Running head CREATING A PLAN OF CARE .docx

Running head: CREATING A PLAN OF CARE
1
CREATING A PLAN OF CARE
10
Creating a Plan of Care
South University
NSG4055 Illness & Disease Management across Life Span
Professor
Creating a Plan of Care
The chronic disease selected for the plan of care is
cardiovascular disease. This disease continues to pose major
challenges not only for patients and their family members but
also to the nation’s health care system. The rationale for
choosing cardiovascular disease is because of the high rates of
mortality and the effects of the co-morbidities associated with
the chronic illness. According to Santulli (2013), cardiovascular
disease is the single leading cause of fatalities in the United
States, accounting for approximately 600,000 deaths annually.
In 2011, approximately 26.6 million Americans were living with
the chronic disease. The health care costs associated with the
disease account for more than $500 billion annually. There are
also many disparities in prevalence of risk factors, mortality,
access to treatment and treatment outcomes based on
race/ethnicity, socioeconomic status, gender, age and
geographic area. Hence, tackling the disease should be a major
priority for the US government. The main objective of the
Healthy People 2020 initiative for cardiovascular disease is
“improving cardiovascular health through early detection,
prevention and treatment of the risk factors for stroke and heart
attack”. This report outlines a comprehensive plan of care that

can help in addressing and mitigating cardiovascular disease.
Holistic Plan of Care
Creating a holistic plan of care will indeed be essential for
ensuring that people with chronic conditions such as
cardiovascular disease lead a healthy life. Cardiovascular
disease has a significant impact on the patient and the health
care system. Apart from the emotional distress, patients with
this condition also face some financial burdens, social burdens
and increased levels of discrimination (Earnshaw & Quinn,
2012). In the course of completing the project, I administered a
questionnaire to a coworker by the initials C.K. during week 2
to find out how she deals with the condition.
The questionnaire looked into various aspects such as family
history, related medical conditions, the risk factors of
cardiovascular disease, lifestyle choices and the coping
strategies or support received by the patient. Understanding all
these aspects can help in developing a well-managed care plan
(Larsen & Lubkin, 2013). The results of the questionnaire
revealed that C.K. observes healthy lifestyle, has the right
levels of support and adheres to the medication regimen. All
these factors helped her to cope effectively with the condition.
However, even though she attested to leading a healthy
lifestyle, C.K. also revealed that her family faced some level of
emotional distress and financial burdens due to her condition.
The subsequent discussion in week 3 tackled the issue of
catering for the support needs of patients afflicted with
cardiovascular disease. As it became apparent, the support
needs can aid the patients to cope effectively with their
conditions. In terms of priority, the most essential support
needs for these patients are emotional support, informational
support, self-management support needs, financial support and
spiritual support. Apart from providing the support needs for
patients, professional nurses can also play a proactive role
towards the acceptance of treatment and diagnosis by patients
with chronic conditions. To this end, they must be on the

frontline in sensitizing patients about the importance of taking
regular screening tests as well as teaching them about available
therapies and self-management techniques (Wagner, Austin, &
Davis, 2001).
Noteworthy, environmental factors such as exposure to
contaminants and various chemicals can increase the
susceptibility of people to cardiovascular disease. Furthermore,
social determinants such as socioeconomic status, availability
of support networks and social norms prevalent in the society
can also aggravate the chronic conditions faced by patients. The
week 4 discussion revealed that people with cardiovascular
disease could gain tremendously from community resources
available in the localities. For example, in my region of Miami,
some of the vibrant community resources that provide support
to patients include the Baptist Health South Florida, the Heart
Smart Initiative and the Patti and Allan Herbert Wellness
Center. All these centers offer free screening services and
sensitize patients with chronic illnesses on the best ways that
can enable them to cope effectively with their conditions.
Incorporating these centers can help in the development of a
well-managed care plan.
Nursing Diagnoses
A nursing diagnosis is essential for identifying the problems
that might arise from cardiovascular disease. For the patients
with impaired cardiovascular function, one applicable nursing
diagnosis is decreased cardiac output. According to Larsen &
Lubkin (2013), the symptoms to look for in this diagnosis
include abnormal heart rhythm, rapid breathing, restlessness,
fatigue, edema, restlessness, dizziness and chest pain. The other
applicable nursing diagnosis for cardiovascular disease is
activity intolerance. The signs and symptoms to check for
activity intolerance include statements of fatigue, exertional
dyspnea, dizziness or chest pain, a significant change in blood
pressure with activity (15-20 mm Hg) and abnormal heart rate
response to an activity, for example an increase in rate of 20

