Mrs. Taylor is a 45-year-old African American female who was presented to the outpatient clinic with complaints of severe abdominal pain, nausea, vomiting, and diarrhea. She stated that she was well until two days prior to visiting the hospital when the symptoms began. The pain was abrupt and she had not taken any medication to alleviate it. She was diagnosed with diabetes seven years ago and hypertension two years later. Two years ago, Mrs. Taylor was hospitalized for three weeks with Peptic Ulcer Disease (PUD). Mrs. Taylor believes she is healthy because her test results for glucose and hypertension are sometimes within the normal range. She received all vaccinations and immunizations as required by the state health department. Mrs. Taylor is allergic to Sulphur drugs and Cipro as they cause rashes on her body. Her father died of liver cirrhosis at the age of 54 and her mother lives with diabetes. Her elder brother is hypertensive and the sister has ulcers. Her paternal grandmother died of gastric cancer. Mrs. Taylor lives with her husband and three children. She is a businesswoman who spends most of her days at her boutique. She has been smoking cigarettes since her teenage years but has reduced drastically since her diagnosis with hypertension.
Mrs. Taylor lacks any significant developmental issues. She lived in Congo for one year when she was attempting to get a formal employment as a humanitarian officer. She is close to her family members and her husband is her immediate next-of-kin.
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Review of systems
Nutritional status: Her BMI is 27kg/m2 (obese). She reports that her weight has not significantly changed within the last six months.
HEENT: No blurred hearing, no discharge, no eye pain but she is short-sighted and wears contact lenses.
Neck: Supple, no lymphadenopathy
Cardiovascular: No palpitations, edema, dyspnea on exertion and she deny any chest pains.
Respiratory: Clear breathing, no wheezing, and cough
Gastrointestinal: Severe abdominal pain, nausea, vomiting, diarrhea, no jaundice, no constipation
Genitourinary: Normal urine frequency, no incontinence
Musculoskeletal: No joint pains, no muscle cramps or stiffness
Skin: Slightly pale, no rash, no lesions
Neurologic: Alert, oriented in time and place, normal sensation, communicates well
On physical examination, her temperature was 37.30C, a pulse of 79, respiratory rate of 16, blood pressure was 125/85, oxygen saturation of 97% on room air and pain score 9/10. Generally, the patient is an overweight, tired but well-oriented woman lying in bed. Her blood sugar level was 6 mmol/L. From the observations made her blood pressure and blood glucose were slightly elevated due to her normal health status. Although she reported that she takes medication as prescribed, the readings might be out of normal range because of her current status and lack of adherence to the diabetic diet. Further, Mrs. Taylor had a slight fever that could be resulting from abdominal pain and discomfort.
Mrs. Taylor was educated on the management of type 2 diabetes, hypertension, and PUD because successful management of these condition requires lifestyle and diet modification (Chen, 2016). The findings on the scholarly articles supported the use of health education to manage diabetes, hypertension, and PUD. According to Olokoba, Obateru & Olokoba (2012), type 2 diabetes is mainly caused by lifestyle and genetic factors. Further, obesity is a key contributor to Diabetes Mellitus. Central obesity also plays a major role in type 2 DM as it causes insulin resistance and dysfunction of beta-cells. Research has demonstrated that lifestyle modification such as regular physical activity, increasing intake of fiber and reducing the consumption of saturated fats enhances management of type 2 DM (Bailey & Pfeifer et al., 2015). Therefore, the topics selected were apt for Mrs. Taylor.
The effectiveness of health education will be influenced by factors such as cultural, psychosocial, developmental and physiological elements. Fortunately, Mrs. Taylor is not mentally impaired so she can remember and attempt to follow what she is taught. Besides, her family is supportive and she has adequate resources to afford some gym equipment or fees for physical exercise. Mrs. Taylor can also assess online health and wellness resources about best practices for managing her conditions. Considering the interrelationship between the various factors and the patient’s strengths and opportunities, the health education will likely be highly productive.
Generally, the interaction between the nurse and the patient was fruitful. The interview process was similar to what I had learned and expected. The biggest enabler to our interaction was the environment of the patient and her orientation. The patient was in a private room, free from any interruptions during the interview with the nurse. Mrs. Taylor narrated to me her entire medical history with great detail. Furthermore, I applied various techniques of therapeutic communication to enable the patient to express herself with ease. For instance, I recognized Mrs. Taylor’s keenness on following the doctor’s prescription on medication as well as her strong family relationship. There were no unexpected challenges to conducting the interview or the physical examination. However, the patient was quite inquisitive and when she asked me if her symptoms indicated reoccurrence of PUD, I could not confirm to her because the laboratory results were not yet out. I feel like next time, I should wait until all the results were known before conducting health education.
References
Bailey, R. A., Pfeifer, M., Shillington, A. C., Harshaw, Q., Funnell, M. M., VanWingen, J., & Col, N. (2015). Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict. BMC health services research, 16(1), 10.
Chen, H. H. (2016). Associations between type 2 diabetes and peptic ulcer disease in Taiwan. Diabetes Research and Clinical Practice, 120, S196.
Olokoba, A. B., Obateru, O. A., & Olokoba, L. B. (2012). Type 2 diabetes mellitus: a review of current trends. Oman medical journal , 27 (4), 269.
