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NRSG 366 Nursing Case Study

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NRSG 366 Nursing Case Study

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Course Code: NRSG366
University: Western Sydney University

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Country: Australia

Discuss about the Complex Care Priorities.

Michael is a patient who suffered from diabetes 2, and also he is obese with a weight of 165kgs and BMI of 56.09m2 which are the risk to his health, he is also facing depression which is contributed by the state if his health (Misra,& Bhardwaj, 2014)). Michael also has got hypertension, and his social history is worrying since he no longer feels to be part of the society.  His medical condition is complex, and he needs care priorities to be handled so that it could give him a better state of health. The essay will address the scenario of Michael Anderson where it will discuss weight management and social isolation as complex care priorities
Complex care priorities
The complex care priorities identified is weight management and social isolation. His weight of 165kg is an issue which should be addressed to save the condition (Handelsman, et al., 2015). It might give him further complications its management will assist him to reduce these risk also will improve his social relationship. Also, social isolation forms another complex care priority. Michael feels isolated from the rest of society due to his conditions, and it is crucial to attend these issues so that it assists him to manage risks such as weight and depression (Franz et al., 2015). The mentioned conditions will be essential to harmonize diabetes and the social part of life where he is feeling uncomfortable to live
Weight management
The objectives of treatment for overweight and obese individuals having diabetes are to attain most favorable glycemic and metabolic control primarily via health behavior involvement. Achieving and managing a fit body weight as well as controlling weight recovery are the short and long-term objectives (Inzucchi, et al., 2015). Diabetic and obese individuals have bigger complexity with weight loss in comparison to obese people devoid of diabetes 
Behavioral therapy, Physical and diet
Behavioral therapy, Physical and diet are planned to assist Michael to attain 5% of weight loss ought to be prescribed for him. These particular interventions comprise of sixteen lessons within a period of six months. The primarily focus on physical activities such as gym, joking and running, correct diet and behavioral plans which will attain 500-750 kcal loss per day (Johns et al., 2014). In case if Michael if Michael will be an individual who attains short-range weight loss objectives, he should be prescribed for comprehensive weight maintenance program which is meant to offer not less than a month contact and motivate routine checks of the weight of the body either more frequently or even weekly.
There should be continued taking of low-calorie diet and also he should engage in physical activities for instance 200 to 300 minutes in a week in order to achieve more than 5% weight loss. Michael also should be prescribed to short-term high-intensity interventions which employ low-calorie diets; less or equal to 800kcal per day with very close monitoring. However, he should be incorporated with long-term comprehensive maintenance counseling.  Weight-loss diets ought to be well balanced and nutritionally enough to make sure extra protein synthesis as well as muscle wasting and to keep away from significant changes in the steadiness of fluid and ketosis (Johns et al., 2014).  Foods with lots of -fiber are linked to much satiety. Sufficient protein consumption is necessary to uphold incline body mass as well as some additional indispensable physiological approaches. Minimized consumption of inundated fat as well as energy-saturated diet ought to be emphasized. However, very-low-calorie foods with less than nine hundred kcal per day are not recommended for him, unless in medical supervision.
Because Michael is suffering from obesity and diabetes 2, the lifestyle changes which lead to modes and sustained loss in weight offer meaningful reductions in the blood glucose and triglycerides. Achievement of greater weight loss offers better advantages such as reduction in blood pressure, HDL, and LDL cholesterol will improve (Powers et al., 2017).
Lifestyle interventions