beats per minute above resting rate (Dzau & Antman, 2006).
The other applicable nursing diagnosis for cardiovascular
disease is ineffective tissue perfusion (cardiopulmonary). Some
of the defining characteristics of this diagnosis include altered
respiratory rate, chest retraction, abnormal arterial blood gases,
chest pain, nasal flaring, dyspnea and sense of “impending
doom”.
Assessment Data (Subjective and Objective)
The subjective assessment data includes information about the
present symptoms and signs, the onset of the symptoms,
frequency of the illness and exposure to allergens. Apart from
the symptoms aforementioned in the nursing diagnosis section,
the subjective data will also include family history, past
medical history and risk factors. The subjective data will also
seek to inquire about any family history of coronary artery
disease, hypertension, diabetes or obesity. For the risk factors
of cardiovascular disease, important data will include
cholesterol level, activity level, cigarette smoking and blood
sugar levels (Dzau & Antman, 2006). The objective data will
come from various measurement instruments including
electrocardiograms, x-rays, stress tests, radiological images and
echocardiograms. These instruments will be able to reveal
valuable data about the blood sugar levels, blood pressure and
level of cholesterol, all of which are critical indicators of the
presence of cardiovascular disease.
Subjective date: C.K is visiting the health center for a follow-
up. C.K is now asymptomatic. Patient would like to discuss
about high blood pressure, hypercholesterolemia, and family
history. Patient’s mother died of heart disease. C.K reported
having one sister with high blood pressure and one brother with
type 2 diabetes. C.K’s level of education is high school. She
works now as a secretary with a salary of $30,000.00 yearly.
Patient engages in regular physical exercises, refrains from
smoking and observes a healthy diet.
Objective Data: Patient's temperature is97.9 degrees Fahrenheit.

Normal values: 97.8 - 99.1 degrees Fahrenheit (MedlinePlus,
2013).Patient's pulse is 68 beats per minute. Normal ranges: 60
- 100 beats per minute, (MedlinePlus, 2013). Respiration rate
is17 breaths per minute. Normal ranges 12 - 18 breaths per
minute, (Medline Plus, 2013). Blood pressure level is 150/88,
Normal ranges from 90/60 mm/Hg to 120/80 mm/Hg, (Medline
Plus, 2013). No pain this follow-up visit.Patient's height is 61
inches. Currently weight is144 pounds. No findings at the
physical assessment follow up. Lab Tests and Results: Total
cholesterol 198. Considered Normal. Normal values 150-199
(Merck Manuals, 2015).Low-density lipoprotein (LDL). 132.
Considered a little high. Normal values of 130 and below
(Merck Manuals, 2015).High-density lipoprotein (HDL). 38.
Considered low. Normal values above 40 (Merck Manuals,
2015). Triglycerides. 249. Considered Normal. Normal value
below 250 (Merck Manuals, 2015). Fasting blood sugar (FBS).
110. Normal values between 70-105 (Merck Manuals,
2015).Hemoglobin A1c 5.5. Normal level is below 5.7 percent.
Chest x-ray is normal. Electrocardiogram shows a normal sinus
rhythm.
Interview Results
The interview results indicate that the patients with the chronic
illnesses have taken some realistic measures to increase their
coping strategies with the condition. For instance, C.K.
confided that she frequently goes for routine medical check-ups
including blood pressure check-ups and tests to determine her
cholesterol levels. Although initially her blood cholesterol and
blood pressure levels were high, she has managed to normalize
them because of adhering to the prescribed medications.
Furthermore, the results from the interview indicated that the
patient engages in regular physical exercises, refrains from
smoking and observes a healthy diet, all of which can go a long
way in enabling her to cope with her condition more effectively.
Desired Outcomes

