Heart Failure A Long Term Care Syndrome Paper


As an advanced practice nurse, it is important to diagnose, treat, and evaluate patients who have chronic disease. A nurse must understand how pathology, treatment, regimens, and psycho-social issues affect patients and the care they receive. Disease management is more than just monitoring a medication or treatment; it is evaluating the disease process from the micro to macro level. As a nurse with an advanced degree, you will be expected to assess patients and individual and population responses to chronic illness.For this assessment, you will investigate pathopharmacological issues related to a specific disease process. You may choose to investigate traumatic brain injury, depression, obesity, asthma, or heart failure. As part of this assessment, you will analyze the various impacts the disease process has on the patients, their families, and populations at a local, national, and international level.


Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to anyone individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.Professional Communications is a required aspect to pass this task. Completion of a spell check and grammar check prior to submitting your final work is strongly recommended.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Investigate one of the following disease processes: traumatic brain injury, depression, obesity, asthma, or heart failure.

1. Analyze the pathophysiology of the disease process you selected in part A.

2. Discuss the standard of practice for the selected disease process.

a. Discuss the evidence-based pharmacological treatments in your state and how they affect management of the selected disease in your community.

b. Discuss clinical guidelines for assessment, diagnosis, and patient education for the selected disease process.

c. Compare the standard practice for managing the disease within your community with state or national practices.

3. Discuss characteristics of and resources for a patient who manages the selected disease well, including access to care, treatment options, life expectancy, and outcomes.

a. Analyze disparities between management of the selected disease on a national and international level.

4. Discussthree or four factors (e.g., financial resources, access to care, insured/uninsured, Medicare/Medicaid) that contribute to a patient being able to manage the selected disease.

a. Explain how a lack of the factors discussed in part A4 leads to an unmanaged disease process.

i. Describe characteristics of a patient with the selected disease that is unmanaged.

B. Analyze how the selected disease process affects patients, families, and populations in your community.

1. Discuss the financial costs associated with the selected disease process for patients, families, and populations from diagnosis to treatment.

C. Discuss how you will promote best practices for managing the selected disease in your current healthcare organization.

1. Discuss three strategies you could use to implement best practices for managing the selected disease in your current healthcare organization.

