DiabetesAmy PullenApril 28, 2019NUR 209 Med. Surg. PathophysiologyMrs. K was admitted to Manassas Health and Rehab with the main diagnosis of Type 2 Diabetes Mellitus. Mrs. K also presented with insomnia, major depressive disorder, polyneuropathy, anemia chronic kidney disease and a lot of other diagnosis. Type 2 diabetes is a chronic condition that affects the way your body metabolizes glucose which is very important source of fuel for your body. This type of diabetes is usually known as adult on-set diabetes, but today a lot of children are being diagnosed of this condition due to rise in childhood obesity. This type 2 diabetes can be easily managed by making lifestyle changes for example losing weight and exercising. The cause of type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin. The reason this happens is unknow, although genetics and environmental factor, such as being overweight and inactive, seem to be factors. (“Type 2 diabetes – Diagnosis and treatment – Mayo Clinic”, 2019)Expected SymptomsI would have never thought Mrs. K had diabetes because she wasn’t overweight. Mrs. K told me she was diagnosed after she had gallstones when she was 52 years old. She also is a left leg amputee which also a cause of the diabetes happening. Amputations usually happen because diabetes lead to peripheral artery disease. PAD causes the blood vessels to narrow and reduces blood flow to your legs and feet. Also, may cause nerve damage, know as peripheral neuropathy which Mrs. K had both and that’s why they had to amputate her leg. (McDermott, 2019) Potential symptoms of type 2 diabetes often develop slowly. Some people can have type 2 for years and not know. Symptoms to look for polydipsia, polyuria, hyperphagia, unintended weight loss, fatigue, blurred vision, slow-healing sores, frequent infections, areas of darkened skin usually in the armpits and neck. (“Type 2 diabetes – Diagnosis and treatment – Mayo Clinic”, 2019)Assessment4/12/19 0930 85-year female client seating on toilet transferred back to chair with maximum 2-person transfer VS- T98.6 oral P 74 reg & strong R-18 reg & even BP-141/65 O2-94 on room air. Client verbalized pain was 7/10. Tylenol just administrated. Pain located in Left hand. A&Ox4. PERRLA. Sclera white & clear. Conjunctival sacs pink & moist. Oral mucosa is pink and moist with no lesions. Complained of sore throat notice a little redness. No JVD. Skin appropriate to skin color. Skin warm and dry to touch. Skin turgor normal. Respirations regular & even with equal chest excursion. Breath sounds auscultated in all lobes heard wheezing in LLL and CTA all other lobes. Stated no cough. Heart sounds auscultated Apical-74 reg & distinct. Bowel sounds active in all quadrants. Abdomen flat and soft to palpitation. Denise discomfort with palpation. States last BM was the morning. Left leg amputee unable to assess extremity. Right arm limited ROM. Right leg and left arm have full ROM. Pitting edema +2 in right foot. Pedal & radial pulse weak. Hand grips equal & strong. Strong left dorsal & plantar flexion. Cap refill brisk. Stated that she didn’t sleep well. Abrasions in between toes. Placed client in the hallway and told her I would be back————————–A. Pullen S.N P. NCare Plan: Nursing Diagnosis # 1Impaired Skin integrity rt diabetes AEB abrasions in between toes and dry skinPerform weekly skin assessments to verify no other injuriesApply lotion to skin everydayKeep abrasions covered to avoid infection Goal: Pts skin condition will not become worse during her stay in 2 weeks. Care Plan: Nursing Diagnosis # 2Excess fluid volume rt fluid retention AEB +2 pitting edema in right footEncourage pt. to prop foot up when restingCollaborate with physician for a fluid restrictionAdminister diuretics as orderedGoal: Pt will have no edema in 2 weeksCare Plan: Nursing Diagnosis #3Risk for falls AEB left leg amputation Teach pt. how to use call light to ask for assistance Collaborate with physical therapy to encourage physical activityEncourage pt. to ask for assistance to transferGoal: Pt will apply safety measure to prevent injuries in 1 week.Care Plan Nursing Diagnosis # 4Fatigue rt environmental change AEB pt. states she didn’t sleep wellCollaborate with occupational therapy to learn new energy conserving techniquesReview medication for side effectsEncourage client to