Case Study: Mr James Storey

Risks Factors

Diabetes may affect feelings, directly or indirectly. Diabetes in uncontrolled blood may directly affect agitation, as it causes behavior change, such as irritation. Sometimes you may feel upset about having diabetes. (Cesar I. Fernandez-Lazaro, 2019)

The risk of diabetes-related depression and distress increases in diabetes type, so in this case, Mr. James is at high risk of getting stress due to age factor.

Further, due to his age, he is more vulnerable to risk of developing hypoglycemia and he will lose the ability to feel.

Moreover, he might feel fatigue in the body that is related to decrease in the production of energy.

Also, there is a high risk of infection. Because of high level of glucose, there is a decrease in functioning of leukocyte and there might be changes in circulation that will result in respiratory infection. (Kalogianni, 2020)

With type 2 diabetes, as body is not using the long hormone competently, which lead to resisting the body from insulin thus forcing the pancreas for working harder to produce more insulin. This will damage pancreas cells & eventually the pancreas cannot produce any insulin.

This may be in relation to the cellular dysfunction of the pancreas or with cell signals and its regulation (it is part of any communication process that governs the primary activities of cells and coordinates all cell procedures)

Required Nursing Assessment

Following are the major nursing assessment required by the Mr. James (Takeshi Horii, 2019)

  1. Continuous examination of the blood sugar level and performing the necessary analyzes relative to this examination. For this, blood sample will be taken at random time, and it can be confirmed by repeating the test. Specifically needed to be record before and after taking the meal

  2. Assess the type of meal that James take in routine and advice a proper diet chart

  3. Nurse must check any sign of fever and inflammation in case of having infection and also take few tests such as checking the cloudy urine.

  4. Monitors the HbA1c-glycosylated hemoglobin of the patient

  5. Ascertain the goals and expectation of the patient

  6. In case of high sugar level nurse must examine the patient in detail and suggest some regular medication and in some case, insulin can be suggested.

  7. Educating the patient on the need to maintain cleanliness of the body and the need to eat a balanced diet and to follow an appropriate diet

  8. Educating the patient about the dangers of this disease if he does not adhere to this system


Good management can reduce risk of serious complications - even life-threatening in case of Mr. James (Takeshi Horii, 2019)

Make a pledge to manage diabetes. Mr. James should take medications as directed and make healthy eating and physical activity as a part of daily routine. Further he needs to establish a relationship with a diabetes educator, and seek help from the health care team.

Schedule Examination

Regular diabetes checks are not intended to replace routine eye exams and annual physical exams. Mr. James at this age must take schedule examination such as eye sight test.

Foot Care

He needs to wash feet daily using the lukewarm water. Gently dry them, especially between toes and moisten feet with solution. Further he must check his feet daily for blisters, wounds, ulcers, redness, or swelling. (Takeshi Horii, 2019)

Healthy Food

He needs to eat healthy foods and exercising regularly that can go a long way toward controlling high blood pressure and cholesterol.

Avoid Drinking Alcohol

Alcohol can cause a rise or fall in blood sugar levels, depending on how much alcohol you drink and if you eat food at the same time. In case of Mr. James it is analyzed that he drinks beer thrice a dat. He needs to take beer in moderate amounts, and make sure that it is with a meal and must check blood sugar levels before going to sleep. (Takeshi Horii, 2019)

Take Stress Seriously

Hormones, which body may produce in response to long-term stress situations, may prevent insulin from working well. This may result in more stress and frustration. In this case, Mr. James must do not take stress and prioritize the tasks. Also, he must learn ways to relax and get enough sleep.


The specific goal selected for this case is developing healthy eating habits. As Mr. James is overweight and he needs to lose at least 5 Kgs. For managing the weight, carbs needed to be adjusted evenly throughout the diet.

Specific; The targeted meal is the breakfast

Measurable; He needs to take 45 grams daily

Attainable; Few options that help in taking the daily 45 grams. For this, the suggested diet is to take 1 cup of cooked oatmeal and a medium sized banana, and black coffee. Other option is to take two scrambled eggs along with one small wheat pita bread. Along with this, one orange and a cup of milk can be taken.

Relevant; Evenly spreading carbs is relevant as it will help in controlling hunger thus avoiding over eating. For hitting the 45 grams, James must eat protein & fat along with carbs in meal. Such as taking a bread with egg will make him to feel full for longer time. Being more satisfied he will eat less through out the day thus controlling the over-eating.

Time Bound; This is a two-week plan and at the end of this period further continuation of the same diet will be decided.

Impact of Goal Setting

For improving the quality of care, it is important to engage the patient in self-management. In past 2 decades, quality of care assessment from the perspective of patient has been shifted to patient experience rather than his satisfaction. This will lead to reducing frequent visits to hospital, improving the effectiveness, improving quality of life, & enhancing the accountability and quality of health service. (Yvonne Bombard, 2018)


Cesar I. Fernandez-Lazaro, J. M.-G.-L.-A.-G.-C. (2019). Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study.

Costa E, G. A. (2015). Interventional tools to improve medication adherence: review of literature. Patient Prefer Adherence. .

Giardini A, M. M. (2018). A cornerstone of healthy aging: do we need to rethink the concept of adherence in the elderly?

Kalogianni, A. (2020). Factors affect in patient adherence to medication regimen.

Pagès-Puigdemont N, M. M. (2016). Patients' Perspective of Medication Adherence in Chronic Conditions: A Qualitative Study. . Advances in therapy.

Pettus AJ, M.-L. C. (2016). Internet-based resources for disease self-care among middle-aged and older. J Womens Health.

Takeshi Horii, K. M. (2019). Determination of factors affecting medication adherence in type 2 diabetes mellitus patients using a nationwide claim-based database in Japan.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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