Madam Aishah Case Study: Chronic Disease Management in Singapore

Madam Aishah Hassan, a 59-year-old married woman, who works as a fulltime food stall assistant at a neighbourhood hawker centre. She lives with her 65-year-old husband in a two room flexi HDB flat and has no children. Her household income is modest, and her work involves long hours with limited rest breaks.

Madam Aishah typically works 10-12 hours a day, six days a week, starting early in the morning. Her job requires prolonged standing, repetitive movements and exposure to oily food. Due to her work schedule, she often skips meals or eats irregularly, relying on leftover food from the stall or quick meals from nearby food outlets.

She reports feeling tired most days and finds it difficult to engage in regular physical activity. After work, she usually spends time resting at home or watching television. Household chores make up most of her physical movement outside of work. Social interactions are mainly limited to brief conversations with customers, co-workers and her husband.

Madam Aishah has been overweight for several years and was previously advised by her doctor to improve her diet and physical activity levels. She does not smoke but reports frequent consumption of sweetened beverages and enjoys desserts daily, which she finds comforting during work breaks.

During a recent visit to the polyclinic for persistent fatigue and shortness of breath, she was diagnosed with Diabetes Mellitus, Hypertension and Hyperlipidaemia.

She has been started on long-term medications and scheduled for regular follow-up appointments. However, Madam Aishah has expressed ongoing challenges in managing her condition effectively. She finds it difficult to maintain consistent medication adherence, particularly with her irregular work hours, and struggles to fully understand and apply the dietary recommendations provided to her. In addition, her demanding work schedule limits her ability to attend regular follow-up appointments, and concerns about out-of-pocket healthcare costs have led her to miss or default some scheduled medical reviews

As a Care Coordinator at the polyclinic, your role is to ensure she receives routine check-ups and appropriate management to help manage her chronic conditions effectively.

Questions:

1a. Choose ONE of Madam Aishah’s chronic conditions and:

• Describe the disease process clearly.
• Identify ONE relevant diagnostic assessment used to evaluate the condition Discuss FOUR major risk factors that contribute to its development.

1b. Based on the chronic disease chosen in Q1a:

• Propose FIVE realistic goals tailored to manage the condition.
• For each goal, suggest TWO appropriate interventions that address Madam Aishah’s specific needs and constraints.
• For each set of interventions, briefly discuss ONE possible complication that may arise if the condition is not adequately managed and how the proposed interventions help to reduce the risk of this complication.

1c. Recommend FOUR subsidies and/or schemes that could help Madam Aishah manage her chronic conditions more effectively. For each recommendation:

• Evaluate the accessibility and practical implementation of each scheme for someone in Madam Aishah’s situation, including potential barriers she might face in accessing these services.

1d. Discuss ONE potential ethical dilemma in managing her care given her financial constraints.

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Chronic condition selected – Type 2 Diabetes mellitus

In this condition, the body becomes resistant to insulin and cannot regulate blood glucose levels effectively. In the given case scenario of madam Aishah, it is the consumption of sweetened beverages daily, unhealthy eating habits, obesity, physical inactivity and chronic fatigue have all contributed towards the issue.
Diagnostic assessment – the assessment available is to perform a blood test to measure Madam Aisha’s average blood glucose level so that control over the long term diabetic condition can be possible. The major risk factors are obesity, poor dietary habits, physical inactivity, and irregular meals and work stress.

5 realistic goals with interventions

The first goal is to improve medication compliance by way of using interventions like phone alarms or pill organisers for reminders. It will help in controlling the plug Glucose level and reduces the possibility of long term organ damage. The second goal is to reduce the intake of sugary drinks which requires interventions like replacing sweetened beverages with other non sugary beverages and reducing the intake of dessert. It will also help in improving the glucose control and reduces the possibility of nerve damage risk. The third goal is to improve attendance for follow up appointments, and the intervention can be to arrange appointments on the day when she is fre. The 4th goal is to increase daily physical activity by following a routine of 15-20 mins walk and such regular movement would improve insulin sensitivity and heart health. The final goal is to improve the understanding of diabetic diet as it also contributes towards stabilizing the Glucose level. The interventions required are to consult a dietitian with different meal choices.

Four subsidy schemes

The four subsidy schemes are community Health assist scheme (CHAS) which subsidizes polyclinic and GP visits for diabetes management. MediSave is another important scheme that can help pay for outpatient diabetes treatment, whereas MediFund is helpful when it is difficult to afford medical bills after subsidies. Finally a healthier SG programme is another such scheme that supports preventive care, chronic disease management etc.

Ethical dilemma

The most significant ethical dilemma in the given case of madam Aishah is to maintain a balance between her autonomy level compared to the healthcare team’s responsibility to prevent serious complications.

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Nursing case study analysis involving conditions like diabetes, hypertension or hyperlipidaemia requires a critical approach along with good understanding of nursing terminology and concepts. If you need a detailed explanation of the above nursing responses, get in touch with our professional nursing homework helpers in Singapore to provide you with quality guidance and support.

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