set small, easily achieved short goalsGoal: Pt will be to explain energy conservation plan to offset fatigue Care Plan Nursing Diagnosis # 5Disturbed body image rt permanent alteration in structure AEB pt. is left leg amputeeMaintain nonjudgmental attitude while giving care, and help pt. identify positive behaviors that will aid in recoverySupport verbalization of positive or negative feeling about the actual or perceived lossGive positive reinforcement of progress & encourage endeavors toward attainment of rehabilitation goals.Goal: Pt will incorporate changes into self-concept without negating self-esteem in 1 week.Care Plan Nursing Diagnosis #6Ineffective breathing rt narrowing airway AEB wheezing heard when auscultated the lungs in LLL. Collaborate with physician to prescribe CorticosteroidEncourage pt. to reposition frequentlyTeach the pt. appropriate breathing & coughing techniques Goal: Pt will establish a normal and effective respiratory pattern in 2 weeks.Care Plan Nursing Diagnosis# 7Impaired Mobility rt muscle weakness AEB pt. needs extensive assistance with transfersCollaborate with physical therapy to perform physical activityPerform passive and active ROMSet goals and reward pt. to meet with a set dateGoal: Pt will demonstrate use of adaptive techniques that promote ambulation and transferring in 2 weeks.Care Plan Nursing Diagnosis # 8Impaired sleeping pattern rt lifestyle changes AEB pts state can’t sleep.Provide a dark, quiet, and comfortable atmosphere for the pt. to sleep inDiscourage caffeine or large meal intake 2 hours before the pt. goes to sleepTeach pt. techniques on how to fall sleep and stay asleep.Goal: Pt will report optimal balance of sleep in 1 week. MedicationsDrug Dose Purpose Nursing ConsiderationsBasaglar Kwikpen 100/mL inject 5 unit subcutaneously in the morning Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene Assess for signs of hypoglycemia. Monitor body weight periodically. Weight changes may necessities change in insulin does. Explain to the pt. this medicine is to treat hyperglycemia. Notify Dr if nausea, vomiting, or fever develop, or unable to eat regular diet or if blood sugars are not controlled. Pts with diabetes mellitus should carry source of sugarNeurontin capsule 300mg give 1 capsule by mouth two times For neuropathic pain Monitor for suicidal thoughts. Monitor for seizures Assess neuropathic pain. Assess for restless leg syndrome during therapy. Advise pt. to take within 2 hr. of antacid. Advice pt. to avoid driving as medicine cause dizziness.Sitagliptin phosphate 100mg 1 tab a day For diabetes Observe pt. for hypoglycemic conditions (hunger, abdominal pain, sweating, weakness, dizziness, headache, tremor, tachycardia, anxiety). Assess for rash periodically. Explain to pt. that it is to control hyperglycemia. Advise pt. to stop if hypertensive reactions to medication and notify Dr. Information regarding nursing interventions for each medication was received from Davis´s drug guide for nurses by Vallerand and Sanoski.Labs and TreatmentType 2 Diabetes Mellitus is diagnosed by using a test called glycated hemoglobin (A1C) test. This is a blood test that indicates your average blood sugar level for the past two or three months. The normal blood test is below 5.7%, and a result between 5.7 and 6.4 % is considered prediabetes. A level of 6.5% or higher on two separate tests means you has diabetes. If the A1C isn’t available their other tests like a random blood sugar test, fasting blood sugar test, and Oral glucose tolerance test. After the A1C test is done then need to be checked two and four times a year. The American Diabetes Association recommends an A1C level below 7%. The doctor also might include measuring your blood pressure and take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. Doctors recommend eye and foot exams also are important. There is no treatment for type diabetes, but it can be managed. Managing diabetes includes weight loss, healthy eating, regular exercise, possibly diabetes medication or insulin therapy and blood sugar monitoring. Weight loss is encouraged because it can lower blood sugar levels. Healthy eating doesn’t mean a diabetic diet but fewer calories, fewer refined carbohydrates, especially sweets, fewer foods containing saturated fruits, and more food with fiber. Physical activity