2. Discuss an appropriate method to evaluate the implementation of each of the strategies from part C1. Welcome to Pathopharmacological Foundations for Advanced Nursing Practice (C155)
In this course, you will acquire skills to assist you in applying what you learn about the pathophysiology of
disease processes, their associated pharmacologic treatments, and the social and environmental factors that
impact them. The course integrates the examination of five disease processes: asthma, heart failure, obesity,
traumatic brain injury, and depression. Each of these is relevant to advanced nursing practice because of their
prevalence and impact on the healthcare system and the nation’s health.
Course Completion
The learning model at Western Governor’s University is a competency-based model. This advocates for you as
the student to determine the best approach for your learning and your ability to successfully pass the
performance assessment (i.e. WUT2) required in this course. It is advantageous to complete this course in an
efficient manner, allowing you to make timely progress towards completing your degree. Each learner will
vary in the time it takes to complete the course based on several factors. There are pacing guides and
resources available within the Course Tips intended to help you achieve your goals. Keep in mind that all
guides and resources are optional to use. If you are in question about a concept or directive, the rubric used to
evaluate the performance assessment is the best resource to refer to for needed clarity. The performance
assessment directions, rubric and submission area can be found in the Assessments tab within the Course of
Performance Assessment
The WUT2 performance assessment, otherwise known as ‘Task 1’, is a paper focusing on your choice of
asthma, heart disease, obesity, traumatic brain injury, or depression. The disease focus must be generalized
to the adult population.
In selecting a topic for your paper, heart disease is the only topic out of the five identified disease processes
that you can narrow down to a sub-topic. Examples include coronary artery disease, hypertension, congestive
heart failure, or myocardial infarction. If choosing a heart disease sub-topic, the necessary components
allowing sub-topics require that the condition has clinical guidelines that are published by a reliable
organization such as the American Heart Association or the American College of Cardiology. Please contact
your assigned Course Instructor if you need further guidance regarding topic choice.
Course Instructor Resources
Learning Resources – Under Preparing for Success on the left side of the Course of Study, you will find
the online course textbooks, as well as Writing Tools to assist you with the fundamentals of academic
writing and APA adherence guidelines.
Course Tips – The Course Tips are located within the Course of Study will have various resources
accessible by hyperlinks. These resources are created and kept current by your Course Instructors. These
documents are secure and only accessible to those with a WGU email address; therefore, you must first
log into Microsoft Outlook (your WGU email) before clicking on the hyperlinks.
Recorded Cohort Link:
Task Submission & Revisions
Task Submission
To submit your Task 1 paper, navigate to the Assessments tab. From the Task 1 description, click the blue
hyperlink, ‘View Task’. Once navigating to the task description page, click on ‘Submissions’ located towards the
left within the blue heading. There you will see a button labeled, ‘Begin Task Submission’. Acceptable file
formats that can be uploaded include doc and pdf files. There are multiple attempts allowed for task 1
Task Revisions
If your task is returned for revision(s), you can access the evaluator’s feedback through the same route
required for submitting the task, but now clicking on ‘Score Reports’ in the blue heading. Passing remarks are
sections deemed Competent and Highly Competent. Sections needing revision are those marked as Minimally
Competent and lower. Evaluator comments will provide the necessary aspects missing from the submission.
Your Course Instructor will also be reaching out to you to assist with the revisions. If revisions are required in
either Professional Communication or Sources sections, the best resource to access is the Writing Center.
Course Instructors can assist you with revisions pertaining to content matter.
Need Help?
Your assigned Course Instructor should be the first line of contact if you have concerns or questions about the
course. Don’t hesitate to email them or schedule an appointment with them. The course email is also
available if you have unique or emergent concerns that your Course Instructor was not able to help with. The
course inbox should not be your first contact attempt for assistance. This recommended process provides
continuity and consistency in course and task directives. Working with various Course Instructors can create
confusion and fragmented guidance, preventing you from progressing efficiently through the course. Your
success is also your Course Instructor’s success! We want to help, so just ask!
Wishing you great success!
Your C155 Course Instructor Team
Running head: TOPIC IN CAPS
Your Name
Pathopharmacological Foundations for Advanced Nursing Practice
Western Governors University
Title of Paper
Investigated Disease Process
Standard of Practice
Pharmacologic Treatments
Introduction of Drugs
First Drug Category
Second Drug Category
Third Drug Category
Local Outcomes
Clinical Guidelines
Patient Education
Standard of Practice Disease Management
Managed Disease Characteristics and Resources
International and National Disparities
Managed Disease Factors
Unmanaged Disease Factors
Unmanaged Disease Characteristics
Patient, Family & Population
Patient Costs
Family Costs
Community Costs
Best Practices
Plan Implementation
Plan Evaluation
Organization. (year). Title of article. Retrieved from:
Last name, I., Last name, I. & Last name, I. (year). Title of Longer Article to Show Example.
Journal Name, #(#): pg # – #.
Running head: DIABETES
**Due to the format of Microsoft Word online, the header is not shown. Your paper needs the
Running head and page numbers in the header according to APA** Click ‘Header’ to the right,
