Down syndrome is a genetic condition triggered by the complete or partially existence of a third copy of chromosome 21. It is frequently associated with characteristic facial features, delayed physical development, distinctive physical characters and slight to moderate intellectual disabilities. They have specific health care necessities above and beyond standard therapeutic care. There is no actual cure for Down syndrome and type 1 diabetes but According to Evert et al.care, support and specialised education can enhance their quality of life and life expectancy. This essay will evaluate the health challenges and their potential impacts on the man who is constantly coping with a cognitive impairment and disability. Using the ICF model, how this man’s activity and participation are affected by his disability and chronic illness will be described. Lastly, nursing interventions for managing his chronic illness to ensure his optimal health and wellbeing will be identified.
The man not only suffers from Down syndrome with moderate intellectual disability but also chronic health issue of type 1 diabetes. These health challenges possess many negative impacts on that man through the lifespan. According to Scott & Havercamp (2016), the psychomotor development tends to make a longer time to present itself and thus it makes him intellectually disabled to moderate level. Patients with intellectual disability needs more time to acquire, adapt and respond to any task. Patients like him find it hard to generalise, conceptualise, abstract and transfer information. It is particularly hard for him to learn and track a figure of directions at the same phase. When it comes to the memory, they face trouble in both short-term and long-term retentions (Cardol et al., 2012). Language is perhaps that area where deliberated improvement is most evident. Individuals like him with Down syndrome faces a hard time giving answers by speaking. Communication is a big barrier for disables with Down syndrome. They rely more on body languages such as signs and gestures. Down syndrome also acts as a barrier for building cognitive and social skills (Taggart & Cousins, 2014). Generalised anxiety is another impact of his health challenges. Situational anxiety is sometimes manifest during transitions to a new situation. Some depressive symptoms are also observed in this type of patients due to their physical and mental infirmities. The most vital aspect of depression in adults with Down syndrome is its link with harmful factors like chronic illnesses (Shireman et al., 2010). This man is also suffering from a chronic illness which is type 1 diabetes. This disease adds more adverse impacts on this patient and makes his health challenges and his quality of life more problematic (Chang & Johnson 2014). In this autoimmune disease, his own immune system damages the beta cells which makes insulin. Type 1 diabetes is strongly related to subsequent physical incapacity and affects mobility and daily living conditions (Cardol et al., 2012 and MacRae et al. 2015). He is incapable to take appropriate care of his health and chronic illnesses. Thus, it makes him more dependable on others to maintain his medical needs.
International Classification of Functioning, Disability and Health (ICF) is a framework based on the principles of primary health where the environment of people as well as participation and activities is considered central to their health and wellbeing. ICF has two core domains: 1) Functioning and disability which measures body function & structure and activity & participations; 2) Contextual factors which evaluates environmental influences and personal factors. The ICF can be applied across the entire lifespan and is also suitable for all age groups (Rouquette et al., 2015). For assessing how the man’s activity and participation are potentially affected across his lifespan, finding his level of disability is very important. This man is moderate intellectually disable. His disability is impairing his intellectual, emotional and physical capacities. This conditions have affected his social activities and participation from his childhood. He is still attaining a disability-specific day program for improving his disabilities. Communication, interpersonal interaction and cognitive skills is also affected because of his disabilities. Type 1 diabetes is a chronic illness and strongly affects mobility and daily living conditions. Down syndrome along with type 1 diabetes causes muscle hypotonicity and this reduces the activity level and energy requirement of the patient (Taggart et al., 2013). His intellectual disability does not allow him not to take self-care. Problems in his body's physiological function and structure affected his normal actions across the lifespan. As stated by Rouquette et al. (2015), these factors sometimes lead to depression and elderly adults with diabetes possess double the normal risks of depression. Depressed individuals may be incapable of perceiving positivity in their environment. His disability and chronic illness create activity and performance limitations for him and also make him incapable of doing basic works of life. He is less proficient in a range of domestic and social tasks and interactions. The combination of all these factors illustrates how the man has become intellectually and somewhat physically disabled by his Down syndrome and chronic illness. In this situation it is the responsibility of a community nurse to provide such an environment that will balance his need and will promote participation by improving his activity limitations.
Type 1 diabetes is triggered by destruction of beta cells up to 80-90%. Due to the lack of these insulin-producing beta cells, blood sugar levels becomes higher and give rise to chronic illness. Managing type 1 diabetes is very important for a community nurse and when the patient is a Down syndrome man with moderate intellectual disability, caregiving becomes more challenging. One of the most important nursing intervention of type 1 diabetes for patients with Down syndrome is medical nutrition therapy (MNT). This therapy is beneficial for managing type 1 diabetes and complications related to it (Evert et al., 2014). Goals of medical nutrition therapy are:
According to Evert et al. (2014), nutritional interventions for type 1 diabetes is effective for disease control. Clinical results of medical nutrition therapy have demonstrated a reduction in HbA1c (A1C) of 1% in type 1 diabetes. Nutritional recommendation can’t be made for complete prevention of type 1 diabetes but blood sugar level can be controlled by effective medication. Insulin to carbohydrate ratio are used to adjust mealtime medication regimens. Medical nutrition therapy can improve A1C and can have a positive effect on quality of life, psychological well-being and satisfaction with treatment.