One of the desired outcomes is that the patients maintain
adequate cardiac output as evidenced by systolic BP within 20
mm Hg of baseline, strong peripheral pulses and heart rate of 60
to 100 beats per minute with regular rhythm. Another desired
outcome is for the patients to report decreased episodes of
angina and dyspnea (Santulli, 2013). After the interventions,
patients will also be able to check the blood sugar levels and
cholesterol levels and ascertain whether they are normal or
high. Another desired outcome is for the patients to verbalize
understanding of the condition, treatment and diagnosis of
cardiovascular disease. People afflicted with the chronic
condition will also be able to initiate measures such as healthy
dieting and refraining from self-destructive behaviors that
increase their susceptibility to the disease such as smoking.
Evaluation Criteria
The evaluation will strive to ascertain whether the plan of care
meets the outcome criteria. As Larsen & Lubkin (2013) clearly
point out, an important instrument for evaluating whether the
plan meets the desired outcomes will be by using a checklist.
The checklist will outline all the desired outcomes including
adequate cardiac output, patients’ ability to monitor their blood
pressure and the ability of patients to make informed lifestyle
choices, after which I will assign a relevant score indicating the
extent to which patients have satisfied the requirements of the
desired outcomes.
Actions and Interventions
One of the nursing interventions for the patients with
cardiovascular disease will be providing assistance with the
self-care activities that patients require for functioning
optimally. The other important action and intervention will be
sensitizing patients on various coping strategies for
cardiovascular disease. To this end, it will be paramount to
inform them the importance of adhering to medication regimen,
the importance of weight control and blood pressure control as
well as the importance of diet, physical exercise and smoking

cessation (Wagner et al., 2001). The education will help to
support individual efforts of controlling or preventing the risk
factors associated with cardiovascular disease. Another
intervention will be liaising with faith and community based
organizations that can help in various domains such as
screening patients with cardiovascular disease. Furthermore, it
will be critical to provide behavioral counseling in order to
empower the chronically ill patients to deal with various issues
such as stress and discrimination from members of the
community.
Evaluation of Patient Outcomes
Evaluating patient outcomes will be essential for guaranteeing
that the plan of care realizes its intended goals. One way of
evaluating the patient outcomes will be comparing the progress
that patients make against national benchmarks such as the
objectives listed under Healthy People 2020 initiative. This will
help to ascertain whether the patients are taking the necessary
measures to alleviate the risk factors associated with the chronic
illness. It will also be critical to use patient registries in order
to evaluate the outcomes. According to Dzau & Antman (2006),
a patient registry is a powerful tool for observing the course of
the disease, understanding variations in outcomes and treatment,
describing care patterns, measuring quality of care as well as
examining factors that influence quality of life and disease
prognosis.
Strategies for the Family or Caregiver
Family members and the caregiver will play an instrumental
role in guaranteeing the success of the care plan. They will need
to provide the right level of support to the patients in order to
enable them cope effectively with their chronic conditions. The
main forms of support that the family and caregiver will provide
include emotional support, social support, informational support
and financial support (Earnshaw & Quinn, 2012). Furthermore,
family members and the caregivers will have to ensure that
patients adhere to the prescribed medications and go for regular

check-ups as advised by the health care practitioner. In
addition, family members will provide relevant information
about the patient’s progress in order to ensure that nurses offer
safe, appropriate, quality, patient-centered and culturally
congruent care.
Conclusion
Cardiovascular disease continues to be a major public health
concern in the nation. This disease is the major leading cause of
fatalities in the US. In addition, it causes tremendous suffering
to patients and places a huge burden on the health care system.
Hence, coming up with a realistic plan of care will help patients
afflicted with the disease to find effective coping mechanisms.
The assignments covered from week 1 to week 4 have been
valuable in creating a well-managed plan of care. For instance,
they have identified the impact of cardiovascular disease, the
importance of meeting the patient’s support needs and the
community resources that can help patients with the chronic
disease. The holistic plan of care will be effective since it has
identified the nursing diagnoses for cardiovascular disease, the
assessment data, interview results, desired outcomes, evaluation
criteria, actions and interventions as well as evaluation of
patient outcomes. In order to enhance the success of the plan, it
will be vital to incorporate family members and caregivers in it,
mainly because of the support that they can provide to the
patients.
References
Dzau, V. J., & Antman, E. M. (2006). The Cardiovascular
Disease Continuum Validated: Clinical Evidence of Improved
Patient Outcomes. Circulation, 114, 2850-2870. Retrieved
October 1, 2015, from
http://circ.ahajournals.org/content/114/25/2850.full
Earnshaw, V., & Quinn, D. (2012). The impact of stigma in
healthcare on people living with chronic illnesses. Journal of
Health Psychology, 17 (2), 157 –168. Retrieved October 1,

