FAMILY CASE STUDY

 INTRODUCTION:
I am Deepanshi Choudhary, MSC Nursing 1st year student, as s part of my Advance nursing
practice requirements. I posted in Malyala village, where I assigned families. Out of those families
I took one family for case study based on priority needs.

Reason for Selecting this Family: The family was selected based on proximity to the
Urban PHC and willingness to participate in the health survey. The family represents a typical
urban labour household with diverse health conditions, making it suitable for health education and
nursing interventions.

 COMMUNITY IDENTIFICATION DATA

a. Name of the Area : Malyala

b. Rural or Urban: Rural

c. Name of the PHC/Sub Centre: PHC, Bommalaramaram

d. District: Siddipet

e. Panchayat : Narayanaraopet

f. Location of family in area map: House no-14, block-16 Malyala village

 FAMILY IDENTIFICATION DATA

a. Name of head of the Family: Mr. Laxmanacharya

b. House Name: House no-14

c. Religion: Hindu

d. Adress: House no 14, block-16 Malyala village

 Family Genogram:

 FAMILY DEMOGRAPHY

S. Name Relation Age Sex Educational Occupation Marrital Health Status Unhealthy
No. with Status Status (Medical and Habits
HOF Surgical)
1 Mr. Head 42 Male 12th class Business Married DM Type II CABG None
Laxman of and in 2019
acharya family Hypertensio
n
2 Mrs. Wife 40 Female ----- Housewife Married Healthy None None
Srilata

RISK GROUP:

Under Five Pregnancy Lactation

Elderly III or diseased Any Other

 VITAL STATISTICS IN LAST 5 YEAR

 According to vital statistics,
Birth : No birth was recorded during specified period
Marriage : No birth was recorded during specified period
Death : No birth weas recorded during specified period
 Cause of Death : Not applicable
 SOCIO-ECONOMICS STATUS:
Monthly income – 10,000/-
Per capita –1,000/-
Per capita expenditure on health – 300/-

 HOUSING AND ENVIRONMENT:

 Types of the house–Pucca House
 Ventilation– Inadequate
 Lighting – Proper, adequate lighting
 Number of rooms - house comprises two rooms
 Kitchen- Separate
 Electricity– Yes, house has access to electricity
 Type of flue used -Gas (Liquefied Petroleum Gas)

 WATER SUPPLY AND SANITATION

 Source of water supply– household receives water through a tap connection
 Water storage & handling - household practices hygienic methods
 Drainage –Closed drainage system
 Disposal of home waste -Closed system
 Animal / pet – household does not keep any pets
 Surrounding environment –Not hygienic, uncleaned surroundings

 PSYCHOSOCIAL AND SPIRITUAL ENVIRONMENT:

 Ethnic background – The family belongs to the Indian ethnic group
 Social &cultural practices related to health– The household integrates traditional health
practices such as Ayurveda and other folk medicine into their lifestyle.
 Relationship with society- The family maintains a friendly and helpful demeanor within
their community.
 Social activity & affairs- The household is socially active, participating in various
community events, festivals, and gatherings.
  Social support system- The family's primary support system comprises immediate family
members and neighbours.