which will show you the format.
Jane Smith
Pathopharmacological Foundations for Advanced Nursing Practice
Western Governors University
*** This paper and topic are for example purposes only, and does not take place of the
rubric guidance. Diabetes is not an approved topic for the Task 1 submission. The authors
cited in this paper are fictitious and for example purposes only. ***
A Lifetime Condition – Type 1 Diabetes Mellitus
Investigated Disease Process
Each year in the United States there are 100,000 people who die from complications of
type 2 diabetes mellitus (Centers of Disease Control & Prevention, 2018). This disease can be
prevented, and risks minimized through lifestyle modification. This paper will discuss various
aspects of this disease process including pathophysiology, review of the standard of practice,
patient outcomes and development of a best practices plan to mitigate negative outcomes of this
disease within an organization.
Diabetes is a disease that affects multiple body systems through altering cellular
metabolism. At a cellular level each cell requires glucose for metabolism purposes. Insulin
produced by the pancreas functions to allow transport of glucose from the extracellular area to
intracellular area (Hoffner, 2018). Those with diabetes have pancreatic insufficiency which
eventually eliminates complete production of insulin. The result is that glucose present in the
intravascular area is not able to move into the cells. The cells will then be starved for glucose and
no longer function appropriately.
With numerous cells lacking glucose the endocrine system stimulates additional glucose
from body reserves that is stored in the liver as glycogen. When glycogen is broken down into
glucose, this increases the circulating glucose levels even more, compounding the severity of this
disease. When intravascular fluid (e.g. serum) is overly saturated with glucose molecules, the
body chemistry changes causing shifts of electrolytes, water molecules, leading to electrolyte
abnormality and pH imbalance (Hoffner, 2018). The body systems that are mostly affected by
these abnormalities and glucose are the cardiovascular system, nervous system, kidneys and eyes
(Hoffner, 2018).
When serum glucose levels are consistently above normal levels, the blood vessels
distribute blood to the eyes, kidneys, distal tissues (e.g. fingers and toes), become inflamed and
respond by constriction decreasing blood flow perfusion (Hoffner, 2018). With decreased
perfusion, oxygen is not delivered, and those organs and cells slowly deteriorate. Over time,
uncontrolled diabetics can be blind, have renal failure, and lose body limbs.
Diabetes is a treatable condition however when uncontrolled negatively affects many areas
of the body. These negative effects lead to poor health outcomes and decreased life expectancy.
While type I diabetes is not preventable, understanding of the disease process is well known and
when treated appropriately patients can live a very normal life.
Standard of Practice
The standard of practice for the disease, diabetes mellitus was published in 2015, by the
American Diabetes Association. This publication provides specific recommendations pertaining
to screening intervals, prevention of comorbidities such as renal failure, skin integrity
impairment, and visual deficits to name a few. The Standard of Practice also provides clear
parameters for the assessment, diagnosis, nonpharmacologic strategies of management and
medication recommendations. The objectives for the standard of practice are to minimize
complications commonly associated with unmanaged diabetes and extend the life expectancy for
this vulnerable population (American Diabetes Association, 2015).
Health promotion strategies are consistent throughout the standard of practice for
diabetes. Not only are there medical guideline recommendations for this disease process, but also
various patient education materials. These extra resources allow providers across the country to
have consistent practices in diagnosing and managing this common disease. The next two
sections will explore the standard of practice recommendations for pharmacologic treatments and
the clinical guidelines.
Pharmacologic Treatments
The best health outcomes occur when patients are compliant with medication
recommendations and lifestyle modifications. Diabetes is best treated through providing insulin
through parenteral routes. Insulin is deteriorated in the acidic environment of the stomach;
therefore, oral insulin is not available as a form of treatment.
Insulin – Short Acting
Short acting insulin is the most common type of insulin given for diabetic ketoacidosis
and glucose correction following a meal (American Diabetes Society, 2018). Short acting insulin
can be administered through injection using an insulin needle and syringe, or through an insulin
pump. Short acting insulin has an onset of action ranging from 5 to 30 minutes, with a duration
of one to two hours (American Diabetes Society, 2018). The most common adverse effect
associated with short acting insulin is hypoglycemia (American Diabetes Society, 2018). This
can be prevented by correctly calculating carbohydrate to insulin ratios and the patient needs to
consume the meal soon after the insulin has been administered.
Insulin – Intermediate Acting
Intermediate acting insulin allows the patient to minimize how many injections they give
in a day by mixing the intermediate insulin with the short acting insulin injection. The short
acting insulin will affect glucose consumed for the meal occurring at that time, where
intermediate insulin will cover glucose consumed two to four hours later (American Diabetes
Society, 2018). Just like short acting insulin the adverse effect of this insulin type is also
hypoglycemia. This can be avoided by encouraging the patient to have a snack in between
breakfast and lunch such as an apple or graham crackers.
Insulin-Long Acting
Like the intermediate acting insulin, long-acting insulin works by affecting glucose
consumed later in the day and to regulate glucose overnight while the patient sleeps. The onset of
action is 1 to 2 hours, with a duration of 6 to 8 hours (American Diabetes Society, 2018). To
avoid hypoglycemia the patient should consume a small snack prior to bedtime. Appropriate
