Reference no: EM133406235

Case Study: The Case of Jake

Jake is a sedentary 42-year-old plastics worker with 18 years of experience. He lives in rural Pennsylvania with his wife and three young children. His father, grandfather and two uncles died because of cardiovascular complications associated with Type II diabetes. The one he remembers most spent his last five years on dialysis.

For Jake, the diagnosis of borderline diabetes at age 40 wasn't at all unexpected. The
term, borderline, however stuck in his head and justified his rationale for dealing with it through what he rigidly describes as avoidance. Despite a comprehensive health insurance package provided by his employer, Jake rarely steps into a doctor's office.

With diminished stamina and a comfortable couch, he gradually puts on three to four pounds per year. Jake's BMI is now over 30, his blood pressure is elevated, and his cholesterol levels are (you guessed it) way beyond the normal range. When prompted to play with his kids, he retreats to the couch, stating, "I feel lousy."

Not surprisingly his work begins to suffer as well. In the past year, he has been written up twice for preventable errors. His supervisor confronts him one day and says, "it's like you're here, but the lights are off."

One evening while driving home from work, he misses a stop sign and collides with another vehicle. Upon transfer to the ER dazed and bruised, an elevated blood glucose level and a blood pressure of 180/130 prompt admission.

After a three-day hospital stay that includes a host of tests and three specialty consults, Jake is discharged with fist full of prescriptions and orders to follow up with his primary care physician and a nutritionist for diabetes education.

A week later he returns to work despite numerous medication side effects. A call to his physician is eventually returned by a nurse practitioner a few days later. She conveys the doctor's comment, "you'll eventually get used to the meds."

The following week Jake meets with a concerned nutritionist and is scheduled for five covered certified diabetes education classes that he reluctantly attends. Insights shared during the sessions never really sink in. Prescriptions run out within the month and are not refilled. Thereafter he is lost to follow up.

A year later and after a fourth warning Jake receives a pink slip due to unjustified absences and poor productivity. Two ER visits later he suffers a heart attack that requires a quadruple-vessel bypass followed shortly thereafter by a left-sided stroke that eventually justifies disability benefits. Seven years later at the age of 50, Jake predictably follows in his father's footsteps.

Question: Describe how to help Jake to track his progress based upon your plan:

Jake will check his blood sugar levels at least twice each day, take his diabetic prescriptions as instructed, and spend the next 2 weeks attending a monthly weekly diabetes education class. And for the next two weeks, Jake will follow a heart-healthy diet and exercise for at least 20 minutes each day, just by getting off the couch and going to the kitchen, three days per week.