Family Coping Appraisal

Name of Student: Deepanshi Family folder Number :1

Date of Beginning :24/03/2025 Name of H.O.F.: Mr. Laxmanacharaya

Date of Termination : 26/03/2025 Address: House no 14, block-16 Malyala village

Rating
Sl. Rating (1–5) Justification
Coping Area (1–5) Justification Beginning
No. Termination Termination
Beginning
Limited activity, fatigue, Improved energy,
Physical
1 2 difficulty with self-care 4 more independent
Competence
due to DM & HTN in ADLs
Now accurate with
Therapeutic Poor understanding of
2 2 4 meds, BP/glucose
Competence medication timing, dosing
monitoring
Little awareness of Good
Knowledge of
3 2 DM/HTN complications 5 understanding of
Health Condition
or lifestyle impact disease, risks, diet
Application of Suboptimal foot care, Now practicing
4 Hygiene 3 medication hygiene; 5 proper hygiene,
Principles infection risk reduced risk
Actively engaged
Attitude toward Low motivation toward
5 2 5 in diet planning,
Health diet, exercise, BP control
walking daily
Reduced anxiety,
Worry, anxiety over
Emotional expresses
6 2 irregular test results and 4
Competence confidence and
disease progression
coping
Role sharing
Stress in family
improved,
7 Family Living 3 functioning due to 4
supportive
caregiver burden
household
Cleaned
Cluttered kitchen, limited
Physical environment, safe
8 3 space for activity and 4
Environment space for meds
medication storage
and activity
 Rating
Sl. Rating (1–5) Justification
Coping Area (1–5) Justification Beginning
No. Termination Termination
Beginning
Use of Unaware of local Now visits UPHC
9 Community 2 hypertension/diabetes 4 for BP/glucose
Facilities clinics or screening camps checks and advice

PHYSICAL ASSESSMENT RECORD

Parameter Mr. Laxmanacharya Mrs. Srilata

General Appearance Mesomorphic Endomorphic
Height 172cm 165 cm
Weight 95kg 60.5kg
BMI 32.1kg/m² (obese class I) 22.0 kg/m² (normal)
Mental Status Conscious, oriented Conscious, oriented
Present Medical CABG Operation in 2018 No medical history
Surgical Illness None None
History
Family History Absent Absent
Immunization Status Partially immunized Partially immunized
Health Habits, Beliefs No bad habits, health-conscious No bad habits, health-conscious
& Attitude
Vital Signs – Temp. 98.6 °F 98.6 °F
Pulse 80 bpm 102 bpm
Respiration 20 breaths/min 18 breaths/min
Blood Pressure 150/60 mmHg 116/82 mmHg
Scalp Clean, no abnormalities Clean, no abnormalities
Hair Normal distribution, black hair Normal distribution, black hair
Skin Normal Normal
Eye – Conjunctiva Normal, pink Normal
Vision Blurring of vision Normal vision
Ear / Nose / Throat Normal Normal
Mouth – Lips / Teeth / Normal color and condition Normal color and condition
Tongue
Chest – Shape / Symmetrical, normal breath sounds Symmetrical, normal breath sounds
Sounds
Abdomen – Palpation Normal, no mass Normal, no mass
/ Percussion /
Auscultation
Extremities – ROM / Normal ROM, no clubbing, no Normal ROM, no clubbing, no edema
Clubbing / Edema edema
Bladder and Bowel Normal, polyuria present Normal
Movements
CNS / CVC / All systems normal All systems normal, with fatigue
Respiratory / GIT /
Musculoskeletal
Endocrine / Normal Normal
Integumentary /
Reproductive

Nutritional Assessment

S. Name Age Actual Expected MAC Type of Nutritional Clinical Treatme

No Weight Weight / Diet Disorders (if Features nt /
(For BMI any) Advice
Children Provided
≤9 Yrs)
1 Mr. 50 95 kg Not BMI Mixed Obesity Fatigue, Low
Laxman Applicable – (Veg + increase calorie
acharay 32.1 Non-Veg) blood diet, high
a (Obes pressure, fiber diet,
ity frequent weight
class urination managem
1) ent
2 Mrs. 40 60.5 kg Not BMI Vegetarian None None Maintain
Srilata Applicable – balanced
22.0 diet;
regular
physical
activity

24-Hour Dietary Recall of Family

Meal Time Food Items Consumed

Breakfast Idli (2) with sambar and coconut chutney,
Midmorning Banana .
Lunch Rice, chicken curry (homemade), leafy green curry (palak), dal .
Evening Tea with murmura or roasted peanuts.
Dinner Chapati (2–3), fish curry and buttermilk
 1-Day Diet Menu (for both Hypertension & Diabetes) (Mr. Laxmanacharya)