2015, from
http://www.researchgate.net/publication/51530503_The_impact
_of_stigma_in_healthcare_on_people_living_with_chronic_illne
sses
Larsen, P. D., & Lubkin, I. M. (2013). Chronic illness : impact
and interventions (8 ed.). Burlington, Mass.: Jones & Bartlett
Learning.
MedlinePlus. (2013). Vital signs. Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/002341.htm
Merck Manuals (2015). Blood test: normal values. Retrieved
form
http://www.merckmanuals.com/professional/appendixes/normal
_laboratory_values/blood_tests_normal_values.html
Santulli, G. (2013). Epidemiology of Cardiovascular Disease in
the 21st Century: Updated Numbers and Updated Facts. Journal
of Cardiovascular Disease, 1 (1), Online. Retrieved October 1,
2015, from http://researchpub.org/journal/jcvd/number/vol1-
no1/vol1-no1-1.pdf
Wagner, E. H., Austin, B. T., & Davis, C. (2001). Improving
Chronic Illness Care: Translating Evidence Into Action. Health
Affairs, 20 (6), 64-78. Retrieved October 1, 2015, from
http://content.healthaffairs.org/content/20/6/64.long
Running head: Support needs of diabetic patient
Support needs of diabetic patient 7
Support needs of diabetic patient

Lissette Valcarcel
SU_NSG4055_W3_A2
Introduction
Diabetic persons require various forms of support if they are to
live long with this disorder. This document discusses three
forms of support that a diabetic person would need drawing
from the interview I had with my diabetic participant. Further,
it discusses some of the strategies for implementing the healthy
people initiative towards achieving its goal concerning diabetes.
Support needs of diabetes patient
Emotional support.
From the interview with my participant, it was clear that very
often he experiences certain negative emotions such as anger,
fear, frustration, hopelessness shame and at the time a lot of
gilts. This is not the case just with my participant, but research
has indicated that it is a common feature in most of the diabet8c
persons. Normally, once diagnosed with diabetes, an individual
goes through stages like those that a bereaved person mentally.
Just like that bereaved person needs some emotional support so
is a diabetic person like my participant. The stages that my
patient underwent are disbelief, denial, anger and currently, he
seems to be in a state of depression. It seems from my interview
with him that despite the support he gets, he still at times
experience depression a lot. This concept of emotional support
is needed from the side of the family to the medical
professionals handling a patient like my participant.
It is important to understand clearly that emotional support is
part of the treatment process for any diabetic person. Research
has indicated diabetes to be linked to other disorders like blood
pressure which is linked to psychological stress (Haas et al.,
2012). One of the best ways of ensuring that a diabetic
individual stays stress-free is to limit or help reduce any
psychological or mental stress that would otherwise result in
negative emotions. The emotional support offered to the

individual makes him feel that, all is not lost. The concept of
making the patient feel that even with diabetes, there is still life
and he can live as normal as other persons make him eliminate
the feelings of hopelessness that brings fear in him. Some of the
ways to provide emotional support are through therapy groups
which will make the patient feel that he is not the only one. The
other one is mental therapy by a medical professional. It
involves just talking to the patient about life and about himself
making him feel not left alone.
Then there is the family concept. Making the individual feel
that despite the disorder, he is still a member of the family. Not
being left out in the family matters and ensuring that the
patient’s happiness matters to all the family members is very
important in providing emotional support. Then there is the
concept of pressure at work. This requires colleagues and the
employer to understand the patient’s situation and handle the
patient with a lot of care. Not subjecting him to a lot of pressure
at work will help eliminate work pressure that maintaining some
peace of mind.
Financial support
Research has shown that diabetic person has financial needs that
are almost three times those of healthy people (Chiang et al.,
2014). On average, my participant indicated that he spends
approximately $13, 700 annually on all the expenses related to
healthcare. In some cases, the family alone is not always able to
cater for the expenses. The healthy people 2020 needs to have a
scheme for financial aid to this population as my participant
stated during the interview. Other than family support, a patient
can get support from insurance scheme. There are insurance
policies that can help cover medical expenses. There are cases
of outpatient where the patient financial sources must be relied
on. When an individual whether healthy or sick is subjected to
financial limitations in time of great need then automatically
stress sets in. This is not healthy for a diabetic person and such
a situation hinders the possible achievement of the healthy
people 2020 goals. There is there for the need for the family,

