Case Study

Case Study

[Name of the Writer]

[Name of the Institution]

Case Study

Response 1

Wendy was admitted to the hospital in the neurology ward as she was diagnosed with brain cancer five years ago. However, the main reason for her admittances was unstable blood sugar level. The BSL (blood sugar level) can be caused by having severe depression or by becoming inactive that is lack of exercise. As Wendy was dependent upon her husband she became less active in doing physical tasks as well as she was suffering from depression after her brain cancer diagnosis. Having an unstable blood sugar level can have serious consequences and should be treated immediately as it can result in vulnerability to infections and even risks of death (Tao & Zhao, 2015). The fluctuations in the BSL contribute to mood swings. This happens because the glucose is not available to the brain causing aggressive behaviour. Due to fluctuations in the BSL Wendy was also being verbally aggressive as stated by her husband. When she arrived at the hospital the first contact with the health professional she had was with the nurse. The nurse immediately checked her blood pressure and then checked her blood sugar level by pricking her finger with the needle and putting the blood on the test strip into the meter and then noting the readings. The initial readings showed that she has high blood sugar level and as a cancer patient she needed to be hospitalized immediately. The nurse also made a chart that includes her past history in which it was stated that Wendy had depression and was an ex-smoker while having a stent in LAD. Due to her medical history, it was necessary to treat her immediately as a further increase in the blood sugar level can result in serious consequences such as death or damage to kidney, eyes, etc. According to Dr Rama Natarajan, Ph.D., “cancer cells love glucose” as glucose works as a primary fuel as cancer cells consume metabolize glucose 200-time more than the normal rate. So increase in the blood sugar level can also result in increasing Wendy’s cancerous cells (Szablewski, 2013). As reported by Wendy’s husband that her blood sugar level was fluctuating another problem was raised as to how to treat this condition as giving medicine to lower the sugar level can be damaging while increasing the sugar level also results in severe consequences. So it is important that Wendy should be referred to the endocrinologists and shifted to the endocrinology ward so that she can be treated immediately. Endocrinologists are the doctors that are specialized in human glands and the hormones the make and secrete. They also deal with metabolism. In Wendy’s case, the endocrinologist will deal with the pancreas and its secretion called pancreatic juice that makes insulin and other substances used in the digestion (Malkani & Harlan, 2016). When Wendy was admitted to the hospital the nurses checked her blood sugar level which was high at that time so after reading the past history and the current BSL the endocrinologists will first manage the insulin timings and then will observe the patient if the BSL is not normal then the doctor will change the medications and type of insulin. The doctor will also recommend avoiding certain foods that contain sugar to avoid further elevation in the BSL. Other treatments besides the insulin therapy are fluid replacement and electrolyte replacement depending upon the requirement of the patient. However, in Wendy’s case as she is not resisting taking medicines orally then electrolyte replacement and insulin therapy are the best options. As her BSL is very high the immediate way to make her BSL normal is to use insulin therapy (Flory & Farooki, 2016). As Wendy has cancer it is important to collaborate with an oncologist as studies show that certain cancer medications such as corticosteroids can also be considered as a factor that causes increase BSL (Suissa & Ernst, 2010). So to treat Wendy it is important that both oncologists, as well as endocrinologist, work together so that she can be treated effectively.

Response 2

Wendy was hospitalized for five days. During this time doctors and nurses constantly monitored her and took certain tests to examine her condition. After doing CT-Brain and Abdomen the doctors determine that Wendy’s cancer is widely metastatic due to which she can experience personality changes as well as aggressive behaviour and will become more forgetful. So in her discharge plan, doctors recommended her to be admitted in the respite facility where her blood sugar level, as well as her medications intake, can be monitored. However, Wendy and her husband belong to a Chinese family and according to their culture, it is the moral responsibility of family members to take care of the sick person (SM, 2019). So they rejected to use the respite facility. The increase in the blood sugar level can directly influence her cancer as metabolic glucose serves as a fuel in the growth of cancerous cells as they occupy glucose 200 times more than any normal cell which can cause her cancer to spread more making her condition worse. As her blood sugar level is still high and needs to be monitored she can access the community pharmacist at her home who can regularly test her BSL and manage the insulin dosage if her BSL falls below or higher than the expected range. Wendy’s family can also contact Chinese healthcare organizations where most of the workers are Chinese so that they can easily communicate and collaborate with the social worker as they have the same cultural background. Due to her personality change and aggressive behaviour, there is also a need to hire a therapist that can help Wendy to cope up with the depression as increase stress causes an increase in the BSL which can lead to serious consequences. She needs to have a diet plan that can help her in getting energy as well as balancing BSL because if given sugary foods or foods having a high amount of carbohydrates can elevate her blood sugar level making her severely ill (Australia, 2019). For this purpose, she can contact a dietician so that her family can give her foods that will balance her BSL. Being a part of a team that facilitate patients after their discharge I recommend hiring a full-time nurse (Bodenheimer & 2016). as she can monitor her blood sugar levels and her daily condition. She can also identify symptoms of any other problem as well so that in case of emergency she can give first aid to Wendy and can take the decision of her re-admittance in the hospital. Nurses are also taught to counsel patients so a nurse can also play the role of a part-time therapist for Wendy and can help her in coping with her depression and taking medications prescribed by the doctors. A nurse can also schedule an appointment with the doctor if she notices any improvement or decline in her present condition. As Wendy belongs from a Chinese family their many nurses that are Chinese. Her family can hire a Chinese nurse as she also has the same cultural background (SM, 2019) as Wendy and her family that can facilitate Wendy.   

References

Australia, H. (2019). Type 1 diabetes.

Bodenheimer, T., & Bauer, L. (2016). Rethinking the primary care workforce—an expanded role for nurses. New England journal of medicine, 375(11), 1015-1017.

Flory, J., & Farooki, A. (2016). Diabetes management in cancer patients. Oncology, 30(6).

Malkani, S., Keitz, S. A., & Harlan, D. M. (2016). Redesigning diabetes care: defining the role of endocrinologists among alternative providers. Current diabetes reports, 16(12), 121.

SM, W. (2019). Holism and caring: nursing in the Chinese health care culture. - PubMed - NCBI. Retrieved 14 August 2019, from https://www.ncbi.nlm.nih.gov/pubmed/12119615

Suissa, S., Kezouh, A., & Ernst, P. (2010). Inhaled corticosteroids and the risks of diabetes onset and progression. The American journal of medicine, 123(11), 1001-1006.

Szablewski, L. (2013). Expression of glucose transporters in cancers. Biochimica et Biophysica Acta (BBA)-Reviews on Cancer, 1835(2), 164-169.

Tao, Z., Shi, A., & Zhao, J. (2015). Epidemiological perspectives of diabetes. Cell biochemistry and biophysics, 73(1), 181-185.