PROTEIN FAT CARBOHYDRATE CALORIES

TIME FOOD ITEM
(g) (g) (g) (kcal)
Oats porridge with
skim milk + berries; 1
Breakfast 18 8 30 ~300
boiled egg; 1 orange
(vit C)
Apple + handful
Mid-
almonds; 1 glass lemon 6 10 22 ~200
morning
water
Brown rice; grilled
chicken breast; mixed
Lunch 30 12 50 ~500
vegetable salad; low-fat
curd
Green tea; roasted
Evening chana; carrot-cucumber 8 5 20 ~180
sticks
2 multigrain chapatis;
fish curry (minimal
Dinner 28 10 40 ~450
oil); sautéed greens;
buttermilk
Warm skim milk with
Bedtime cinnamon + 1 soaked 6 4 15 ~150
fig
Total 96 g 49 g 177 g ~1780 kcal

MORBIDITY PATTERN OF GERIATRICS GROUP

Sl Name Age Sex Any H/o of Special Present Health Treatment /

No. chronic Illness aids used Condition Advice Given
---- ----- ----- ---- ----- ----- ----- -----
-

ASSESSMENT: ANTENANTAL/ POSTANATAL/INFANT/TODDLER

PRESCHOOLER/SCHOOLER/MENTALLY ILL: Not applicable

MCH SERVICES (Mrs. Srilata)

 Antenatal: Normal
 Intranatal period: Normal
 Delivery: normal
 Birth : full term
 Birth Defects : Not
  Postnatal complication: not significant
FAMILY PLANNING STATUS: - Permanent method not adopted

EPIDEMIOLOGICAL SIGNIFICANCE OF SIGNIFICANT HEALTH PROBLEM:

Epidemiological Significance of Diabetes Mellitus (DM) and Hypertension

(HTN) in India

 Diabetes and hypertension in India have reached epidemic proportions, emerging as

major public health concerns due to their sheer scale, co-occurrence, and far-reaching
health, social, and economic consequences. According to the International Diabetes
Federation, approximately 89.8 million adults aged 20–79 have diabetes in 2024,
with 43% remaining undiagnosed, and the number is projected to surpass 150
million by 2050.

 India Nationwide (2012–14):

 Diabetes prevalence: ~7.5%

 Hypertension: ~25.3%
 Rising sharply with age—~12.1% hypertension in 18–25-year-olds, increasing to
~40% in those over 65

 Recent NFHS-5 (2015–21):

 Highest DM in >50 yrs: 11.9% (males), 7.8% (females)

 Highest HTN in >50 yrs: 41.4% (males), 31.2% (females)

 Comorbidity:

 Over 50% of Indian hypertensive patients also have type 2 diabetes

 Globally, HTN is 1.5–2× more common among diabetics

 Twin Epidemic:

 NFHS-5 data (adults 30+): 33% had hypertension; 20% had diabetes.
 Co-occurrence: 43% of diabetics had HTN; 25% of hypertensive had DM

 Telangana (2022):

 ~8% diabetic; ~8–11% hypertensive

 NFHS-5 projected ~26% HTN and ~13% diabetes in those aged 30+
  Rural-urban gaps are narrowing: urban prevalence ranges from 20–40%, rural from
12–17%. Vulnerably, younger adults (<30 years) are demonstrating alarming trends,
especially in less developed regions.
 The coexistence of DM and HTN compounds risk: about 43% of diabetics also have
hypertension, and 25% of hypertensive individuals have diabetes, indicating a
"twin epidemic" that amplifies cardiovascular risk.
 Globally, these conditions account for almost one-third of all deaths, especially from
heart attack, stroke, and kidney disease.
 In India, over 50% of cases remain undiagnosed, with control rates under 25%,
contributing significantly to mortality and disability.
 The public health impact is profound: these chronic conditions strain families,
healthcare systems, and the economy, leading to increased hospitalizations,
productivity loss, and catastrophic out-of-pocket expenses. With diabetes-related
mortality still rising and hypertension increasing the probability of life-altering
complications, early detection, integrated management, and lifestyle interventions
are crucial to control the twin NCD burden and advance progress toward Sustainable
Development Goal 3.4.

