Teaching Plan Scenario
Teaching Plan Scenario
K.N. is a 66-year-old woman with a history of type 2 diabetes, obesity, high blood pressure, and migraine headaches. Nine years earlier, when she had moderate polyuria and polydipsia, she was positively diagnosed with diabetes. K.N. is 5′4′′ on the broadside and often weighs from 165 lb to 185 lb. Oral sulfonylurea with quick metformin was initially used for her diabetes. Besides, her diabetes was somewhat regulated, with 7.4% of the latest red blood cells A1C.
Additionally, her blood pressure was detected five years ago when the range of 160/90 mmHg was raised continuously three times. K.N. was initially treated with lisinopril from 10 mg daily to 20 mg. Still, the regulation of her blood pressure fluctuated. Microalbuminuria was found on a yearly urine examination one year ago, and a spot urinalysis of 1,943 mg/dl microalbumin was found. For her regular follow-up appointment for diabetes, K.N. arrives at the office today. The physical test shows an obese woman with 154/86 mmHg B.P. and 78 bpm pulse.
K.N. is an obese, diabetic, and high blood pressure patient. Nonetheless, her B.P. power can be controlled. Ideally, for the B.P. target of < 130/80 mmHg, maximizing the ACE blocker dose and adding a second and perhaps a third agent may be appropriate. Diuretics showed cytotoxic activity with beta-blockers, and one could be added. Because K.N. has migraine headaches and diabetic nephropathy, her care will have to be personalized. A β-blocking agent to the ACE inhibitor would lower its B.P. and are correlated with strong cardiovascular disease evidence.
Moreover, the β-blocker also can contribute to reducing the burden of its migraine headaches. Microalbuminuria can also be used to minimize B.P. and delay the development of diabetic nephropathy by combining ARBs and ACE inhibitors. Thus, more intensive therapy is required to manage hypertension of L.N. Latest trials and potential new drug agents now facilitate B.P. regulation goals.
K.N will need information collected through several mediums on pathophysiology and care of diabetes and hypertension. When asked how she learned from her illness, many people suggest that they get it from their families. People are often defined as essential sources of knowledge by family, friends, and colleagues with diabetes or hypertension (De Boer et al., 2017). Furthermore, others also explained that only a doctor, nurse, or community health worker in the health facility has learned about diabetes and hypertension when diagnosed. In this case, K.N can get more insights into her condition through medical manuals, radio programs, or television. Similarly, just like other people with diabetes have learned more about their condition through seminars organized by the Health Ministry, she can do the same.
As age progresses, the sensory ability, including vision, hearing, and feeling, decreases accordingly. In this case, K.N reveals that she has some sight and hearing loss. Furthermore, physical agility and stamina are typically reduced. Indeed, 80% of people over the age of 65 have some chronic illness. The effects and natural change with the aging of chronic conditions will inhibit learning (Rizvi, 2017). A patient’s willingness to obey a prescribed care plan may also be provided with valuable details.
In this case, the consideration of using particular methods of teaching in providing older adults with health education. Some older people have more difficulties in comprehension, have less skill in drawing lessons, and have motor activities problems than younger generations. Therefore, K.N reveals that she prefers new knowledge to be conveyed slowly and with a low voice tone. It gives her some time to assimilate and integrate concepts.
The risk of sedentary lifestyles and deconditioning for elderly individuals is increasing. Recent acute diseases, coexisting medical problems, chronic pain, lack of access to a healthy physical setting, history of falls, and cravings are all contributing factors. Before implementing a physical activity schedule, these considerations must be evaluated. Ideally, regular exercise greatly benefits older adults (Solini et al., 2019). Besides, exercise also improves cardiopulmonary ability, muscle strength, gait and balance, and general quality of life and enhances blood glucose, systolic and diastolic blood pressure lipid regulation. Before administering a drilling scheme, it is crucial to evaluate the patient’s functional ability and adjust the system for specific needs and social environments.
Additionally, weight loss and malnutrition should also be assessed for older people because the unintended weight loss in aging diabetes patients increases morbidity and death. After actual disease and hospital stays, the risk for calorie restriction and catabolic status in this patient population is increasing. In older adults who wish to lose weight, diet modification and exercising regularly should be promoted instead of rigid calorie restriction (De Boer et al., 2017). Therefore, the individual diet plan aims to minimize nutritional barriers and facilitate improvements in eating behavior, leading to better health results, expanded function, and better quality of life.
Treatment regimens must be reasonably straightforward. Besides, new skills may be longer to learn, and a visiting infant will be needed to ensure that the job is wholly incorporated into the patient self-care scheme. Physical therapy or local psychosocial support may be required to assess the home environment and avoid possible injuries from falling or incidents.
Non-pharmacological interventions should be promoted when obese patients with diabetes have moderate hypertension. These include decreasing body weight, increased physical activity, and reduced salt intake in food, quitting smoking, and alcohol consumption. Moreover, reducing body weight and increasing physical activity by lowering insulin resistance can improve glucose control (Solini et al., 2019). Despite all of the obvious cardiovascular benefits of decreased weight in obese patients, including reduced blood pressure, falls in left ventricular weight, and improvements in lipid profile, there is no evidence for the associated decrease in death.
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The treatment of hypertension is critical for R.N., both for preventing cardiovascular and minimizing the development of nephropathy and retinopathy illness, as a cornerstone in early and ongoing lifestyle interventions. Hence, non-pharmacological approaches include weight reduction and dietary changes that improve fresh fruits, vegetables, fatty milk products, and physical activities (Rizvi, 2017). Besides, it also encompasses avoidance of sodium-high processed foods of preventing excessive consumption and alcohol. The ADA directives recommend that lifestyle changes and primarily non-drug modalities be adopted to minimize B.P. in patients like K.N with high blood pressure.
Obese people like K.N also hope to lose more weight than is realistically accomplished. When enrolled in a non-chirurgical fitness program, she is expected to lose 38% of body weight, but she would be satisfied with a 31% – 25% decline. She was frustrated that her initial weight loss was 17% less. Besides, she lost an average of 16% of her initial weight following 48 weeks of nutrition and lifestyle treatment. Hence, patients seeking bariatric intervention also have lofty aspirations of unrealistic weight loss. Thus, a practical and clinically positive weight loss response to the treatment and a predicted patient’s predicted weight loss often differ significantly.
De Boer, I. H., Bangalore, S., Benetos, A., Davis, A. M., Michos, E. D., Muntner, P., … & Bakris, G. (2017). Diabetes and hypertension: A position statement by the American Diabetes Association. Diabetes Care, 40(9), 1273-1284. https://doi.org/10.2337/dci17-0026Rizvi, A. A. (2017). Addressing hypertension in the patient with type 2 diabetes mellitus: pathogenesis, goals, and therapeutic approach. European Medical Journal. Diabetes, 5(1), 84. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679430/Solini, A., Penno, G., Orsi, E., Bonora, E., Fondelli, C., Trevisan, R., Vedovato, M., Cavalot, F., Lamacchia, O., Baroni, M. G., Nicolucci, A., & Pugliese, G. (2019). Is resistant hypertension an independent predictor of all-cause mortality in individuals with type 2 diabetes? A prospective cohort study. BMC Medicine, 17 http://dx.doi.org/10.1186/s12916-019-1313-x