healthy people 2020 initiative and other organizations like
American Association of the Diabetic persons to come to the
financial aid of persons with diabetes.
Physical support
In my interview, it came out clear that my participant felt tired
after doing hard physical jobs. That is an indication that
diabetic persons are not good with hard labor jobs. In cases of
the workplace, the employer needs to ensure that the kind of
responsibilities assigned to the person is light in terms of
physical labor required. The family plays the greatest role in
ensuring physical support is offered in terms of the kinds of
physical responsibilities performed by the patient in the family
are not heavy duties. Physical support from the family also
involves the family members ensuring that the patient has a
recommended eating habit and lifestyle (Haas et al., 2012).
Advising the patient against certain foods and making available
the right ones are some of the physical support aspects that
family members can provide. Co-workers can ensure that the
patient is engaged in light physical activities as recommended
by their physicians. This can be during gymnastics among other
organization leisure moments.
Implementation of healthy people 2020 objectives
The main objective of healthy people 2020 to the diabetic
people is to increase the life expectancy of the people with
diabetes, reducing the cases of disorders associated with
diabetes to the diabetic patients and finally reducing new cases
of people being diagnosed of the disorder. There are various
implementation strategies put by the healthy people 2020
initiative that will help my client.
Interventions that involve community health workers
This strategy is to use the community health workers to help the
patients manage and live a longer lifespan. The community
health worker in case acts as the bridge between the patient and
the healthcare system. This strategy is such that the patient has
a very close contact with the community health worker

responsible for the specified location. The community health
worker is in turn in close coordination with the doctors and
other medical professionals in the healthcare facilities and
systems. The key responsibility of the healthcare worker is
monitoring the patient closely and reporting the progress of the
whole treatment and management process. Further, the
community health care professional provides advice to the
patent on various diabetic management issues. This individual
also schedules the meetings with the doctor.
Self-management mobile phone application
The healthy people 2020 initiative also has a mobile application
used by the patients for self-management. The patient enters
data into the application or they can use medical devices that
automatically enters data into the application (Diabetes, 2016).
The application then sends the data to the centralized healthcare
system the patient then receives a response from the medical
professionals assigned to assist by the system. Based on the data
entered, the response is the doctor’s feedback concerning the
state the patient is in. The feedback provides the patient with
what they are required. It works as a consultation interface for
the patient.
Use of telehealth to provide dietary intervention to the patients
This is a concept of information technology applied in this case.
In this case, the healthcare providers and the patients can
communicate through phone, e-mail, or even web-based
applications. The intervention is to help the patients manage
their diet and live a lifestyle recommended by the professionals.
In most cases, this intervention would be distance.
Public education
The other strategy that is applicable to implementing this
healthy person 2020 initiative is general education to the public.
Providing information to the public concerning diabetes as a
disease helps create awareness in them. It involves indicating to
them what it is, what can cause it and ways to prevent it.
Further, it is aimed at educating them on how to live together
with the diabetic people, what to do and what not to do.

Combining all these together, the concept of reducing new cases
will be achieved.
Conclusion
Diabetic persons require three main forms of support.
Emotional, financial, and physical support. Emotional support is
about feeling, financially is concerned with money needs and
physical support is for duties. Public education, telehealth,
community health workers and use of mobile phone application
are some of the strategies for achieving the goals.
References
Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L.
(2014). Type 1 diabetes through the
lifespan: a position statement of the American Diabetes
Association. Diabetes Care, 37(7), 2034-2054.
Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P.,
Edwards, L., ... & McLaughlin, S.
(2012). National standards for diabetes self-management
education and support. The Diabetes Educator, 38(5), 619-629.
Diabetes. (2016). Retrieved November 27, 2017, from
https://www.healthypeople.gov/2020/topics-
objectives/topic/diabetes/ebrs
Running head: Healthy people 2020
Healthy people 2020
2

Healthy people 2020
Diabetes mellitus
Introduction
This is a disease that results from the body’s inability to
produce enough insulin or inability of the body to produce an
appropriate response to insulin. This is the hormone regulation
the way the body absorbs glucose. The improper functioning of
the insulin in the body may result in elevated levels of blood
glucose resulting in various abnormal metabolic activities. This
finally results in complications in the body functioning. I am
interested in this illness because of its prevalence currently.
Across the globe, the number of individual suffering from
diabetes mellitus has increased in the past ten years and that has
brought this concern. Currently, in the United States, the effect
is estimated at 29.1 million. The disease has been classified by
the healthy people 2020 initiative group as occupying the 7nth
position among the leading causes of death currently.
Morbidity and comorbidity in the United States
There are various disparities in the diabetes risk. The people
from the minority population are most likely to suffer from type
2 diabetes. The minority groups, in this case, comprises 25% of
the adult patient suffering from diabetes in the United States.
The majority group comprises the children and adolescent with
diabetes type 2. According to the healthy people initiate 2020,
the African American, American Indians, and some Asian
Americans are at higher risk of suffering from type 2 diabetes.
The prevalence of this illness among the American Indians is 2-
5 times that of the whites. Averagely, African Americans are
1.7 times as likely compared to Mexican Americans (Healthy
people 2020, 2016). There are some barriers to the progress of