Public Health Relevance

Both diabetes and hypertension are lifestyle diseases deeply tied to:
 Urbanization and unhealthy dietary patterns
 Tobacco/alcohol use
 Psychosocial stress
 Lack of awareness, screening, and healthcare access
The dual burden results in:
 Increased DALYs (Disability Adjusted Life Years)
 Overburdened healthcare systems
 Reduced economic productivity
 High out-of-pocket medical expenditure
 Multigenerational impact on families
DM & HTN: Shared Burden
 Common roots: insulin resistance, obesity, chronic inflammation, oxidative stress lead
to both conditions.
 High comorbidity: ~85% of middle-aged diabetics also have hypertension; half of
hypertensive Indians have diabetes.
 Combined presence dramatically raises risk for heart, kidney, and vascular
complications.

 Both DM and HTN are chronic, overlapping conditions driven by lifestyle, genetics,
and environmental factors, with silent progression until complications arise. Early
diagnosis, lifestyle interventions, combined pharmacotherapy, regular monitoring, and
integrated care are critical to reducing morbidity and mortality.

BURDEN OF DIABETES MELLITUS (DM) AND HYPERTENSION (HTN) AT

GLOBAL, NATIONAL (INDIA), AND TELANGANA LEVELS

Global Burden

Diabetes (WHO / IDF):

 Prevalence among adults aged 20–79 years is approximately 11.1% (1 in 9 people) in

2025, with numbers expected to reach 853 million by 2050.
 Estimates show 589 million adults currently living with diabetes, of whom around
43% are undiagnosed
 In low- and middle-income countries, case numbers have quadrupled since 1990,
from about 200 million to 830 million adults.

Hypertension (Global Health Data):

 Hypertension affects over 1.2 billion people (aged 30–79), with prevalence doubling
since 1990
 Among individuals with diabetes, the prevalence of hypertension is approximately
43%, and inversely, 26–28% of hypertensive patients have diabetes.
India

Diabetes (ICMR, NFHS-5):

 National diabetes prevalence is around 6.5–7.5% among adults.

 India currently bears the second-largest diabetic population globally, estimated at
74 million in 2021, projected to reach 124.9 million by 2045

Hypertension (ICMR / NFHS-5):

 Hypertension affects approximately 25.3% of Indian adults based on pooled surveys

including the Annual Health Survey
 NFHS-5 also highlights the “twin epidemic”: 43% of individuals with diabetes have
hypertension and 25% of hypertensive individuals have diabetes

Telangana

Telangana (NFHS-5 / Apollo Survey):

 Among adults over 30, hypertension affects around 26% and diabetes about 13%
 Apollo Hospital surveys align with these estimates, reporting ~8% diabetes,
potentially higher when accounting for undiagnosed cases, and hypertension
prevalence even greater.
 In a recent household survey of 20 residents in Mallapur, I identified one male with
both hypertension and diabetes mellitus, one female with hypertension only, and
one male with diabetes only, indicating a condition prevalence of 5%–10% within
this small community sample.

Community Survey Significance (Malyala Findings)

 In a survey of 20 households in Malyala, 1 female was found diabetic, indicating a

5% prevalence.
 Hypertension cases were not directly reported, but symptoms and unawareness
suggest potential undiagnosed cases.
 Although prevalence appears lower than the national/state average, this might reflect:
o Lack of previous screening
o Limited awareness or reporting
  This underscores the need for:
o Community-based screenings
o Targeted interventions for women, elderly, and high-risk individuals
o Strengthened NCD control programs at grassroots level

Diabetes and hypertension are silent yet steadily rising epidemics in India and Telangana.
Their combined impact threatens individual health, family wellbeing, and national
development. Focused community-level action involving awareness, screening, behavioral
change, and access to care is essential, especially in underserved areas like Malyala, to
reduce their long-term impact and ensure healthier populations.

