Question

Carolyn Mason is a nurse working in a community health setting. One of her roles is to organize screenings and clinics in local retirement communities. She is conducting a diabetes screening clinic in a lower income retirement complex. The center has access to transportation for the residents to visit primary care providers. The residents live independently and prepare their own meals.

Carolyn is approached by a 72-year-old woman who has non–insulin-dependent diabetes and hypertension. She shares with Carolyn that she has been experiencing episodes of fatigue, weakness, and thirst. She is able to perform her grocery shopping through public transportation, but because of her limited income, she relies on convenience foods most of the time.

1. In a lower income retirement community, what is the community health nurse most concerned with regarding diabetes care and control of symptoms?

1. Medication and diet compliance
2. The use of complementary therapies
3. Access to transportation
4. Availability of general practitioners in the community

2. Carolyn Mason uses technology to upload glucose readings to primary care providers to ensure that they are aware of trends. What are the most significant negative aspects of the use of new technology? (Select all that apply.)

1. High cost of equipment
2. Potential for privacy breach
3. More convenient for providers
4. Increased legal liability
5. Increased efficiency

3. A few residents of the retirement community in which Ms. Mason is working belong to the Medicare Advantage program. This is an example of which of the following systems?

1. Health maintenance
2. Primary care
3. Public health
4. Managed care

4. In the event that a resident of the senior retirement community required follow-up for a tuberculosis exposure, which entity would have primary accountability for service?

1. State health department
2. Centers for Disease Control and Prevention
3. Local public health department
4. Home health providers

Answer 1

Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance)

ASSESSMENT OF GLYCEMIC CONTROL

Techniques are available for health providers and patients to assess the effectiveness of the management plan on glycemic control.

1.

Self-monitoring of blood glucose

The ADA’s consensus statements on SMBG provide a comprehensive review of the subject . Major clinical trials assessing the impact of glycemic control on diabetes complications have included SMBG as part of multifactorial interventions, suggesting that SMBG is a component of effective therapy. SMBG allows patients to evaluate their individual response to therapy and assess whether glycemic targets are being achieved. Results of SMBG can be useful in preventing hypoglycemia and adjusting medications, MNT, and physical activity.

2.

MNT

MNT is an integral component of diabetes management and diabetes self-management education. A review of the evidence and detailed information can be found in the ADA technical review and position statement titled “Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications”

• Attain and maintain recommended metabolic outcomes, including glucose and A1C levels; LDL cholesterol, HDL cholesterol, and triglyceride levels; blood pressure; and body weight.

• Prevent and treat the chronic complications and comorbidities of diabetes. Modify nutrient intake and lifestyle as appropriate for the prevention and treatment of obesity, dyslipidemia, CVD, hypertension, and nephropathy.

• Improve health through healthy food choices and physical activity.

• Address individual nutritional needs, taking into consideration personal and cultural preferences and lifestyle while respecting the individual’s wishes and willingness to change.