Teaching and Learning From Case Studies: The Added Value of Using a Nursing Conceptual Model to Construct Cases.

The purpose of this paper is to discuss the influence of applying Orem's self-care framework practice methodology on the content and comprehensiveness of a case study about a woman who denied having self-care deficits. The discussion begins with presentation of the case as it might have been found in a classroom or health professions journal and contrasts this with application of Orem's self-care framework practice methodology to illustrate how much more comprehensive the content of the case study is and how well it highlights the role of the primary care nurse practitioner in complex geriatric care. Through application of Orem's practice methodology, the nurse practitioner is better able to address the high-level risk experienced by an older adult with complex comorbidities whose only initial complaint was "imbalance."

A case of a patient with hyperosmolar hyperglycemic state: implications for nurse practitioners in primary care.

PURPOSE: The purpose of this case study is twofold: first, to present the pathophysiology of hyperosmolar hyperglycemic state (HHS) as it relates to a hospitalized patient with undiagnosed diabetes; the second is to increase awareness among primary care nurse practitioners (NPs) about the complexities of diagnosing less typical forms of diabetes. The case illustrates how HHS can be life threatening, how it is differentiated from diabetic ketoacidosis (DKA), and how it is treated. The importance of closer surveillance of blood glucose in high-risk individuals is highlighted. DATA SOURCES: Review of the literature and application to the case. CONCLUSIONS: HHS is a potentially lethal and preventable hyperglycemic crisis, which is in a continuum with DKA, occurring frequently in individuals with no prior diagnosis of diabetes. The incidence of HHS is increasing as the epidemic of diabetes continues. It is important for NPs to understand the pathophysiology of HHS, and identify which patients are at risk. Many high-risk patients, when under stress, develop acute hyperglycemic crisis, which begets further cardiovascular complications. IMPLICATIONS FOR PRACTICE: With improved understanding of the phenomena leading to glucose dysregulation, less typical forms of diabetes might be identified earlier and controlled. NPs in primary care are uniquely positioned to reduce the risk of hyperglycemic crises.

'Patient-centered care' for complex patients with type 2 diabetes mellitus-analysis of two cases.

PURPOSE: This paper serves to apply and compare aspects of person centered care and recent consensus guidelines to two cases of older adults with poorly controlled diabetes in the context of relatively similar multimorbidity. METHODS: After review of the literature regarding the shift from guidelines promoting tight control in diabetes management to individualized person centered care, as well as newer treatment approaches emerging in diabetes care, the newer guidelines and potential treatment approaches are applied to the cases. RESULTS: By delving into the clinical, behavioral, social, cultural and economic aspects of the two cases in applying the new guidelines, divergent care goals are reached for the cases. CONCLUSIONS: Primary care practitioners must be vigilant in providing individualized diabetes treatment where multiple chronic illnesses increase the complexity of care. While two older adults with multimorbidity may appear at first to have similar care goals, their unique preferences and support systems, as well as their risks and benefits from tight control, must be carefully weighed in formulating the best approach. Newer pharmaceutical agents hold promise for improving the possibilities for better glycemic control with less self-care burden and risk of hypoglycemia.