Question

Jack Taylor is a 34-year-old male who came to the clinic with a complaint of a sinus infection. He had an episode of hematuria yesterday, so the clinic nurse checked his urine sample with a dipstick. The client is six feet tall, 272 pounds, and his vital signs were T.101.6, P. 68, R. 18 and BP. 130/80. The urine sample has the following results: Glucose ++, Protein +, Ketones trace, Blood trace, Specific gravity 1.020, leukocytes none, and Nitrites none. The health care provider schedules the client to return to the clinic tomorrow for diabetic education. The provider also writes an order for home glucose monitoring equipment and for Augmentin 875/125mg tablet by mouth twice a day for 10 days.

Focus Questions

1. Discuss the pathophysiology of diabetes as applied to the client
2. What educational information should the nurse provide the client today?
3. Are there any questions the nurse should ask the client today to assist in preparing for tomorrow’s educational session?
4. What educational information should the nurse prepare for tomorrow’s educational session

Jack returns for his follow-up appointment. He has not eaten breakfast, so a fingerstick fasting glucose is performed. The result is 168 mg dl. He is happy about his sudden diagnosis. He listens politely to the nurse’s information but gives every indication that he will do as he pleases. During the discussion, Jack revealed that he had a work-related accident four years ago, that resulted in permanent disability. He has a weight lifting restriction of 10lbs and cannot stand or walk for more than 20 minutes. His typical meal pattern is one meal for three or four days per week. He usually does not eat on the other days of the week. He is the family cook as he is home while his wife works. There are two children, ages 6 and 9, at home. Jack consumes a wide variety of foods preferring to fry meats.

Focus Questions

1. What adjustments should the nurse make in the teaching plan?
2. What referrals are appropriate for the client?
3. What psychosocial needs might the client have?
4. How will the nurse address the client’s psychosocial needs?

After 3 months Jack returns for a follow-up appointment. His blood glucose monitoring log reveals fasting blood glucose of 155mg dl-210mg dl and evening blood sugars of 220 mg dl to 286mg dl. The client states that he has been watching what he eats and trying to eat more regularly. The client is not exercising. His weight today is pounds. The health care provider orders Glucophage 500mg 1tablet by mouth 3 times per day.

Focus Questions

1. How could the nurse obtain a more accurate picture of the client’s diet?
2. What educational information is appropriate to discuss with the client today?
3. What psychosocial support can the nurse give the client today?

Answer 1

The disease diabetes mellitus is a syndrome which is having disordered hyperglycemia and inappropriate metabolism due to either the deficiency of the hormone insulin secretion or due to the insulin resistance and reduced insulin secretion to compensate.

Normal Pathology of the Human Body

In the healthy body, pancreas, which is an organ located near to the liver and stomach, which will secrete digestive enzymes and it will produce the hormones insulin and glucagon into the bloodstream. Which can control the amount of glucose in our body.

The release of the hormone insulin into the blood flow can lower the level of blood glucose (ie., simple sugars from food. If the glucose levels get low, our pancreas will secretes glucagon to increase the release of glucose from the liver indeed.

The insulin will enables the glucose to enter cells, especially in to muscle and liver cells. As the blood level of glucose reach its peak, then the pancreas will reduces the production of insulin hormone.

Ø Here the pathophysiology of Jack Taylor may be due to the below explained way,

VIRAL INFECTION (treated with Augmentin 875/125mg)

lead to

                              ALTERATION OF SELF CELLS

(T.101.6, P. 68, R. 18 and BP. 130/80.)

lead to

                              AUTO IMMUNE RESPONSE

leads to

                                 DESTRUCTIION OF BETA CELLS (Glucose +, Protein +,Ketones trace)

leads to

                                    INSULIN DEFICIENCY

leads to

                                  TYPE 1 DIABETES MELLITUS

> The educational information by the nurse provide to client today

1) Should know what number carbs you’re intake and the way usually you've got them. Managing your carbs will facilitate keep your glucose in check. opt for high-fiber carbs, like inexperienced vegetables, fruit, beans, and whole grains.

2) Regular exercise will assist you reach or maintain a healthy weight. Exercise additionally cuts stress and helps management pressure level, cholesterin, and lipid levels. Get a minimum of half-hour daily of cardiopulmonary exercise five days every week. attempt walking, dancing, low-impact aerobic exercise, swimming, tennis, or a stationary bike. begin out a lot of slowly if you are not active currently. you'll be able to split the half-hour -- say, by taking a 10-minute walk when each meal. embody strength coaching and stretching on some days, too.

3) Check your glucose level a minimum of double daily

4) Tests to search out out your average glucose for the past two to three months. the general public with kind two polygenic disorder ought to aim for AN A1c of seven or lower. raise your doctor however usually you wish to urge AN A1c take a look at.

5) Control your pressure level, cholesterin, and lipid levels. polygenic disorder makes heart condition a lot of probably, thus keep a detailed eye on your pressure level and cholesterin. speak along with your doctor concerning keeping your cholesterin, triglycerides, and pressure level in restraint. Take medications as prescribed

6) The stress and polygenic disorder do not combine. Excess stress will elevate glucose levels. however you'll be able to realize relief by sitting quietly for quarter-hour, meditating

7) Make a whole examination a minimum of once a year, tho' you will ask your doctor a lot of usually.

8) The patient ought to take “Augmentin at a dose of 875/125milligram pill by oral “bid” for ten days.

THE QUERIES OF NURSES TO THE CLIENT OF TODAY

Ø What square measure patients goals concerning blood glucose levels?

Ø  Will the patient forever would like medications/insulin? however can he judge whether or not these medications square measure the simplest treatment for him?

Ø  Should he check his hexose-glucose levels reception with a glucose monitor? however usually ought to check them?

Ø How is patient able to amendment his manner and diet in an exceedingly manner that may be healthy?

Ø What square measure the warning signs or symptoms that his blood sugars square measure too high?

Ø What do he do if his blood sugars square measure too high?

Ø What square measure the warning signs or symptoms that his blood sugars square measure too low?

Ø What can he do if his blood sugars square measure too low?

Ø What square measure the aspect effects of his medications/insulin?