Med-Surg+Case+Study+2

Names:

Nekita Ramsay Adria

Mr. Jeff Torres is a 45-year-old Hispanic man admitted to the medical unit with an infected arm wound. He has a history of diabetes and has been taking an oral agent. He performs SMBG (self-monitoring of blood glucose) routinely, and his diabetes has been well controlled.
 * CASE STUDY **
 * Patient Profile**

· Alert and oriented, cooperative · Blood pressure 132/80, pulse 102, respirations 18, temperature 101.6° F · Open wound to left arm, sustained while working as a mechanic · Blood glucose on admission 360 mg/dl
 * Initial Objective Data**

· States he did not anticipate being admitted to the hospital · Worries about his family and his job · Expresses anxiety about the elevated blood glucose
 * Subjective Data**

1. Does Mr. Torres have type 1 or type 2 diabetes? How does the nurse make that decision? Type 2. This disease occurs in people over 35 years of age. Prevalence of type 2 is greater in some ethnic populations, including Hispanic Americans. In type 2, the pancreas usually continues to produce some endogenous insulin. However, the insulin that is produced is either insufficient for the needs of the body and/or is poorly utilized by the tissues. The presence of endogenous insulin is the major distinction between type 1 and type 2. A majority of cases are polygenic. Assessing if the symptoms of diabetes was gradual or rapid can also assist in distinguishing what type of diabetes the patient has. Also, assessing the type of insulin he is taking helps as well. Brandi B. You can also ask the pt. if he knows what type of diabetes he has, what Oral Agents he is taking & when and how he is performing his blood glucose monitoring.(Adria)
 * Critical Thinking Questions**

2. What is the explanation for the increased blood glucose? causes for increase blood glucose include injury, infection, illness and stress. (Nekita) Also possible ineffective Oral Agent management regiment.(Adria)

3. The nurse enters Mr. Torres’ room to administer an insulin injection to lower the blood glucose. Mr. Torres objects to the insulin saying, “I don’t use insulin.” What patient teaching is indicated? Is very necessary to use insulin to regulate / control blood sugar levels to reduce symptoms, promote well-being, prevent acute complicantions of hyperglycemia, and prevent or delay progression of LT complications; as the result insulin is need up to four to five injections per day to adequately control blood glucose levels. (Diana Z)

4. What other laboratory test will help determine Mr. Torres’ risk for diabetes-associated retinopathy, nephropathy, and neuropathy? A1C tell how level is for past three months nephropathy - annual microalbuminuria ( MAU ) and creatinine tests are recc. for early detection of nephropathy. ( Rachel ) retinopathy- annual funduscopic- dilated eye examination. (Nekita) neuropathy- physical exam including nervous system (neurological) and sensory tests, may diagnose neuropathies. A common early finding is the absence of ankle reflexes, a Monofilament is a brush like instrument used often forloss of sensation. Als an electrodiagnostic testing may be done (Adria)

Read more: [|http://www.drugs.com/enc/diabetic-neuropathy.html#ixzz0mB7qopSQ]

5. What content should be included in patient teaching for Mr. Torres? Inspect feet daily, cut toenails even, not in corners. Consult a podiatrist for thick toenails. Avoid open-toe shoes. Wear clean socks, do not apply external warmth to warm feet. Avoid extensive periods of crossing legs, standing, or sitting. Refer client to dietician. Call the primary provider if Blood glucose is over 250mg/dL, ketones are mod. Or lg. fever is over 102. If you feel confused. Rapid resp, vomiting, diarrhea for over 24 hrs, unable to keep down liquids, and illness that last longer than 2 days.

Hypoglycemic? Treat with 15g Carbs, recheck blood glucose in 15 mins. Is still low give 15g of more carbs, recheck in 15 mins. If in normal limits take 7g of protein. ( orange juice, grape juice, milk, are good examples) If client is unconscious administer glucagon SC or IM and notify dr. know and recognize signs and symptoms and treat readily, eat all recommended food at proper time, carry simple carbohydrates on person, educate family and friends on signs and symptoms and how to treat them. (Nekita) Hyperglycemia? Encourage oral intake, administer insulin, restrict exercise when blood glucose are over 250mg/dL, test urine for ketones. Provide info about rotating sites, and how to administer insulin. ( Rachel ) wear identification bracelet, take prescribed dose of medication at the correct time, check blood glucose as ordered, maintain proper personal hygiene and diet. (Nekita) If Mr. Torres is stable and ready for discharge I would begin instruction on nutrition for a diabetic. Proper bandage change for his wound. I would instruct him to use proper hygiene (Hand Washing) since diabetics are prone to infection(Bacteria thrive on glucose), Review instruction on Oral Agents and insulin injections and proper technique of injection (Maintaining Sterility). Encourage Mr. Torres to establish an excercise routine only if his blood glucose is within normal range. The importance of personal hygiene should be stressed. Also to obtain a hemoglobin A1C test every 3-6 months. Instruct patient to have anual eye examinations.(Adria)


 * [|What is diabetes]**