diabetes care. The first one being the challenges arising from
the design of the healthcare system and the other one being the
continuous increase of diabetes cases. This results to decrease
in the attention and resources available for every patient. Apart
from the two, there are other comorbidities associated with
diabetes. These include fracture risks, cancer risk, and
prognosis, cognitive impairment, and incontinence.
Impact on health of the nation
Though manageable, diabetes is still one of the diseases posing
a major health threat to the United States population and its
healthcare system. This illness affects approximately 26
million people in this country with approximately 18.8 million
people diagnosed and about seven million not yet diagnosed.
Diabetes comes with an array of health issues. Among them
being lower limb amputation, it has been determined to possibly
cause blindness and kidney failure. Again, it contributes a lot to
cardiovascular diseases. Research has indicated that
approximately 68% of people suffering from diabetes end up
dying of cardiovascular diseases. Economically, research shows
that in 2012, this illness caused the United States to close to
$245billion as both direct and indirect costs (The Cost of
Diabetes, 2015). Since 1990, the prevalence of this illness has
increased by approximately 60% to the currently estimated
figures of 29.1 million. Looking at the figure as at 2012 which
stood at 18.8 million and the figures produced by the healthy
2020 people as at 2017 which stands at 29.1 million. That
indicates clearly how fast this disease is escalating and how
much it is affecting the United States healthcare system.
Even though the government is trying all the best to equip the
healthcare facilities with the necessary equipment and personnel
to fight this disease, the rate at which it is advancing is too high
for the government to meet. That is what results in the high
doctor-patient ratio and minimum resources allocated to each
patient. This intron effects the quality of medical care provided
by the hospital facilities across the country and for that matter,
the difficulty in fighting the illness sets in. Looking at the total

population of the United States population which is
approximately 324 million, 29 million are diabetic. That is a
large population of unhealthy people. That implies that the
number of people who can work effectively to deliver to the
country’s economy is reduced by 29 million. The numbers
indicate that the health of the United States population is
reducing as years passes by.
Healthy people 2020 goals and objectives
The healthy people 2020 initiative have various objectives and
goals for this population.
i. Reduce the number of new cases of diabetes. The initiative is
aiming at providing lifestyle education and other means of
living free of diabetes through conduction public education and
awareness.
ii. Reduce death rate caused by diabetes. This involves teaching
the diabetic person way to live with diabetes. The concept of
disease management is something the initiative has the aimed at
doing. This is to be achieved in three ways, the first way is to
reduce the general mortality among the persons with diabetes
and secondly is to reduce the number of cardiovascular deaths
occurring to the diabetic persons. Finally, the initiative is aimed
at reducing the rate if lower extremity amputation in diabetic
patients.
iii. To improve the glycemic control among diabetic patients.
The initiative is aimed at reducing the proportion of the persons
with diabetes with an A1c value which is greater than 9%.
Secondly, the initiative aims at improving the lipid control in
diabetic persons, increase the number of people diagnosed with
diabetes and their blood pressure put under control. Ensure that
the proportion of persons with diabetes having annual dental
examination is increased. Increase the number of diabetic
individuals with glycosylated hemoglobin measured at least
twice a year. Increases the number of people receiving diabetes
education once they are diagnosed with the disease. Increasing
the number of diabetic patients performing self –blood glucose
monitoring daily. Increase the number of diabetic persons who

obtain urinary microalbumin measurement. Increase the number
of diagnosed cases of diabetes (Healthy people 2020, 2016).
iv. To increase behaviors for prevention for persons at high risk
of suffering diabetes. This goal has the various objectives
among them is increasing the number of people at high risk of
suffering from diabetes who have prediabetes reporting the
increase in levels of physical activity. Secondly, the initiative
aims at increasing the number of people with prediabetes
reporting attempts of loss of weight. Finally, this initiative also
aims at increasing the number of people at high risk of suffering
from diabetes who report reduced amounts of fat in their diets.
In general, the main objective of this initiative is to reduce the
burden of diabetes and improve quality of life for the people
who are suffering from the illness and those at risk of being
affected by the disorder.
Questionnaire
Please enter the following details
Name__________________________ Age
_________________________________
Gender_________________________
Date_________________________________
Please answer the following questions to the best of your
knowledge. Feel free while providing your response and do not
feel obligated or compelled.
When were you diagnosed of this disorder?
_____________________________________________________

