Meet Mathew – 33, 180kg Mathew lives alone on a small farm holding outside of Farmdale. His father is James Thornton (who you met in HSNS270) and his mother is Melinda, who is 70 years old. Melinda was born in Farmdale and is an elder in the Aboriginal community. Mathew also identifies as being of Aboriginal descent. Mathew has two sisters, one of which is Rebecca who is currently living with their parents after separating from her husband due to domestic violence. She has 3 boys, Paul (10), Steven (6) and Peter (4). Mathew feels that his life is at risk. Mathew has vowed to lose weight as he now has type two diabetes and he is frightened of losing a limb or ending up on dialysis. Instead however, he turned to food as support and put on more weight. Mathew’s nieces and nephew are his greatest joy – he takes them on trips but gets frustrated with his limited mobility. At his other sisters he found he was distressed by walking in the paddocks. He has to stop every four or five steps due to being so obese and physically restricted. His back aches under the pressure of the weight around his stomach and his legs swell up. Mathew is a 33 year old Aborginal gentleman with a history of obesity, diabetes type 2 and hypertension. He is seeking treatment in an out-patient clinic at Farmdale Community health center with the local dietitian. The local dietitian suggest that he sees his local GP to get a referral to a specialist endocrinologist for medical weight loss management. He is well aware of the link between obesity, diabetes and cardiovascular disease and felt this appointment could be his last chance in getting help with his health problems and losing weight. As a child Mathew had been normal weight; during adolescence he played rugby for his local club and ended up in a prop position on the field (the props “prop up” the hooker in the scrum. They form part of the front row of the scrum and push against the opposition’s props). He gradually put on weight and was overweight in his early twenties. The football culture which he loved was fun and he drank a lot of beer and ate a lot of fast food such as meat pies at the football field after the games. Mathew developed diabetes type 2 and hypertension in his early thirties (two years ago) and is now medicated with anti-hypertensive and anti-diabetics. His GP (primary care physician) had not really been interested in his weight and instead suggested higher doses of medications or insulin injections on multiple occasions. Mathew was not interested in insulin injections as he was afraid of gaining more weight. Mathew has now been sedentary for the last 5 years and has also had to give up work as a local farm hand on his sister’s property out of town. He had previously tried many weight loss efforts but his diet had been high in fat and calories although he was very well educated in nutritious food. However, he has admitted to overeating, and periods of bingeing. He drinks about 3 litres of coke a day and has at least three serves of hot chips per day. Mathew is referred to a weight management clinic in a metropolitan tertiary hospital 600km form Farmdale . His initial anthropometric measurements included a weight of 180kg with a height of 1.81m, a body mass index (BMI) of 54.94kg/m2 which classified him as morbidly obese. His fat % was 52.2% with 85 kg fat mass measured by bioelectrical impedance analysis (BIA) (Tanita Body Composition Analyzer BC-418) for analyzing the composition of the body, such as weight, lean body mass (LBM), total body water (TBW), fat free mass (FFM) and basal metabolic rate (BMR). His HbA1c had in the last 2 months ranged from 11.7% to 8.8% and his BP was 160/95 mm Hg. Weight management clinic – Intervention It was suggested that Mathew attempt a weight loss of 5-10% to assist him to manage his diabetes with diet rather than medication. On attending he appeared motivated and had a positive approach to losing weight. He felt the time was right for him, and he was keen to manage his diabetes on diet alone. Following assessment the specialist addressed Mathew’s weight management issues in an emphatic manner. Through changes in his eating pattern (smaller portions) and increased activity he could lose weight. Mathew was referred to the community nurse at Farmdale to commence his weight loss and it was suggested he attend a lifestyle modification program. Sustainable lifestyle modification strategies are needed to address obesity and cardiovascular risk factors. Intensive, individualised programs have been successful, but are limited by time and resources. The community nurse was asked to formulate a group-based lifestyle education program based upon national diet and physical activity (PA) recommendations to manage obesity and cardio-metabolic risk factors for the community. The community nurse begins to develop a lifestyle modification program using the self management framework. Prior to Mathew being enrolled in the program the community registered nurse assesses Mathew, including his readiness for change. Mathew’s readiness for change assessment: The Transtheoretical Model describes the stages of behaviour required prior to change. It focuses on the individual’s decision making. This model involves the state of feeling, awareness, judgments, perceptions, and behaviour. This model has been used in a variety of problem behaviours.The Transtheoretical Model describes the process of change in 5 stages.TRIMESTER 1 2022 HSNS362 Transforming Nursing Practice 1 Task 1: Written Assignment Must Complete: Yes Weighting (%): 30 Assessment Notes: Written assignment No. Words: 1500 Relates to Learning Outcomes: ULO1, ULO4, ULO5, ULO6 Due Date: Is displayed at the bottom of this page Nursing managment of chronic conditions.
Using the case study in Module one; Mathew Thornton to address the task below Task: Outline what strategies and assessments you as a Registered Nurse would provide as part of your care for Mathew Thornton. Ensure you include holistic, person-centred and culturally appropriate care. Reflect on how these strategies and assessments would facilitate optimum health outcomes and relate these to the National Strategic Framework for Mathew.