[reidesert]

We were assigned a case study. Here a few of the questions and my answers. Could someone read it over and let me know if I am on the right track?

okie-dokie- here it is
You are caring for a 66 year old Type 2 Hispanic diabetic woman, who has had diabetes for 24 years. She as been admitted to the hospital for uncontrolled blood sugar, and an abscess of her foot. She is 5 feet 1 inch tall and weighs 262 pounds. Blood sugar is 653 on admission. She is started on IV antibiotics, wound care, accuchecks AC and HS, and continues on her Glucovance and Glyset along with a 1600 calorie ADA diet.

Question 13
If the patient told you she had morning (fasting) hyperglycemia, how would you interpret that, and what would you advise her to do about it.
*I would have her check the blood glucose in the morning. I would think that she may need an insulin dose since the oral hypoglycemics are not controlling the blood glucose levels sufficiently. I would inquire her about her eating habits. Does she have a late night snack? To ensure that it is indeed fasting hyperglycemia. I would get all the information and then from that information may suggest limiting her eating time to a certain time at night or her needing an insulin dose to cover her night to control her hyperglycemia.

Question 14
Identify a NANDA dx, including 'related to' and 'as evidenced by', a short term outcome, and two independent nursing interventions that would be a high priority for this patient. Please do not use 'infection' or 'pain'
NANDA dx:
Ineffective Health maintenance r/t deficient knowledge regarding care of diabetic condition.
As evidenced by:
1. Blood sugar @ 653 on admission
2. Patient's weight @ 262 lbs (obese)
3. abscess on the patient's foot.

Short term outcome
Patient will have the knowledge needed to manage her diabetes to keep her blood glucose under control and care for her feet.

Nursing Interventions:
1. Pt education about diet. Since she has been a diabetic for 24 years she may not know that she is allowed sweets but the must be counted into the meal plan. Explain the importance of following her diet. The importance of weight loss and the impact it has on blood sugar. Encourage her to exercise when her foot is better. Advise her to start walking around the block or water aerobics., (after assessing her cardiovascular status) Ask her what she finds most challenging about following a diet and exercise plan. Find if she needs clarification about what she should do to manage her diabetes.
2. Instruct her on the importance of checking her feet. Ask her to show you how should would check her feet to see if she can or if she needs a mirror or a person to come by and help her. See what kind of support she has at home. If she needs home health to come by and help her.

If this were a 7 year old newly diag nosed Type I diabetic, withthe identical blood sugar.
Identifiy 5 things that are different in his tx plan from that of the woman in the 1st part of this
case study.

1. He has Type I diabetes.
2. He is not on restricted calories to try and lose weight.
3. He is a child. His insulin doses and meals will vary on his growth development and activity level.
4. She is on oral hypoglycemics to control her Type II diabetes. Type I diabetics are not on oral hypoglycemics.
5. Lifestyle changes such as diet and exercise and weight loss are effective for decreasing the complications of Type II diabetes but not on Type I diabetics.

Explain 3 ways in which the teaching for self care of this child differs from that of the older adult.
1. Importance on family teaching especially to the adult who is caring for the child the importance of meals and insulin doses. How to test blood sugar, draw insulin and give insulin injections.
2. Make the family aware of hyperglycemic and hypoglycemic signs and symptoms and what to do in each case.
3. Explanation of what Type I diabetes is, that it is a life long disease and must be managed long term. What the complications are if it is not managed.

If you got this far a big thank you!
Again, am I on the right track? Should I add something or am I way off base.

[Daytonite]

You are caring for a 66 year old Type 2 Hispanic diabetic woman, who has had diabetes for 24 years. She as been admitted to the hospital for uncontrolled blood sugar, and an abscess of her foot. She is 5 feet 1 inch tall and weighs 262 pounds. Blood sugar is 653 on admission. She is started on IV antibiotics, wound care, accuchecks AC and HS, and continues on her Glucovance and Glyset along with a 1600 calorie ADA diet.

Question 13
If the patient told you she had morning (fasting) hyperglycemia, how would you interpret that, and what would you advise her to do about it.
*I would have her check the blood glucose in the morning. I would think that she may need an insulin dose since the oral hypoglycemics are not controlling the blood glucose levels sufficiently. I would inquire her about her eating habits. Does she have a late night snack? To ensure that it is indeed fasting hyperglycemia. I would get all the information and then from that information may suggest limiting her eating time to a certain time at night or her needing an insulin dose to cover her night to control her hyperglycemia.

Follow the nursing process (which is a problem solving method). I would review with her a history of her blood sugars, diet and exercise (for assessment) and try to find some kind of common pattern that might account for the elevated blood sugars (determination of the problem). From that I would review the importance of staying within dietary parameters and review the kind of foods she should be eating and ones she is eating that she really needs to stay away from (planning).

