Question

Mr. Gennaro is a 61-year-old Spanish-speaking man who presents to emergency room with his wife Dolores. Mr. Gennaro is also Spanish-speaking, but understand some English. Mr. Gennaro complains of nausea and vomiting for two days and symptoms of confusion. His blood glucose is 796 mg/dL. Intravenous regular insulin is prescribed and he is admitted for further evaluation. He will require teaching regarding his newly diagnosed diabetes.

He is a past medical history of coronary artery disease (CAD) and hypertension (HTN). Smokes one pack of cigarettes per day; tobacco use for 35 years. He also takes jerbero, and curandera.

Mr. Gennaro is newly diagnosed with diabetes. His hemoglobin A1c is 10.3%. Mr. Gennaro is slightly overweight. He is 5’10” tall and weighs 174 pounds. He reports no form of regular exercise. He does not follow a special diet at home. He states, “I eat whatever Dolores puts in front of me. She is a good cook.” Neither can recall how long it has been since these changes are Mr. Gennaro began. Dolores states, “it has been quite a while now. It just seems to be getting worse and worse.”

1. How might the nurse briefly explain what diabetes is in lay terms to Mr. and Mrs. Gennaro?

Answer 1

Following a brief history, it is important to guage the patient's knowledge of their condition.some patients may have a family members with diabetes and therefore have a fairly hood understanding of what the condition entails ( be careful to differentiate between insulin dependent and non insulin dependent). Other patients may have heard of diabetes but only have a vague understanding of the important details.the patient sitting before you may not even know at this point that they have diabetes you may be the first person to inform them of the diagnosis.

Due to these reasons it is important to start with open questioning .good example include,

* why do you think is causing your symptoms?

* what do you know about diabetes?

Open questioning should help you to determine what the patient currently understand.

At this stage primarily focus on listening to the patient.it may also be helpful to give positive feedback as the patient talks ( I.e should a patient demonstrate some understanding reinforce this knowledge with encouraging words and non verbal communication such as nodding).

Patients concern's should never be overlooked.a diagnosis of diabetes can be significant life event and provoke a variety of worries.

After determining the patient's current level of understanding and concerns you should be able to explain their condition clearly.

Explain to patient diabetes is what?

In diabetes the sugar cannot get into the cell as the insulin is not working properly.

There are two types

Type 1 :- a chronic in which the pancreas produces little or no insulin.

Type 2 :- a chronic condition that affects the way the body processes blood sugar.

Symptoms of diabetes

Extreme hunger

Loss of vision

Fatigue

Frequent urination

Weight loss

Complications of diabetes

* cardiovascular disease

* nerve damage

* kidney damage

* eye damage

* hearing impairements

* Alzheimer's disease

Management

Reinforce to the patient that they need to work with you as a team to achieve a good result

Start by explaining what the patient can do to manage their condition,

* change life style: healthy diet,(avoiding foods high in sugar), losing weight, and regular exercise

* stop smoking ( if relevant)

* emphasise the importance of tight glycemic control

* attending diabetic checks

* encourage good foot care and regular podiatrist appointment

* regular check ups to screen for diabetic complications

* regular blood test to check blood sugar levels

* follow the regular insulin asper doctor order

* managing any complications as they arise

After ask to the patient if they having any questions or concerns ask to me .