snacks include fruit such as an apple or orange, or crackers.
Local Outcomes
University Hospital is the leading organization in the Greene County, Missouri area who
manages patients with diabetes. This organization cares for patients who are newly diagnosed
through their lifetime. University Hospital aligns with the American Diabetes Association
guidelines recommendations for use of the medications as previously outlined, in addition to
technological advances such as continuous glucose monitoring devices and insulin pumps. The
latest initiatives at University Hospital have been the implementation of technology in insulin
dosing. Insulin pumps provide a more consistent way to administer appropriate doses
continuously as opposed to interval injections given by the patient. This technological
intervention has greatly improved management of diabetes for patients care at University
Hospital. In the past year, the average hemoglobin A1C measurement of patients managed at
University Hospital was 8%, which is 6% lower than averages two years ago (University
Hospital, 2018). This impressive data suggests that adapting to innovative medication practices
are an effective means to improve medication compliance and patient outcomes as evident by the
improvement of hemoglobin A1C of diabetes patients at University Hospital.
Clinical Guidelines
Patients with diabetes who are not yet diagnosed will often report excessive thirst, hunger and
urination (American Diabetes Society, 2018). Despite excessive drinking and eating the patient
will continue to lose weight, have decreased energy and eventually may have neurological
changes such as altered mental status, and worst-case scenario, a coma (American Diabetes
Society, 2018). On physical assessment the patient may be jittery, diaphoretic, and pallor. If
laboratory studies are obtained the patient may have changes in their potassium, metabolic
acidosis, and elevated blood glucose level (American Diabetes Society, 2018).
Unfortunately, when diabetes is diagnosed the patient is often quite ill and experiencing
diabetic ketoacidosis. There isn’t a specific test for diabetes but a diagnosis of inclusion
including elevated blood glucose, elevated hemoglobin A1c and associated laboratory test
abnormalities consistent with the disease process such as potassium and bicarbonate abnormality
(American Diabetes Society, 2018).
Patient Education
Once a patient is diagnosed with diabetes, they will sustain a complete change in lifestyle
such as altering their nutrition, checking blood glucose frequently and dosing of insulin for the
rest of their life. Priority patient education that is recommended are accurate calculation of
carbohydrates, proteins and fats consumed in their diet (American Diabetes Society, 2018). This
calculation is essential because insulin dosing is based on grams of carbohydrates. Other priority
education should take place is making the patient aware of the available resources that they have
questions or trouble managing their blood glucose, as well as unique situations such as glucose
changes when ill or when the disease has been diagnosed in a child (citation, year). Each patient
will have a unique experience and education should be provided accordingly.
Standard of Practice Disease Management
As previously identified, University Hospital is the leading expert in the Denver area
where patients with diabetes or managed. University Hospital aligns with the American Diabetes
Society standard of practice regarding the diagnosis, and management using nonpharmacologic
and pharmacologic strategies when required. To diagnose diabetes, University Hospital uses
laboratory studies including a fasting glucose and hemoglobin A1c to diagnose diabetes,
consistent with recommendations by the American Diabetes Society (2018). Non-pharmacologic
strategies provided by University Hospital providers include referral to a nutritionist who
specializes in caring for patients who have diabetes, and referral to exercise therapies in cases
where patients are obese. Nutrition and exercise are both recommended strategies suggested by
the American Diabetes Society.
Patient outcomes that have resulted from these practices have been positive. In 2017,
72% of patients referred to University Hospital have improved control of their diabetes through
the previously mentioned practices (University Hospital, 2017). Of those who demonstrated
control of their diabetes, hemoglobin A1c’s were consistently less than 9%, body mass index was
maintained less than 28 kg/m², and 52% of this population consistently met with the nutritionist
as recommended (University Hospital, 2017). This data represents that following
recommendations set forth by the American Diabetes Society are effective and yield promising
outcomes for those who have diabetes.
Managed Disease Characteristics and Resources
The first characteristic of the patient with well managed diabetes is adherence to the
diabetic diet. To maintain consistent blood glucose levels, patients must count carbohydrates and
proteins with each meal and dose insulin needs accordingly (American Society of Diabetes,
2017). Patients who consistently keep track of their nutrition are more likely to have a healthy
body mass index, less likely to have hypertension and decrease the risk of comorbidities
associated with diabetes (American Society of Diabetes, 2017). To achieve this goal a resource
that a patient will use is a nutritionist who specializes in the management of diabetes (American
Society of Diabetes, 2017). This individual can help them with food choices and answer any
questions they have if blood glucose levels are inconsistent.
The second characteristic of a patient with well managed diabetes is medication
compliance. Management of blood because levels requires daily tracking and medication
administration. Patients who consistently follow blood glucose levels will be more likely to note
inconsistencies and make appropriate changes with medication dosing (American Society of
Diabetes, 2017). Proper use of medication leads to more consistent blood glucose levels, which
in turn leads to better health outcomes. A resource the patient can access to improve medication