________________________
What type of diabetes were diagnosed of?
_____________________________________________________
________________________
What were some of the symptoms you had before being
diagnosed of this disorder?
_____________________________________________________
_______________________
What was your lifestyle before the diagnosis of the disorder?
I.e. feeding habit and level of exercise.
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
___________________
Have any member of your family suffered from diabetes before?
If yes please indicate who.
_____________________________________________________
_____________________________________________________
__________________________________________________
How do you feel when working or after doing some physical
job?
_____________________________________________________
_____________________________________________________
__________________________________________________
Please comment on you level of anger?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
______________________
How frequent are attended to by your doctor?
_____________________________________________________

________________________________
What advice have your doctor given to you on how to make a
difference on our physical and emotional health?
What kinds of food have your healthcare team advised you to
take?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
______________________
Which tests have your healthcare doctor asked you to take?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_
What medications have the doctor prescribed for you? Please
indicate the dosage where you can.
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
______________________
What are some of the physical activities your doctor has advised
you to undertake?
_____________________________________________________
_____________________________________________________
_____________________________________________________

_____________________________________________________
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References
1-Healthy people 2020 (2016). Retrieved November 12, 2017,
from https://www.healthypeople.gov/2020/topics-
objectives.
2-The Cost of Diabetes. (2015). Retrieved November 12, 2017,
from
http://www.diabetes.org/advocacy/news-events/cost-of-
diabetes.html
Running head: Impact of chronic illness
Impact of chronic illness 2
Impact of chronic illness
Lissette Valcarcel
SU_NSG4055_W2_A2
Introduction
Diabetes mellitus has various impacts on the patients, their
families, and the friends around them. Various patients have
various mechanisms of coping with the situation most of which
is as advised by their doctors or healthcare facility

professionals where the diagnosis was done. This document is a
discussion on the impacts of this disorder as per the analysis of
an interview I conducted with one of my diabetic friends.
Results of the interview
The initials of the patient friend with whom I conducted the
interview is R.O. He was diagnosed with the disorder in 2010
while he was at the age of 22. He was diagnosed with type 1
diabetes. Before being diagnosed with the disorder, R.O
experienced the following symptoms; frequent urination and in
large quantities. He often felt very thirsty and wanted to drink
water always. He was losing weight over time. He indicated in
his response that his weight dropped from 70kg in March 2009
to 65Kg in August 2009. He always felt very hungry. Sometimes
he experienced blurred vision and felt tired most of the time.
R.O admitted that in his life, he has never been engaged in any
meaningful exercise. He liked consuming meat and other animal
products implying that there was a possibility of feeding on
saturated fats. He also had no regular eating hours. In fact, he
liked skipping breakfast according to his response. No member
of his family has ever suffered from this disorder.
Sometimes he feels angry at very simple things, he feels very
tired when he engages in the vigorous activity. He indicates that
since the diagnosis, his family has offered emotional support
such as encouragement and physical support such as ensuring he
has not involved in vigorous physical chores around. He feels
that this has enabled him to cope well. According to R.O., his
doctor has advised him to avoid emotional stress and engage in
light physical exercise. Since the diagnosis, the doctor advised
him to avoid foods rich in saturated fats, those that contain high
levels of sodium and those containing excess sugar. There are
other tests that the doctor advised him to take. One is the blood
pressure test and those related to cardiovascular systems. The
main medication prescribed by his doctor is insulin given by
regular injection and pramlintide also regularly injected.
Analysis
According to the results of the interview, the ability to live for

