Identify a patient, stating the reason for admission/appointment. It must be on diabetes. Describe a specific problem that has been highlighted through the assessment process. Explore factors that may have led to their hospital admission/appointment. This could include physical psychological and social aspects.
In this essay we shall discuss the case of Mrs Singh. She is an elderly lady of 76 yrs. old. Who lives in warden assisted accommodation. She has done so for the last ten years since her husband died. She has had Type II diabetes mellitus for the last 17 years, and copes reasonably well considering her age and her comparative infirmity. She has been able to go out and get her shopping from the nearby shops and is otherwise self-caring, clean and tidy. According to the referral letter from her General Practitioner, who arranged this admission to hospital, a number of people had recently commented that she looked ill and was not caring for herself as well as she used to do. Her family live a considerable distance away from her and, although they see her about once or twice a month, they do not stay for long as they have a business to run. When she was admitted she was found to be lucid and coherent but her family told us that she had had a number of episodes of confusion recently. She was occasionally very sleepy and had left the gas burning on one occasion. She had a large infected ulcer on her left shin, which had clearly been there for a matter of weeks, but because of her habit of wearing long skirts, no one had noticed it. She had a degree of ankleoedema, but her physical examination was otherwise unremarkable, apart from the fact that she had a BMI in excess of 29. She is a moderate smoker.
Mrs Singh as an individual is clearly unique, but sadly, she also represents a great many elderly diabetic patients who live in similar conditions. The thrust of this particular discussion will be the aetiology and management of her condition with particular relevance to her leg ulcer. Diabetes Mellitus, an overview Diabetes is a comparatively common disease process in the UK. In children it is the commonest major illness (after childhood infections). There are approximately 1.5 million diabetic patients in the UK at present and the number is relentlessly increasing. (Devendra et al 2004). The 1.5 million are not equally spread across all segments of the population. People from the Asian and Afro-Caribbean ethnic backgrounds have a markedly increased risk of developing Diabetes Mellitus (UKPDSG 1998) with one in four of all Afro-Caribbean women over the age of 55 being diabetic. (Nathan 1998). Increasing age and BMI also are both independent risk factors for Diabetes Mellitus (James 1997). Of this number, it is expected that about 10% will develop some form of lower limb ulceration while they are diabetic.
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