compliance can be a resource nurse specific to the management of diabetes. Or the healthcare
provider who manages their diabetes can be a great resource for the patient to ask questions and
clarify aspects of medications (American Society of Diabetes, 2017).
The last characteristic of the well managed diabetic patient includes consistent medical
evaluation according to the recommended intervals. When patients are 1st diagnosed, the
recommendation is that they are evaluated every three months to determine that they are
managing the disease process correctly (American Society of Diabetes, 2017). A hemoglobin
A1c is a common test performed at these visits, which provides information regarding the
patient’s management of their diabetes over the past three months (American Society of
Diabetes, 2017). This interval assessment allows you nutrition and medication adjustments to
better meet the requirements for that specific patient. The resource most appropriate for this
characteristic is having a medical home that specializes in the management of diabetes.
The American Society of Diabetes (2017), reports that those who managed their diabetes
can live 10 to 20 years longer than counterparts who do not manage the disease successfully. In
managing the disease, the characteristics outlined previously are those that contribute to this
difference in life expectancy outcomes. The emphasis suggested to improve the outlined
characteristics begins with patient education (American Society of Diabetes, 2017). Therefore,
upon initial diagnosis healthcare professionals need to prioritize a successful educational
experience throughout the patient’s life.
International and National Disparities
Diabetes is a worldwide issue. It is not a disease process specific to the United States
alone. In Australia, the mortality rate of diabetes is 18%, compared to 26% in the United States
(World Health Organization, 2016). In Afghanistan, the reliability of tracking statistics related to
diabetes is inconsistent however the World Health Organization (2016) estimates a mortality rate
of 39% in those who are known to have diabetes at the time of death. What are these countries
doing differently in terms of managing this common disease process?
In Australia, the healthcare structure is very different from United States. Health
insurance is not just something achieved through employment, it is something that every citizen
has by right. This leads to improved health maintenance exams and interval health care visit
needs (citation, year). As a result, more patients are screened for diabetes and the diagnosis is
promptly found. With earlier diagnosis, treatment can be initiated, and health outcomes are
subsequently improved. The prevalence of diabetes is 32% in Australia compared to 28% in the
United States (Cantery, 2019). This difference in prevalence is likely caused by increased
screening for the disease process. Meaning, in the United States there are likely many who are
not yet diagnosed because they have not sought medical care or been appropriately screened
according to guidelines practiced in Australia. Once diagnosed, healthcare providers follow
similar guidelines in managing the disease process through the use of nutritional modification
(e.g. carbohydrate and protein modifications), and pharmacologic management including
injectable insulin (Cantery, 2019). Another factor leading to better control of diabetes and
Australia is related to the costs associated with medical equipment. These costs are covered
100% by the Australian government health insurance plan (Cantery, 2019). This prevents
patients from limiting supplies or medication secondary to income.
As previously mentioned, statistics around diabetes in Afghanistan are not reliable,
therefore it is difficult to understand the true disparity. In areas where medical facilities exist,
patients will seek care with illness or health concerns. It is common that patients who are not yet
diagnosed with diabetes often seek medical care when their disease is severe and more lifethreatening (Simms, 2017). This is likely the reason for a higher mortality rate. In areas of the
country where primary care type facilities exist, screening practices are performed and
management including injectable insulin is prescribed (Simms, 2017). The population that these
serves are likely those who have health insurance or a means to pay for healthcare. However,
most of the population are not getting routinely screened for this disease process and there are
many who are not diagnosed appropriately and therefore health outcomes are grim (Simms,
2017). Once diabetes is diagnosed, insulin is the medication of choice used for these patients.
Depending on the provider, they will prescribe various practices around checking glucose levels
and assigning insulin unit dosing (Ross, 2015). Without specific guidelines regarding
management, there is great variability across Afghanistan which leads to numerous different
patient health outcomes.
Using these two countries as a representation of international practices compared to
national practices of the United States, it is evident that routine screening for diabetes is a
predictor of mortality. In countries where screening is routine, the diagnosis of diabetes is
punctual and management strategies can be initiated. In countries where routine screening for the
disease does not occur, treatment is delayed leading to worse health outcomes and death. It is
also evident that consistent adherence to management guidelines are also a predictor of mortality
and comorbidities associated with diabetes. In Afghanistan for example, each provider has their
own way of managing the disease process that may or may not lead to desirable health outcomes
for their patients. If there were a guideline we could follow, patient health outcomes would be
easier to track and adjustments to the guidelines be made. In countries like the United States and
Australia, specific guidelines are published by reliable evidence-based resources which allows
patients to receive care immersed in best practices.
Managed Disease Factors
The first factor that allows the patient to manage the disease process of diabetes is
economic stability. Patients with diabetes will require many healthcare visits, medications and