also lowers blood sugar levels but make sure to check blood sugars before any activity. Generally, Metformin is the first medication prescribed for type 2 diabetes. Which works by lowering glucose production in the liver and improving the body’s sensitivity to insulin so that your body uses insulin more effectively. (“Type 2 diabetes – Diagnosis and treatment – Mayo Clinic”, 2019)ResourcesThe most crucial factor in developing a successful care plan is including other members of the patients care team. The most important person to the care of the patient is the patient herself. Listening to the patient and determining the patient´s needs is crucial in the wellbeing of the patient. Also, it is important for the patient to have access to resources to manage her condition and reach optimal health. Some resources that I would include would be the follow. Physical therapy and exercise programs to achieve strong mobility to transfer. Nutritional services for a controlled diabetic diet need. A case manger for home care needs if she decides to go home. I would also include the family in the needs of patient as they might know more about the patient than they do. (Dewitt Stromberg & Dallied, 2016)Interesting Aspects of CareI meet Mrs. K the first day I was at MHR. I learned that she was a night CNA for years. Also learned just by talking with her that she didn’t have diabetes tell she was 52 after having gallstones. Which was very interesting to me because type 2 diabetes is an adult onset type condition, and this was proof. Patient SafetyWith the goal improving patient safety, the Joint Commission created the National Patient Safety Goals for facilities and health care providers to adhere to. The goals include, identifying residents correctly, using medicine safely, preventing infection, preventing residents from falls and preventing bed sores (The Joint Commission, 2018). Measures to identify the residents correctly by using two methods MHR does by showing their picture on the screen and make sure the medicine has their name because they don’t have wrist bands. The simplest, yet crucial method to preventing infection is hand hygiene which MHR was very crucial with the hand sanitizer and hand washing in between the clients. To prevent falls Mrs. A knows that she needs to press the call bell for assistance. Assisting Mrs. K with wound care and applying lotion or cream to hear abrasions was a way to preventing from getting to a worse condition.Teaching PlanI would like to create a teaching plan for the client Mrs. K. Although there are many things I would like to educate Mrs. K on, I think one of the most important aspects of care would be regarding her skin break down as she has abrasions on her toes and dry skin. This important to teach because with diabetes sores take a longer time to heal. I would first assess her learning style so that I can provide the correct educational material that would most benefit her. If she is a visual learner, I would have her watch me demonstrate how she should apply and protect her skin with lotion and wrapping her toes. If she was a kinesthetic learner, I would perhaps supervise her as she watches a video on how to protect her skin. Then I would have her repeat the steps provide her also I could provide her with a handout about preventing skin breakdown because Mrs. K could have information on them since she didn’t know much about them. So, including the handout can help her know what she will need to do to prevent skin damage or making the abrasion worse. Then I would follow up with her my next shift to see if any further teaching needs to be done and to see if they have any concerns.References2018 Nursing care center national patient safety goals. (PDF). (2018). Retrieved from https://www.jointcommission.org/assets/1/6/NPSG_Chapter_NCC_Jan2019.pdf Dewitt, S., Stromberg, H., & Dallied, C. (2016). Medical-surgical nursing. Philadelphia: Saunders.McDermott, A. (2019). Diabetes and Amputation: Why It’s Done and How to Prevent It. Retrieved from https://www.healthline.com/health/diabetes/diabetes-amputationType 2 diabetes – Diagnosis and treatment – Mayo Clinic. (2019). Retrieved from https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199Vallerand, A. H., & Sadoski, C.A. (2017). Davis’s drug guide for nurses. Philadelphia: F.A. Davis Company.