For anyone to lose weight, lifestyle strategies can be employed to attain energy deficit of 500 to 750 kcal per day. On the other hand provision of 1500 to 1800 kcal per day for men can be changed on personal baseline body weight. The advantages can be observed with at least five percent weight loss, but the continual weight loss of 7 per cent is most favorable (Dunkley et al., 2014). The kind of diet meant for Michael can differ on the restrictions of the diet. For instance high carbohydrate foods and fat foods but on the other hand, they are very crucial if they develop needed energy deficit. However, the choices of the diet have to be based on the health condition of the patient and also his preferences. The intensive behavioral lifestyle interventions encompass more than or equal to sixteen within a period of six months sessions
When choosing glucose lowering medication for obese or overweight individuals, the implications on the weight should be considered. It is wise to reduce the medications for comorbid state linked to gain in weight (Campbell, 2014). The medication on weight loss can be successful as adjuncts to physical actions, diet and behavioral psychotherapy for Michael. The significant advantages ought to be weighed alongside the critical threats of the offered treatments.
If Michael reaction to the loss in weight is more than 5%  after three months or if there is the safety problem, the medication ought to be discontinued, and another option for medications have to be considered. The agents which are linked to weight loss are sodium–glucose co- transporter two inhibitors, amylin mimetics and glucagon-like peptide one agonists (Campbell, 2014).  However, Dipeptidyl peptidase four inhibitors look as neutral to weight. Some agents such as insulin, insulin secretagogues should not be administered to Michael because they are usually linked to weight gain.
Concomitant Medications
The health care providers ought to evaluate and review the concomitant medications of Michael. However, they should consider offering options for any medications which facilitate weight gain (Lee et al., 2014). For instance, they use of anticholinergics, antidepressants, and antihistamines.
Bariatric surgery
This kind of surgery is meant for people who have BMI more than 35kg/m2    and also these with diabetes 2. For the case of Michael, the surgery is appropriate since he has got BMI of 57.09 m2 and he has got diabetes 2 (Buchwald & Oien, 2013). These surgeries encompass procedures which involve bypassing, resection, gastric branding or the transposing the stomach sections and ileum. It is convenient procedures for severe obesity while done to be part of comprehensive weight loss supervision strategy. It will involve a lifelong support together with medical management.  The gastric branding leads to less weight loss in comparison to Roux-en gastric bypass sleeve gastrectomy. But the recommended guidelines prefer bariatric surgery for individuals with more than >35 kg/m2 BMI and also those with diabetes 2.
The use of bariatric surgery has been indicated to attain normalization of glycemia in the period of 2eyars fully after surgery in 72% of the individuals under research in comparison with 16% of the group of patients who had been under pharmacological and lifestyle interventions (Lopez-Nava et al., 2015). The medication interventions have been found to work effectively with medical treatment as compared to merely medical therapy.  Even though this kind of surgery makes better the metabolic conditions of patients with morbidly obese, it still needs lots of studies.
Social isolation
Social isolation is a condition where an individual is completely or nearly completely lack contact with and the general society (De Jong Gierveld, et al., 2016). For the case of scenario, Michael Anderson feels completely uncomfortable with his condition. Michael is socially secluded for the reason that he is humiliated by the size and he seldom goes out. He finds it more and harder to carry out undertakings of daily living. He notices that he is the crucial part of his life and he needs to reduce weight. The care priorities are meant to win him back to feel part of the society engage in activities which can assist him to improve his health condition.
Attending social programs
There are different social programs which are meant to keep people busy for instance environmental cleaning (Shankar et al., 2013). Michael in this case, therefore, should be encouraged to attend such programs which will eventually improve his contact with other people in society. It will encourage him, and he will avoid stigma.
Social support
The society has a significant role in ensuring that socially isolated individuals are taken care of. What people should do is offering support to Michael by helping him to do his domestic duties. From this point, Michael will not feel alone but he will feel part of the society, and he will not hide in his premises again (Shankar et al., 2013). The church also should visit him frequently as a way of encouraging him and giving him more hope that his condition will be better. In addition, people in society should positively compliment him whenever they meet him. Through this idea, Michael will feel loved hence he will get out of isolation quickly.