LIST OF NURSING DIAGNOSIS:

INDIVIDUAL DIAGNOSIS (Mr. Laxmanacharya)
1. Fluid volume deficit related to osmotic diuresis productivity to increase blood glucose
level as evidence by polyuria.
2. Impaired skin or tissue integrity related to aging spot (Liver spot) as evidence by skin
is thinner and more fragile.
3. Imbalance nutrition less than body requirement related to deficit production of insulin
as evidence by food intake that’s less than the recommended daily allowance (RDA).
4. Activity intolerance related to physiological function as evidence by level of perform.
5. Risk for unstable blood glucose related to fluctuation between hyperglycemia and
hypoglycemia within short period of time.

COMMON FAMILY DIAGNOSIS:

1. Deficient Knowledge related to lack of exposure to information and misinterpretation of

health instructions as evidenced by Verbalization of lack of understanding, poor
compliance with treatment, inappropriate health practices.

ENVIRONMENTAL DIAGNOSIS:

1. Risk for Contamination related to improper waste disposal by neighbouring house as

evidenced by presence of dumped waste in surrounding area, risk of vector breeding
(flies, mosquitoes), and resident concerns about cleanliness
1. FAMILY NURSING CARE PLANS

Assessment Nursing Expected Planning Rationale Implementation Evaluation

Diagnosis Outcome
Subjective data: Fluid volume Short term Establish rapport. To gain patient’s Established The patient
deficit related to Goals: After 1 trust and rapport. demonstrated
Client says that I Monitor and
osmotic diuresis hour of cooperation correct self-
am having document vital Monitored and
productivity to intervention, the monitoring of
frequent sign. For baseline data. document vital
increase blood patient will be blood glucose
urination. sign.
glucose level as able to identify Assess oral To detect with
Objective data: evidence by measures and mucous dehydration for Assessed oral understanding of
polyuria. apply such to membranes to early nursing mucous the results and
Skin is warm to prevent and treat aims to maintain a
check on sign of intervention. membranes to
touch fluid volume loss. long-term fasting
dehydration. check on sign of
Less than of 30ml glucose level
dehydration.
Long term goal: Assess color and of urine output in between 80–130
After 1 month the amount of urine. an hour is not Assessed color mg/dL.
patient will be normal. and amount of
adapt to lifestyle Monitor and
urine.
modification in document Concentrated
order of his temperature. urine is an Monitored and
condition. indication of fluid document
deficit. temperature.
Febrile state of
the body decrease
body fluids due to
perspiration and
increase
inspiration.
Assessment Nursing Expected Planning Rationale Implementation Evaluation
Diagnosis Outcome
Subjective Activity Short Term Establish rapport To gain patient’s trust Established The goal is not
data: intolerance Goal: with the client. and cooperation. rapport. completely
related to achieved but
Client says that After 8 hours of Assess client’s To provide information Assessed client’s
physiological the patient
he feel fatigue nursing activity level. baseline planning care. activity level.
function as stress level is
during and after intervention, the
evidence by Avoid stress and To collect basic Avoided stress reduce and
performing patient will be
level of perform. unnecessary activity information for making and unnecessary increase
activity. able to achieve
and take rest in plan to client health. activity and take condition of
an increased
Objective data: between activity. rest in between physical state.
conditioned To reduce the burden
activity.
I observed the physical state Encourage to perform of activity and increase
patient activity and the patients' basic and simple stamina of client. Encouraged to
level. family will exercise. perform basic
verbalize To prevent
and simple
understanding Give diet plan to complication and for
exercise.
of Self- client. reduce future
Management prevention. Given diet plan
and when to to client.
seek medical
attention.
Assessment Nursing Expected Planning Rationale Implementation Evaluation
Diagnosis Outcome
Subjective data: Imbalance After a week Establish rapport with To gain patient’s Established rapport After a week of
nutrition less than of nursing the client. trust and with the client. nursing
Client says that I
body requirement intervention, cooperation. intervention,
taking food less Assess daily weight Assessed daily as
related to deficit the patient client will be
than body ordered. Weighing serves ordered.
production of will be able take adequate
requirement. as an assessment
insulin as take adequate Ascertain patient’s Ascertained food intake
tool to determine the
Objective data: evidence by food food intake as Dietary program and patient’s recommended
adequacy of
intake that’s less per usual pattern Dietary program and daily allowance
I observed the nutritional intake.
than the recommended then compare with usual pattern (RDA).
client daily food
recommended daily recent intake. Identifies deficits then compare with
allowance daily allowance allowance recent intake.
and deviations from
(RDA). (RDA). Auscultate bowel therapeutic needs.
sounds. Hyperglycemia and Auscultated bowel
fluid and electrolyte sounds.
Note reports of disturbances can
abdominal pain, Noted reports of
decrease gastric
Bloating, nausea, vomiting abdominal pain,
of undigested food. motility and/or bloating, nausea,
Maintain NPO status function (due to vomiting of
as indicated. distention or ileus) undigested food.
affecting choice Maintain NPO
of interventions. status as indicated.
 COMMON FAMILY DIAGNOSIS

