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. Explain the difference between type I diabetes type II diabetes and who is at increased risk for developing each type. Based on this understanding, which type of diabetes does Mr. Gennaro have?

2. Discuss the prevalence of diabetes and the potential long-term complications of diabetes.

3. List five nursing diagnosis appropriate to consider for Mr. Genaro.

4. Discuss Mr. and Mrs. Gennaro’s learning needs. Consider the communication preferences of Mexican Americans.

5. Discuss the dietary recommendations for diabetics based on the diabetic food pyramid.

Answer 1

Difference between type 1 and type 2 diabetes.

CAUSE:
Type 1 : Immune system mistakenly attacks the pancreatic beta cells, which produce insulin.

Type 2 : The body’s cells start to resist the effects of insulin. In time, the body stops producing enough insulin, so it can no longer use glucose effectively.This means glucose cannot enter the cells. Instead, it builds up in the blood.This is called insulin resistance.

RISK FACTOR :

Type 1 develops at any age(common in childhood and adolescent) while type 2 occurs above 45 years. People who have excess weight, who smokes and have immediate family member with type 2 diabetes are more prone to get Type 2 diabetes, while Type 1 is mostly genetic.

SYPTOMS :

Type 1 DM symptoms appear suddenly than that of Type 2. Symptoms in both cases are the same and includes: increased thirst and urination

• increased hunger
• blurry vision
• tiredness and fatigue
• numbness or tingling in hands and feet
• sores or wounds that take a long time to heal
• unexplained weight loss.

TREATMENT :

There’s no cure for type 1 diabetes. People with type 1 diabetes don’t produce insulin, so it must be regularly injected into the body. Type 2 diabetes can be managed with diet and exercise alone, but many people need extra support. If lifestyle changes aren’t enough, medications help use insulin more effectively.

As Mr Gennaro is 61 years old, a chronic smoker, overweight and has uncontrolled food habits he is having Type 2 diabetes. Also he has developed symptoms long before.

Prevalance and complications of Diabetes :

The global diabetes prevalence in 2019 is estimated to be 9.3%, rising to 10.2% by 2030. The prevalance is higher in urban areas than in rural.
Complications

• cardiovascular disease, including a risk of heart attackand stroke
• kidney disease and kidney failure
• eye problems and vision loss
• nerve damage
• problems with wound healing
• ketoacidosis

Diagnosis :

• Hypoglycaemia
• Hyponatremia
• Food poisoning
• Migraine
• Anxiety

As the patient is able to understand English communication is better in English and the doctor should explain to him in the simplest way possible.

Dietery recommendations :

The key to eating with diabetes is to eat a variety of healthy foods from all food groups, in the amounts your meal plan outlines.

The food groups are

• vegetables
  • nonstarchy: includes broccoli, carrots, greens, peppers, and tomatoes
  • starchy: includes potatoes, corn, and green peas
• fruits—includes oranges, melon, berries, apples, bananas, and grapes
• grains—at least half of your grains for the day should be whole grains
  • includes wheat, rice, oats, cornmeal, barley, and quinoa
  • examples: bread, pasta, cereal, and tortillas
• protein
  • lean meat
  • chicken or turkey without the skin
  • fish
  • eggs
  • nuts and peanuts
  • dried beans and certain peas, such as chickpeas and split peas
  • meat substitutes, such as tofu
• dairy—nonfat or low fat
  • milk or lactose-free milk if you have lactose intolerance
  • yogurt
  • cheese

Food to avoid :

• fried foods and other foods high in saturated fat and trans fat
• foods high in salt, also called sodium
• sweets, such as baked goods, candy, and ice cream
• beverages with added sugars, such as juice, regular soda, and regular sports or energy drinks.