durable medical equipment to manage their disease process (Ross, 2015). Depending on
insurance status these items will have copayments or deductibles associated with them. A patient
who is economically stable is more likely to have the means to pay for them and therefore better
manage the disease process.
The next factor that influences a patient to have better managed diabetes is health
insurance. Patients who have health insurance will be able to seek medical care promptly when
acute or chronic health concerns arise (Ross, 2015). When healthcare is easily accessible health
outcomes will be evaluated and treated preventing negative health effects and better overall
health outcomes.
Last, transportation is an essential component to accessing necessary aspects of disease
management. A patient with transportation is going to be able to travel to healthcare
appointments, the pharmacy to get prescription medications and other locations required as part
of managing this disease process. When a patient is initially diagnosed, healthcare appointments
will be more frequently ensuring that they are managing their blood glucose correctly, therefore
a means of transportation is essential for this to occur (Ross, 2015).
Unmanaged Disease Factors
The first factor leading to unmanaged diabetes is economic stability. As previously
mentioned, management of this disease process requires frequent medical visits, medications and
medical equipment. These resources can become quite costly therefore patients who have lack of
financial reserve will be less likely to purchase medications and medical equipment they require
and are less likely to follow healthcare visit recommendations. When diabetes is unmanaged,
health maintenance needs and health outcomes can worsen leading to even more financial burden
(Kunich, 2017).
Patients who do not have health insurance will be required to pay out of pocket costs for all
healthcare visits, medications and durable medical equipment (citation, year). Patients who have
to pay out of pocket for these things are going to be less likely to obtain all necessary modalities
to care for their diabetes. There is a high Association of individuals who do not have health
insurance as pertains to negative health outcomes and shorter life expectancy, which is
compounded in patients with chronic diseases such as diabetes (Hoffner, 2018).
Patients who lack transportation are less likely to travel to healthcare appointments,
pharmacies to get medications and other needs required of the disease process (Hoffner, 2018).
Those with diabetes can have sudden changes in health status, therefore being able to travel
promptly to care facilities is essential. Those who do not have transportation will have to find
another means which the patient might not be successful, or care interventions may be delayed.
Unmanaged Disease Characteristics
The first characteristic found in patients with unmanaged diabetes is inconsistent blood
glucose measurement and insulin dosing titration. Patients who do not trend their blood glucose
measurements will not be able to adjust their insulin dosing accordingly leading to more
fluctuate blood glucose levels (Ross, 2015). When blood sugar levels are very high and very low,
negative health outcomes such as renal failure, blindness, decreased perfusion and potentially
altered mental status can occur (Ross, 2015). These negative health outcomes will ultimately
affect life expectancy and the patient’s quality of life.
The second characteristic of a patient with unmanaged diabetes is altered nutritional
intake (citation, year). Patients with diabetes must closely monitor each meal and measurement
of carbohydrates, proteins and fats. When patients do not attend to these meal components, they
are less likely to dose their insulin correctly and likely to consume foods that are not conducive
to a stable glucose level.
Last, the patient who does not attend recommended healthcare visits will be more likely
to miss priority educational opportunities. In addition, when patients are 1st diagnosed with
diabetes they are required to manage their glucose by providing several injections throughout the
day and checking blood glucose frequently. There are other modalities of treatment such as an
insulin pump, however care providers require that patients know how to manage blood glucose
using a blood glucose measurement and several injections throughout the day. The rationale for
this is that if an insulin pump were to malfunction, the patient would be able to still manage
blood glucose through old methods. Therefore, if patients are not consistently attending
healthcare visits, they are not going to be given this opportunity for modalities such as an insulin
pump. Insulin pumps create a more consistent blood glucose level and overall management is
much easier for the patient. The patient not given this opportunity is more likely to have
fluctuating blood glucose levels.
Patients, Families and Community
Burden to Patient
In the Denver area, patients with diabetes have limited options available for healthcare
providers. Specialty providers who focus on diabetes management are limited in the area which
has decreased available appointments for patients with diabetes. As a result, there is a 27%
prevalence rate of progressive diabetes causing negative health outcomes related to
comorbidities such as renal failure or blindness (Anderson & Lebowski, 2019).
Burden to Family
Families who have a family member with diabetes will often experience lifestyle changes
as well. It is estimated that 42% of the diabetes population in Denver are children. When children
have this disease process, they will be reliant on family members for management. This creates
an increased risk for a phenomenon called “caregiver burden” (Johnson, 2018, para. 4). In the
pediatric population, those who require daily health management interventions are in an
increased risk for child abuse (citation, year). This can range from neglect to physical abuse.
Burden to Community
As previously mentioned, 42% of the diabetic population are children 18 years of age are
younger, therefore there will be other environments where parents will not be available to check
glucose levels and dose insulin. This results in care providers such as daycare institutions,