Assessment Nursing Diagnosis Expected Planning Rationale Implementation Evaluation

Outcome
Subjective data: Deficient Knowledge related to Family - Assess current - To tailor health - Assessed family’s The patient
Family members lack of exposure to information members will level of education based baseline demonstrates
say, “We don’t and misinterpretation of health demonstrate understanding- on the family’s knowledge- improved care
know what kind of instructions as evidenced by understanding Identify learning current Delivered dietary- by correctly
food to give her for Verbalization of lack of of diabetes needs and preferred knowledge level- related identifying
her diabetes and understanding, poor and learning styles- To ensure educationusing fiber-rich foods,
hypertension.” compliance with treatment, hypertension, Provide simple, learning is charts and understanding
Objective data:- inappropriate health practices its causes, clear, and culturally effective and examples- the purpose and
Family shows lack dietary appropriate retained Discussed iron-rich timing of
of awareness management, information- Use - To support foods and correct supplements,
regarding and visuals and examples informed use of anti- actively
management importance of to enhance learning- decision-making hypertensive participating in
- Poor dietary medication Encourage questions for better care of tablets- Encouraged the patient’s
practices observed by the end of and active the patient- To questions and care, and
- Irregular the health participation- promote cleared doubts- enhancing
medication education Provide written sustainable health Provided a take- medication and
adherence session instructions if behaviour in the home guide in local diet compliance.
needed family language
 ENVIRONMENTAL DIAGNOSIS:
Assessment Nursing Diagnosis Expected Planning Rationale Implementation Evaluation
Outcome

Subjective data: Risk for The household - Educate family on - Education - Provided health - The household
Resident says: “Our Contamination and nearby safe waste empowers education on solid continues
surroundings are dirty related to: Improper environment will management and families to protect waste disposal hygienic practices
because the nearby waste disposal by remain free from environmental their environment by using waste
house throws waste neighbouring house as contamination hygiene - Discussed risks of bins
outside.” evidenced by: and health risks - Proper waste vector-borne appropriately,
Presence of dumped by promoting - Advise covering of handling reduces diseases reducing
Objective data: waste in surrounding safe waste waste and use of contamination surrounding
Household has tap area, risk of vector management proper bins risk - Encouraged family waste, ensuring
water stored breeding (flies, practices within to speak with neighbour
hygienically mosquitoes), and 1 week - Encourage - Community neighbours about cooperation, and
resident concerns about communication with engagement cleanliness thereby
- Closed drainage cleanliness neighbours about promotes long- minimizing the
system- Solid waste safe disposal term - Supported them in risk of
dumped without a environmental contacting local contamination.
collection system - Report to local change health authority
authority or
- Nearby house panchayat for - Reporting helps - Promoted
disposes of waste community-level in regulatory community-level
improperly intervention action and awareness
sanitation support
- Visible garbage - Promote
around the premises community
cleanliness
campaigns
2. Overall evaluation of family care
 Evaluation of care:
-Family has understood what I taught and discussed with them.
-Knowledge of the family was improved after given health education and they show very supportive
behavior during providing care and education.
 Prognosis:
-Prognosis of the family towards disease condition is good.
 Strength:
-All family members were cooperative and have desire to care about health condition and they are
conscious also.
 Motivation:
-Family members themselves participate well in health-related talk and they are aware about health.
 Weakness / obstacles faces while providing care to family:
-There were no such obstacles as the family was cooperative
15. Health Teaching