Different hospitals have various workshops for individuals with various types of diseases. As for Michael, he should visit obese and diabetes workshops and here he will interact with various patients who have various issues which are even worse than his (Shankar et al., 2013). Through these workshops, he will develop an active mind knowing that he is even much better and he can still do better provided the therapies.
Encouraging a sense of purpose
A sense of purpose or just hobbies which bring curiosity among patients with diabetes and obesity should be encouraged. There are very less to succumb to consequences of social isolation.  Hobbies and interests are social in nature. Almost everything which encompasses teams encourages participation, and it is socially healthy (Shankar et al., 2013). Michael should be encouraged to continue doing his hobbies to make him active. However, by encouraging him to volunteer in some organizations can assist him to develop a sense of purpose
Offering him a job
Provided that the conditions of Michael are improving based on the suggested therapies; his two children should start him a simple business which is meant to keep him busy (Shankar et al., 2013).For instance, he should be given popcorn machine which he will conduct his business of baking popcorns and sell to people. This is a simple business which will assist him to interact with diverse people in society.
The condition of Michael is a critical approach which nurses should consider with much attention. Having diabetes 2 and obesity at ago needs combined therapies which can save the situation. The weight management will assist him to reduce lots of fats in his body which also assist in maintaining severity of diabetes 2. In addition, in order to continue with the therapies, his social contact should be improved through, workshops, encouraging a sense of purpose, participating in hobbies and even engaging in businesses.
Buchwald, H., & Oien, D. M. (2013). Metabolic/bariatric surgery worldwide 2011. Obesity surgery, 23(4), 427-436.
Campbell, R. K. (2014). Pharmacotherapy of Diabetes: Past, Present, and Future.
De Jong Gierveld, J., Van Tilburg, T., & Dykstra, P. (2016). Loneliness and social isolation.
Dunkley, A. J., Bodicoat, D. H., Greaves, C. J., Russell, C., Yates, T., Davies, M. J., & Khunti, K. (2014). Diabetes Prevention in the real world: Effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations. Diabetes care, 37(4), 922-933.
Franz, M. J., Boucher, J. L., Rutten-Ramos, S., & VanWormer, J. J. (2015). Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. Journal of the Academy of Nutrition and Dietetics, 115(9), 1447-1463.
Handelsman, Y., Bloomgarden, Z. T., Grunberger, G., Umpierrez, G., Zimmerman, R. S., Bailey, T. S., … & Davidson, J. A. (2015). American Association of Clinical Endocrinologists and American College of Endocrinology–clinical practice guidelines for developing a diabetes mellitus comprehensive care plan–2015. Endocrine Practice, 21(s1), 1-87.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care, 38(1), 140-149.
Johns, D. J., Hartmann-Boyce, J., Jebb, S. A., Aveyard, P., & Group, B. W. M. R. (2014). Diet or exercise interventions vs combined behavioral weight management programs: a systematic review and meta-analysis of direct comparisons. Journal of the Academy of Nutrition and Dietetics, 114(10), 1557-1568.
Lee, M. S., Lin, R. Y., & Lai, M. S. (2014). Increased risk of diabetes mellitus in relation to the severity of psoriasis, concomitant medication, and comorbidity: a nationwide population-based cohort study. Journal of the American Academy of Dermatology, 70(4), 691-698.
Lopez-Nava, G., Galvão, M. P., da Bautista-Castaño, I., Jimenez, A., De Grado, T., & Fernandez-Corbelle, J. P. (2015). Endoscopic sleeve gastroplasty for the treatment of obesity. Endoscopy, 47(05), 449-452.
Misra, A., & Bhardwaj, S. (2014). Obesity and the metabolic syndrome in developing countries: focus on South Asians. In International Nutrition: Achieving Millennium Goals and Beyond (Vol. 78, pp. 133-140). Karger Publishers.
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … & Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53.
Shankar, A., Hamer, M., McMunn, A., & Steptoe, A. (2013). Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosomatic medicine, 75(2), 161-170.
Simmons, D., Jelsma, J. G., Galjaard, S., Devlieger, R., van Assche, A., Jans, G., … & Harreiter, J. (2015). Results from a European multicenter randomized trial of physical activity and/or healthy eating to reduce the risk of gestational diabetes mellitus: the DALI lifestyle pilot. Diabetes Care, 38(9), 1650-1656.

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