Reference no: EM133397150

Case: Nate is a young man, 18 years old, newly diagnosed with type I diabetes after being hospitalized with ketoacidosis. He has a pre-existing diagnosis of anxiety. His single mother has been raising him and works as a VP of a bank. He is close with his grandmother, who has been by his side through the entire hospitalization. He has progressed in managing his anxiety, after years of therapy and finding the right balance of SSRI medication. He and his grandmother say he still gets easily overwhelmed by details and has frequent panic attacks when there is a lot of change in his life.

Nate loves music-and finds it extremely healing. He has become a gifted pianist and has decided to pursue a college degree in music performance. His mother has been able to support his lessons and also a couple of week-long music camps-which have gone well when Nate attended. He has been researching programs where he could study piano, and the program he wants to attend most is in Chicago. He has been accepted to this program as well as a local program that he thinks will not challenge him enough.

Nate and his mother had decided he should pursue the program in Chicago and he has enrolled there. It is the spring before his freshman year, and you are working with the family to make plans to ensure his physical and mental health care will be seamless between his stays on campus and when he comes home on breaks; and also to make plans to anticipate challenges that may come up as he moves away from home and pursues this challenging course of study. Nate says he feels ready to start taking over his own life, but up until now, all of his care has been managed between by his mother and his grandmother. His mother feels very concerned because Nate's anxiety can often make him avoid tasks and he doesn't have a good track record of meeting due dates, etc without quite a few reminders and support from those around him. His grandmother is scared that he will have another life-or-death complication from his diabetes because of not caring for himself. She feels he should study in town for a year and then move away after a more progressive transfer of who's responsible for his health management.

Use Roy's Adaptation Model as a guide for the RN case-manager and Nate to plan a preventive plan to manage his psychological health and related diabetic self-care (expected and unexpected stressors, social and cultural stressors, wellness maintenance).

Questions:

• As June approaches and plans come together for Nate to take over his health care management, the community-based RN case-manager now wants to do some planning with Nate and his family to help him develop independent preventative mental health self-care.
• It is expected that new social situations, new professors, and school stress will be challenging to Nate.
• The case manager and the healthcare providers in the Diabetes Care Clinic are particularly concerned about how Nate will react if he has a particularly critical professor-will he be able to handle perceived failure when his course of study is so personally important to him?
• How will Nate adapt if he experiences anxiety and/or negative diabetic responses?