long with this disorder is all about its management. The
management of the illness can be divided into three aspects.
These are treatment, copying, and support.
Treatment
The main form of treatment as per this case is insulin injection.
The existence of diabetes type 1 implies the inability of the
pancreases to produce enough insulin. The role of insulin in the
body is to ensure proper usage of the glucose consumed by an
individual. Low level of insulin implies that the glucose
consumed is not properly used in the body such that its level in
the blood rises (Chiang et al., 2014). The treatment is aimed at
ensuring that the glucose level in the blood is kept at normal
levels. The injection of insulin in the body is to restore its level
back to normal so that the blood glucose levels are maintained.
That implies three options of insulin depletion, the first one is
short-acting insulin, and there is the rapid-acting insulin and
finally the intermediate-acting insulin. The other for medication
used in the treatment of this disorder is the pramlintide. This
medication delays the time taken by the stomach to empty itself.
It basically lowers the secretion of glucagon after the meals
taken. Further, it reduces the appetite through a central
mechanism so that at the end of it all it helps reduce the glucose
level in the blood. As part of treatment, other tests are
necessary. Diabetes is known to result in other disorders such as
blood pressure and various cardiovascular diseases.
Determining their presence and treating or controlling the is key
to the success of the treatment process. It is not logical to treat
a person with diabetes without treating and managing any
associated disorder. The main objective is to increase lifespan
hence the need to take these tests as in the case of R.O.
Copping
The other management method to this disorder rests on the
advice offered by the doctor. The first one is a change in eating
habit. Reducing consumption of red meat, animal products
means reducing the calories that an individual takes in. this
reduces the possibility of obesity and diabetes. Sugary foods

high glucose contentment once they have been broken down.
With the low levels of insulin in the body, consuming a lot of
this food implying introducing high levels of surplus glucose in
the body which in turn causes a rise in the blood glucose level
hence worsening the situation (Evert et al., 2014). The other
aspect is avoiding emotional and physical stress. Mental or
psychological stress has been found to increase glucose level in
the blood and that is the reason it is discouraged. Stress
hormone called cortisol increases the blood sugar level (Reagan,
2012). Exposing oneself to stress result to production of this
which in turn increases the glucose level in the blood. Light
exercise helps relax the mind and the whole situation is hence
kept under control. Constant doctor-patient contact like the case
of R.O is another coping mechanism. Further advice from the
doctor and close monitoring to avoid any escalation of the
situation.
Support
The other coping strategy is drawn from support from various
people within the environment of the patient. In the case of
R.O, family and workmates provided the necessary support. The
family is one of the main sources of stress. The family in
ensuring that the patient is not subjected to emotional family
stress is very key (Haas et al., 2012). Finding a solution to
family problems without causing any tension that would
escalate the situation is the key concept of family support.
Further, the family provides financial support for treatment and
medication. Family members taking over responsibilities that
require a lot of mental effort or physical effort that would result
in stress is also a mechanism. The other support source is an
understanding of the employer and the work. The main idea
behind this is to provide a conducive environment for
management of the illness. The employer ensuring that work
pressure is reduced is important. The baseline is understanding
the patient and what is required of the people in his

environment.
Impact of the interview findings on care plan for diabetic
persons
The development of care plan for a given group of people
suffering from a given disorder relies heavily on knowledge of
the illness. That is management mechanisms which include
copping, treatment, and support. The information gathered from
this interview provides the care program planner with the
information on what is required in the care environment. Again,
it provides the information on treatment methods which is a key
concept in the development of the care program. What should be
avoided and that which should be encouraged by the care
program depends on the information gathered in the interview.
In general, the interview sheds light on the requirement that
must be included in the care program which is treatment
mechanism, copping and support.
Conclusion
Diabetes as a disorder associated with low levels of insulin in
the body. The resultant effect is a high level of glucose in the
blood. Treatment of the disorder involves insulin injection and
pramlintide for those with diabetes type 1. The copping
mechanism includes reducing emotional and psychological
stress. This requires support from family members and the
workmates among the different types of people in the patient’s
environment. The development of a care plan relies on the
knowledge about the patient’s disorder type and what kind of
support necessary for him. The care plan must ensure that the
coping mechanisms necessary for the patient are included.
References
Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L.
(2014). Type 1 diabetes through the
lifespan: a position statement of the American Diabetes
Association. Diabetes Care, 37(7), 2034-2054.
Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P.,
Edwards, L., ... & McLaughlin, S.

(2012). National standards for diabetes self-management
education and support. The Diabetes Educator, 38(5), 619-629.
Reagan, L. P. (2012). Diabetes as a chronic metabolic stressor:
causes, consequences and clinical
complications. Experimental neurology, 233(1), 68-78.
Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz,
M. J., Mayer-Davis, E. J., ... &
Yancy, W. S. (2014). Nutrition therapy recommendations for the
management of adults with diabetes. Diabetes Care,
37(Supplement 1), S120-S143.

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