Dietary Teaching

 Balanced, nutrient-rich meals: Focus on whole grains, lean proteins, fruits, and vegetables—
aligning with DASH and diabetes-friendly meal planning concepts
 Carbohydrate control: Utilize the plate method (~45–60 g per meal), reduce refined carbs and
added sugars to maintain consistent blood glucose.
 Low sodium intake: Limit to <2.4 g/day (<6 g salt) to manage blood pressure
 Increase potassium & fiber: Green leafy vegetables, legumes, and citrus fruits help balance
BP and support cardiovascular and metabolic health
 Hydration: Encourage adequate water intake while avoiding sugar-heavy beverages.

Hygiene

 Emphasize foot care: wash daily, inspect for sores or swelling, dry thoroughly, and
moisturize—crucial to prevent diabetic foot complications
 Promote handwashing before meals and after restroom use to minimize infection risk.
 Maintain clean home environment: avoid clutter and ensure proper waste management to
support overall health.

20
Rest & Sleep

 Encourage 7–8 hours of quality sleep to stabilize blood pressure and glucose levels .
 Suggest short rest breaks during the day to manage stress and conserve energy.

Medication

 Teach regular and correct medication use (e.g., oral hypoglycemics, antihypertensives):
adherence is essential to prevent complications
 Avoid skipping or self-adjusting: never change doses without physician guidance.
 Monitor blood sugar and BP at home; record readings and bring them to follow-up visits .
 Discuss managing side effects, such as dizziness from ACE inhibitors, and safe strategies to
prevent postural hypotension .

Exercise

 Advise ≥150 minutes/week of moderate aerobic activity (walking, cycling) plus 2 strength
sessions, improving insulin sensitivity and reducing BP duration
 Incorporate flexibility and balance exercises (e.g., yoga, Tai Chi) to reduce fall risk in older
adults .
 Teach deep-breathing exercises to manage stress and support BP stability.

Health Checkup & Follow-Up

 Emphasize routine monitoring: HbA1c every 3–6 months, fasting glucose, BP, kidney and
lipid profiles, foot and eye exams .
 Schedule regular clinical follow-ups: aligned with diabetes and hypertension management
plans.
 Encourage community-based services (UPHC/HWC) and self-monitoring to empower disease
control

21
The health prevention model

Primary Prevention – Prevent Onset

1. Nutrition & Lifestyle Education

o Promote DASH-style or Mediterranean diets: high in fruits, vegetables, whole grains;
low in saturated fats, sodium, and added sugars—effective for T2DM and HTN
prevention
o Encourage daily physical activity (≥150 min moderate exercise/week) to maintain
healthy weight and improve insulin sensitivity
2. Risk Factor Reduction
o Tobacco and alcohol avoidance; stress management through mindfulness, yoga, or
deep-breathing.
o Community-wide screening for high BMI, prediabetes, and prehypertension to facilitate
early behavior change
3. Policy & Environmental Actions
o Integrate health education in schools and workplaces.
o Support food environments that offer healthy choices, limit junk food marketing, and
reduce salt in processed foods

Secondary Prevention – Early Detection & Control

1. Screening Programs
o Regular community screening (adults ≥30) for fasting glucose/HbA1c and blood
pressure to identify undiagnosed T2DM/pre-HTN.
o Opportunistic screening at every healthcare visit for high-risk individuals.