Question 14
Identify a NANDA dx, including 'related to' and 'as evidenced by', a short term outcome, and two independent nursing interventions that would be a high priority for this patient. Please do not use 'infection' or 'pain'

NANDA dx:
Ineffective Health maintenance r/t deficient knowledge regarding care of diabetic condition.
As evidenced by:
1. Blood sugar @ 653 on admission
2. Patient's weight @ 262 lbs (obese)
3. abscess on the patient's foot.

Good call on the diagnosis! Your instructor might not agree with this, but I would change the language on this to: Ineffective Health Maintenance R/T deficient knowledge of disease process [I would keep the word "diabetes" out of this because it is a medical diagnosis] AEB elevated blood sugar levels, overweight for body height, and abscess on right foot.

Short term outcome
Patient will have the knowledge needed to manage her diabetes to keep her blood glucose under control and care for her feet.

Your short term goal has to relate back to one of your nursing interventions. Your interventions are to teach her about her diet and how to check her feet--nothing about keeping her blood sugar under control. Keep it simple and down to ONE thing. So. . .By tomorrow patient will correctly order a balanced diabetic diet from the dietary service that is within the caloric restrictions she is allowed.

Nursing Interventions:
1. Pt education about diet. Since she has been a diabetic for 24 years she may not know that she is allowed sweets but the must be counted into the meal plan. Explain the importance of following her diet. The importance of weight loss and the impact it has on blood sugar. Encourage her to exercise when her foot is better. Advise her to start walking around the block or water aerobics., (after assessing her cardiovascular status) Ask her what she finds most challenging about following a diet and exercise plan. Find if she needs clarification about what she should do to manage her diabetes.

The parts I put in black font really do not pertain to dietary teaching, do they? Some of what you have there can be other interventions.

2. Instruct her on the importance of checking her feet. Ask her to show you how should would check her feet to see if she can or if she needs a mirror or a person to come by and help her. See what kind of support she has at home. If she needs home health to come by and help her.

"Instruct her on the importance of checking her feet (how frequently?). Ask her to return demonstrate a foot check." Some of what you have there can be other nursing interventions!

If this were a 7 year old newly diag nosed Type I diabetic, withthe identical blood sugar.
Identifiy 5 things that are different in his tx plan from that of the woman in the 1st part of this
case study.

1. He has Type I diabetes. (this is a statement of fact not a treatment)
2. He is not on restricted calories to try and lose weight.
3. He is a child. (statement of fact, do not need to repeat it) His insulin doses and meals will vary on his growth development and activity level.
4. She is on oral hypoglycemics to control her Type II diabetes. (delete this first part) Type I diabetics are not on oral hypoglycemics.
5. Lifestyle changes such as diet and exercise and weight loss are effective for decreasing the complications of Type II diabetes but not on Type I diabetics. (this tells about Type II DM but not Type I)

You have stated much of the above in terms of the Type II diabetic or made repititious statements that could be removed.

• 1. Parents (caregivers) will need to be involved in the teaching of insulin administration, glucose testing, and diet.
  2. Teach parents that tight glycemic control is important to prevent the development of complications over time. [unless Type I DMs stay in good control they get every DM complication in the book at a very young age.]
  3. Teach the signs and symptoms of hypoglycemia and the emergency actions to take if it occurs. [this is a big distinction between Type I and Type II DMs. Type II DMs do not usually get hypoglycemic. Type I's get hypoglycemic a lot and need to institute emergency measures.]
  4. Children have short attention spans and learn best by short sessions that repeat the teaching.
  5. With proper control of glucose, the child can have a normal life like everyone else.

Explain 3 ways in which the teaching for self care of this child differs from that of the older adult.
1. Importance on family teaching especially to the adult who is caring for the child the importance of meals and insulin doses. How to test blood sugar, draw insulin and give insulin injections.
2. Make the family aware of hyperglycemic and hypoglycemic signs and symptoms and what to do in each case.
3. Explanation of what Type I diabetes is, that it is a life long disease and must be managed long term. What the complications are if it is not managed.

• 1. Family/caregivers will be primarily managing the care so they need to be included in the teaching.
  2. Teaching strategies for children differ from those for adults because children have a shorter attention span
  3. Evaluation that the parent and child have the correct information is important since it affects the childs quality of life. Incorrect information about the disease or treatment must be rectified ASAP.

[reidesert]

Thanks Daytonite!
I feel so overwhelmed with all the information and everything we have to learn. Being a great RN seems so far away. Thanks for all your help!

[nightmare]

I have one comment.Do you check that this lady ,being Hispanic,is understanding all that she is being told? If she has a language deficit do you get someone to translate all info so that she understands? (maybe I am going out on a limb here,just wondered why the question specified Histanic)

[celclt]

good point about the poible language barrier--also cultural food, disease process idea differences? you did great reidesert!