D., Baikpour, M., Heshmat, R., Baikpour, M., & Hosseini, M. (2013). The effects of education based on extended health belief model in type 2 diabetic patients: a randomized controlled trial. Journal Of Diabetes & Metabolic Disorders, 12(1), 45. http://dx.doi.org/10.1186/2251-6581-12-45

Brunani, A., Raggi, A., Sirtori, A., Berselli, M., Villa, V., & Ceriani, F. et al. (2015). An ICF-Based Model for Implementing and Standardizing Multidisciplinary Obesity Rehabilitation Programs within the Healthcare System. International Journal Of Environmental Research And Public Health, 12(6), 6084-6091. http://dx.doi.org/10.3390/ijerph120606084

Brundisini, F., Vanstone, M., Hulan, D., DeJean, D., & Giacomini, M. (2015). Type 2 diabetes patients’ and providers’ differing perspectives on medication nonadherence: a qualitative meta-synthesis. BMC Health Services Research, 15(1). http://dx.doi.org/10.1186/s12913-015-1174-8

Ervin, D., Williams, A., & Merrick, J. (2014). Primary Care: Mental and Behavioral Health and Persons with Intellectual and Developmental Disabilities. Frontiers In Public Health, 2. http://dx.doi.org/10.3389/fpubh.2014.00076

Kota, S., Kota, S., Jammula, S., & Tripathy, P. (2013). Type 2 diabetes mellitus: An unusual association with Down′s syndrome. Indian J Hum Genet, 19(3), 358. http://dx.doi.org/10.4103/0971-6866.120818

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Nyenwe, E., Jerkins, T., Umpierrez, G., & Kitabchi, A. (2011). Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes. Metabolism, 60(1), 1-23. http://dx.doi.org/10.1016/j.metabol.2010.09.010

Taggart, L., Coates, V., & Truesdale-Kennedy, M. (2013). Management and quality indicators of diabetes mellitus in people with intellectual disabilities. Journal Of Intellectual Disability Research, n/a-n/a. http://dx.doi.org/10.1111/j.1365-2788.2012.01633.x

Taggart, L., Truesdale-Kennedy, M., & Scott, J. (2015). Working with people with people with intellectual and developmental disabilities who have diabetes. Journal Of Diabetes Nursing, 19(5), 190-194.