Problem
ELLA MICHAEL
A 53-year-old woman, Ella has three grown-up children, her eldest son, john, lives nearby with his husband, Matthew, but Ella refuses to maintain contact because she disapproves of his same-sex relationship. Ella's daughter Mary and her son both now live in Australia. Ella's husband died in a road accident sixteen years ago. After this, Ella began to struggle with depression and gained weight. Ella is visited daily by her friend Cantrice from the local Kingdom Hall of Jehovah's Witnesses that Ella used to attend; she shops and cleans for Ella and provides her with cooked meals five days a week.
Ella now has a BMI of 37 and struggles with mobility; she lives in a third-floor council flat. She was diagnosed with Type-2 diabetes nine years ago, which is poorly controlled.
Ella is visited at home by the community nurse, who is anxious that her condition is deteriorating and feels she needs reviewing by the diabetic consultant clinic. Ella is not keen on attending the hospital.
OBSERVATIONS TAKEN BY THE COMMUNITY NURSE AT THE INITIAL HOME VISIT
• Airway: Able to talk in complete sentences when at rest.
• Breathing: RR 25 at rest, SpO2 97% on air; feels breathless with deep gasping breaths.
• Circulation: HR 114, BP 205/110,
• Disability: AVPU: Patience is alert and oriented.
• Exposure: Temperature 36.4C, Blood sugar 'HI' on BM test.
Problem I
Using the A-E approach, what are the nursing priorities for Ella's care?
Problem II
Provide a rationale for the care you have suggested in Problem 1.
Relevant pathophysiology, pharmacology and appropriate care guidelines are to be used to support your argument.
Developing Scenario:
Two years later, Ella is much better. Following counselling and successful help with dieting, her BMI is now 28, and she has regained considerable mobility and is again attending the Kingdom Hall. Ella's type-2 diabetes is now much better controlled. Microvascular complications from Ella's diabetes persist, however.
Problem III
How might Ella's rehabilitation in terms of regaining movement and returning to previous life activities have been managed in the community, taking into account the multi-disciplinary team and the likely availability of services to help Ella to rehabilitate.