2. Early Treatment Initiation

o Prompt initiation of lifestyle modifications and pharmacotherapy (metformin, ACE
inhibitors/ARBs) when thresholds are met
o Educate patients on self-monitoring of blood glucose and blood pressure.
3. Patient Education & Engagement

22
 o Teach self-management skills: interpreting readings, dietary choices, medication
adherence, and sign recognition for hyperglycemia/hypertension emergencies.

Tertiary Prevention – Managing Complications

1. Optimize Disease Management

o Control blood sugar (HbA1c <7% or tailored per comorbidities) and blood pressure
(<130/80 mmHg in most diabetic patients)
o Use cardio-renal protective medications (e.g. ACE inhibitors, SGLT2 inhibitors) to
address established disease.
2. Complication Prevention
o Regular screening for diabetic complications (retinopathy, nephropathy, neuropathy,
foot ulcers), cardiovascular events, and chronic kidney disease
o Foot care clinics, eyecare checks, kidney monitoring, and cardiovascular rehabilitation
where needed.
3. Rehabilitation & Support
o Provide physical rehab (especially after cardiovascular events), dietary counseling, and
peer support groups.
o Address psychological wellbeing and promote gradual reintroduction to daily activities.

FOLLOW UP DETAILS:

Over the five-day follow-up period, Mr. Laxmanacharya’s health showed marked improvement
following tailored nursing interventions.
On Day 1,

 A comprehensive assessment established baseline vitals—BP 150/60 mmHg and elevated

fasting glucose—and identified gaps in his understanding of disease management.
 Rapport was built and initial education emphasized self-monitoring and medication adherence.

23
 Day 2

 Focused on medication compliance and home monitoring: the patient was coached on correct intake
of metformin and antihypertensives, and helped to track daily BP and glucose readings in a
logbook—actions shown to support BP control.

Day 3

 Addressed lifestyle adaptations, including DASH-style diet planning and encouraging ≥150 minutes
of moderate exercise per week, combined with stress reduction via deep-breathing or yoga—
evidence-based tactics proven to aid both glycemic control and hypertension management.

On Day 4,

 Critical foot and personal hygiene practices were reinforced, targeting prevention of diabetes-related
complications. evaluating progress—a review of logs confirmed improved self-care and early trends
toward target readings.
 I clarified queries, strengthened family support, and scheduled follow-up visits with referrals to
dietitians and foot care specialists to prevent chronic complications. The integration of these
interventions aligns with nurse-led clinic models that have demonstrated efficacy in managing
chronic diseases like DM and HTN.

3. Summary
In (advanced nursing practice) community posting Malyala some families was allotted to me. From which
I selected Mr. Lamanacharya on priority bases.
In this family Mr. Laxmanacharya is suffering from DM Type II and HTN since 8years. His complaints
were fatigue, headache and tiredness, polyuria. .I provided appropriate care to the family according to
their needs. All the family members were corporative during providing care. I provided health education
regarding diabetes and hypertension, healthy diet and environmental hygiene.

24
4. References

1. Chintamani. Lewis's Medical Surgical Nursing. 1st ed. New Delhi: Elsevier; 2011.
2. Park k. Textbook of preventive and social medicine. 27th ed. Jabalpur: Banarsidas Bhanot
Publishers; 2023
3. Ashalatha P, Deepa G. Textbook of Anatomy and Physiology for Nurses. 4th ed. New
Delhi: Jaypee Brothers Medical Publishers; 2015.
4. Park K. Park’s Textbook of Preventive and Social medicine. 21st edition. Bhanot
publications ;2011: P 779-782
5. Clement I. Basic Concepts of Community Health Nursing. 2 nd edition. Jaypee publications;
New Delhi. 2009. P 485
6. Lal S, Adarsh, Pankaj. Textbook of community medicine. CBS Publishers and distributers.
New Delhi. 2007. P 35-39, 328-332

25