As a community nurse for a Down syndrome patient with type 1 diabetes, it is vital to gather information about his medical history and use MNT as a nursing intervention. A personal counselling of the man and discussing his conditions with other support staffs in essential for successful implementation of the nursing strategy (Shireman et al., 2010). The main nutritional priority for the patient is to integrate an insulin therapy into his lifestyle. Out of many available insulin options, an appropriate insulin therapy must be developed in concern with his preferred food choices, meal routine and pattern of his physical activities (McVilly et al., 2014). With a proper insulin regimen for him, regular carbohydrate intake should be kept stable with respect to amount and time.
A good cardiovascular health activity plan is also required for his physical and mental refreshment (Heller et al., 2014). Insulin dose must be adjusted for a planned health activity pattern. Beside medical treatments, an associated learning is required to provide the man with the knowledge and skill of self-care (Haas et al., 2013). It is important for a caregiver to understand the patient’s special situation and requirements and implement MNT according to those situations. With the help of community nurse and other supportive people, this man can achieve a better quality of life despite his disabilities.
In the end of this essay, it is clear that people with Down syndrome constantly cope with many physical and emotional complications. Understanding the interaction between intellectual disability due to Down syndrome and chronic illness is vital for nursing caregivers in order to improve and inform their practice. A responsible nurse cannot only give emphasis on the chronic illness, but also needs to recognize and appreciate the association between the functional impairments, activity limitation and also restrictions in participations. It is the responsibility of a community nurse to provide care beyond her duties. This essay has explained how maintaining the blood sugar level with proper diet, regimen of insulin and health activity can improve the man’s quality of life. A profound knowledge of these elements can enhance the practice method a nurse through the adaptation of interventions that will have a greater possibility of being effective.
Cardol, M., Rijken, M., & van Schrojenstein Lantman-de Valk, H. (2012). People with mild to moderate intellectual disability talking about their diabetes and how they manage. Journal of Intellectual Disability Research, 56(4), 351-360.
Chang, E., & Johnson, A. (Eds.). (2014). Chronic illness and disability: Principles for nursing practice. Elsevier Health Sciences.
Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., & Yancy, W. S. (2014). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes care, 37(Supplement 1), 120-S143.
Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., & McLaughlin, S. (2013). National standards for diabetes self-management education and support. Diabetes care, 36(Supplement 1), 100-S108.
Heller, T., Fisher, D., Marks, B., & Hsieh, K. (2014). Interventions to promote health: crossing networks of intellectual and developmental disabilities and ageing. Disability and health journal, 7(1), 24-S32.
MacRae, S., Brown, M., Karatzias, T., Taggart, L., Truesdale-Kennedy, M., Walley, R., & Davies, M. (2015). Diabetes in people with intellectual disabilities: A systematic review of the literature. Research in developmental disabilities, 47, 352-374.
McVilly, K., McGillivray, J., Curtis, A., Lehmann, J., Morrish, L., & Speight, J. (2014). Diabetes in people with an intellectual disability: a systematic review of prevalence, incidence and impact. Diabetic Medicine, 31(8), 897-904.
Rouquette, A., Badley, E. M., Falissard, B., Dub, T., Leplege, A., & Coste, J. (2015). Moderators, mediators, and bidirectional relationships in the International Classification of Functioning, Disability and Health (ICF) framework: An empirical investigation using a longitudinal design and Structural Equation Modelling (SEM). Social Science & Medicine, 135, 133-142.
Scott, H. M., & Havercamp, S. M. (2016). Systematic Review of Health Promotion Programs Focused on Behavioral Changes for People With Intellectual Disability. Intellectual and developmental disabilities, 54(1), 63-76.
Shireman, T. I., Reichard, A., Nazir, N., Backes, J. M., & Greiner, K. A. (2010). Quality of diabetes care for adults with developmental disabilities. Disability and health journal, 3(3), 179-185.
Taggart, L., & Cousins, W. (2014). Health promotion for people with intellectual and developmental disabilities. McGraw-Hill Education (UK).
Taggart, L., Coates, V., & Truesdale-Kennedy, M. (2013). Management and quality indicators of diabetes mellitus in people with intellectual disabilities. Journal of Intellectual Disability Research, 57(12), 1152-1163
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