schools and other friends and family members being held accountable and managing the
patient’s blood glucose levels. This can be a challenging responsibility for someone who has not
gone through the same level of education as the patient and their family (Johnson, 2018).
Patient Costs
Diabetes is a lifelong disease process that requires daily management. It is estimated that
each year diabetic patients pay $8,000 – $15,000 for the various requirements of managing this
disease process (Diaz, Morse & Ramsey, 2018). Some of these costs can be reduced through the
use of discount program offerings and health insurance, however many times copayments and
deductibles will be expensive as well.
Family Cost
Costs that incur to the family and managing diabetes of one family member can decrease
available funds for other necessary living expenses. This can be things such as housing, food,
transportation, and clothing. Shifting expenses away from necessary medical needs will result in
poor management of diabetes. When diabetes is unmanaged, it is estimated to double the
baseline costs in patients who manage their disease well (Anderson & Lebowski, 2019).
Community Costs
Most chronic diseases will interfere with daily activities such as school or work attendance.
Absenteeism within the workplace is a significant problem when employees have chronic health
conditions. While the disease is not preventable, management of it is a choice. Anderson, Smith
and Jones (2017), calculated that employees with unmanaged diabetes will cost organizations on
average, $4,300 each year. What makes up this quantity is lost productivity, payment of others to
perform job function of the employee, and benefits such as paid time off for short-term and longterm disability (Johnson, 2018).
Best Practices
Within the medical surgical unit at my hospital many patients admitted for complications
of diabetes such as skin integrity impairment, diabetic ketoacidosis, hypertension or kidney
abnormalities. When these patients are admitted to the hospital the acute health issue is managed,
however the underlying issue being diabetes is rarely addressed. The American Association of
Endocrinologists (2017) recommends diabetic assessment with every healthcare visit in patients
who have type I or type II diabetes. This represents a clear contradiction occurring within my
organization that I will address using recommendations from the Standard of Practice. The goal
would be to improve assessment of diabetic management of patients admitted to the medical
surgical unit within my organization.
Plan Implementation
The first intervention will be to develop an electronic health record screening modality that
identifies patients who have diabetes. Currently there is no screening process, therefore these
patients are not provided with additional information or management to help them better control
her disease process. To develop this screening report, a request will be sent to the IT department
with specific patient metrics that are consistent with those that have diabetes. The report will
capture patients who have diabetes on their problem list, a body mass index above 26 kg/m², or
laboratory measurement indicating elevated blood glucose or hemoglobin A1c. The American
Association of Endocrinologists (2017) identifies these metrics as being a reliable predictor of
unmanaged diabetes.
Once the patient population is screened, a referral will be made to initiate an endocrine
nurse visit. The endocrine nurse will develop a chronic disease action plan with the patient that
provides guidance with nutrition, physical activity and medication management. Chronic disease
action plans provide patients with a triaging system allowing them to be better informed about
managing not only complications but everyday requirements of the disease process (Anderson &
Lebowski, 2019).
Last, patients identified through the screening process will be required to use a smartphone
application to track blood glucose trends and insulin dosing. Smartphone applications increase
accountability and improve the management of patients who have chronic disease processes like
diabetes (Johnson, 2018).
Plan Evaluation
Electronic health records provide numerous benefits including the ability to obtain
retrospective data and prospective information pertaining to the patient population. The
evaluation method that will be used to determine effectiveness of the intervention of screening
will be retrospective data trending consistent with practices suggested by the American
Association of Endocrinologists (2017). Using consistent metrics as suggested allows for data
trending and prevalence analysis. Retrospective data analysis will occur once monthly, and data
trends will be collected and compared from month-to-month.
To evaluate the intervention of providing a chronic disease action plan, the teach back
method will be used upon completion of the action plan. The endocrinology nurse will ask the
patient to explain the chronic disease action plan steps and actions in their own words. This
method demonstrates that the patient successfully perceived management suggestions for their
disease process (Wilmer, Presley & Smith, 2016).
Last, to evaluate blood glucose and insulin dosing trends, the patient will meet with the
endocrinology nurse one month following implementation of the smartphone application. The
smartphone application allows evaluation of patient accountability, correct dosing of medications
based on measured glucose levels (Jones, 2017). If the patient had consistent blood glucose
levels, and insulin dosing was appropriate for those levels this intervention would be found
Organization. (year). Title of article. Retrieved from:
Last name, I., Last name, I. & Last name, I. (year). Title of Longer Article to Show Example.
Journal Name, #(#): pg # – #.
CEFS 546
Mr. Boyle is a 55-year-old high school principal who has come in for an assessment. He reports
that this is due to his wife’s concern after he had a heated interaction with the school board
recently. This interaction has put his job as a principal in jeopardy. Mr. Boyle reports that his
wife states that their marriage is unbearable due to Mr. Boyle’s difficulty in getting along with
others, and that if it does not improve, she will have to leave him. During the interview, Mr.
Boyle states that although he has always been a suspicious person, this has lately increased.
Despite this admission, he goes on to explain that he believes members of the school board are
conspiring with some of the faculty at his school and bitter parents of former students to have
him removed from his position as principal. He reports that 1 of the school board administrators
recently shared with Mr. Boyle that since his appointment as principal 2 years ago, he has been
driving everyone “nuts” because he is too structured. Mr. Boyle reports that he has been doing
the best job he can and that he believes this statement stems from jealousy, as the board
member’s friend also wanted the principal position. When questioned in more detail, Mr. Boyle
shares that he may be overreacting and that he may be at fault for some of these issues. However,
he reports that he spends a significant amount of time thinking about how he is being mistreated
by the school board. He admits that this is causing him not to perform as well as he could at
In addition, Mr. Boyle reports that he recently has started drinking some wine in the evenings to
deal with this. He often decides that he will only have one glass of wine, but 2 or 3 times a week
will realize that he has had as much as 3. In addition, he reports that he has tried to cut down or
even cut out his alcohol use, but has not been successful at this yet. He reports that he does not
think that this is a problem, but just thinks it is something he should work on. The client reports
the use of no other substances.
When Mr. Boyle’s wife is questioned separately, she reports that Mr. Boyle has always had a
difficult time making friends and trusting in others. She reports that recently he has become more
irritable and argumentative with her, his friends, and the faculty at his school. She shares that the
recent fight with the school board was over Mr. Boyle’s insistence that he had been passed over
for an adequate yearly raise. Although the school board explained to Mr. Boyle that all of the
principals’ yearly raises had been reduced this year due to budget cuts, he insisted on presenting
his case to the school board. She reports that after he was still refused the raise, he has been
sullen, has told her he feels helpless and hopeless, and has lost interest in most of the things that
previously interested him. She reports that this began the same week he was refused the raise.
Mr. Boyle’s 2 children are also interviewed—a boy, 15 years old, and a girl, 17 years old. They
both report that Mr. Boyle is very strict and runs the household like a drill sergeant. He monitors
every expense, where they go, and who they are with. Mr. Boyle’s daughter even reports that he
will check her gas gauge in her car to see if the gas used matches the distance she told him she
went. She believes he is just a “penny-pincher.”
When asked to describe himself, Mr. Boyle says he is very proud of the fact that he is a person
who cannot be taken advantage of, as he can spot a con from a mile away. He reports that he
came from a very poor family and worked his way to where he is today. He reports that although
he has had to endure a lot of adverse situations and jealous people, he has made his way to the
top on his own abilities.
Submit Case Study 3 by 11:59 p.m. (ET) on Friday of Module/Week 8.
CEFS 546
Follow the example below as you complete your Case Study assignment. You will have 3 major
areas to your case study response: (1) key issues, (2) diagnostic impressions, and (3) treatment
recommendations. This assignment needs a current APA-formatted title page, and you are
required to cite the sources for the treatment recommendations and include a reference page. It
must be 3–4 pages for content. The Case Study assignment is an opportunity for you to think
through a clinical case, identify and prioritize key issues involved, consider and clarify relevant
diagnostic issues, and formulate treatment recommendations that are most likely to be helpful to
the client.
Key Issues
A. List in order of importance the key issues you believe are involved in the case study,
as if you were the client’s counselor. Provide a rationale for the order in which you
prioritized issues. What are the most important features to you, and why?
B. Link your rationale to what you believe outcomes of treatment should be for this
client. How will your order of priority contribute to a successful outcome for the
Diagnostic Impressions
A. Based on the information provided in the case study, use the current version of the
DSM to accurately diagnose the type(s) of disorder(s) involved. Refer to specific
diagnostic criteria when presenting your impressions. What category could this be in?
What disorder in that category does this appear to be and why? Provide rationale for
diagnosis, giving consideration to differential diagnostic considerations. In other
words, what disorders in this category or other closely related categories were
considered? Why could this not be any of those disorders? You may want to consider
here theories of normal and abnormal personality development. Also, consider
systemic and environmental factors that affect human development, functioning, and
B. Be sure to consider other disorders in addition to the main disorder. Is there more than
one diagnosis? Provide rationale for diagnosing any additional disorders.
III. Treatment Recommendations (cite sources in this section)
A. List your recommendations (e.g., 1., 2., 3., etc.) so that you can clearly delineate what
you believe will be of most help to your client. Consider recommendations that will
be motivating to your client and reflective of a collaborative approach. Also, consider
essential interviewing, counseling, and case conceptualization skills.
B. Be sure to consider the biopsychosociospiritual aspects of the case. Make sure your
recommendations are relevant to the case, able to be implemented by the client, and
have some basis of support from professional literature—include your 2–3 academic
sources here. Ensure that you have included evidence-based counseling strategies and
techniques for prevention and intervention for this client.

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