Question

Robert, 62, newly diagnosed Diabetic discharged after treated for Diabetic Ketoacidosis. Recently retired Postal worker who lives alone in a private home. Has Medicaid services and private insurance. Resides in zip code 11201

A client scheduled for discharge back to their community (zip-code area) from the acute care setting. As the Community Health Nurse assigned to be the Case Manager for this client, the student will be required to prepare a discharge plan of care for the client (template provided). Plan of care must focus on Primary, Secondary and Tertiary levels of prevention for management of the client while in the community, resources and knowledge of the resources available within the community

Priority Teaching Topic: _______________________________________________________________

Priority Nursing Diagnoses	Primary Prevention needs	Secondary Prevention needs	Tertiary Prevention needs	S.M.A.R.T Objectives for each Diagnosis	Based on the diagnoses, list the resources needed to care for this client in their Community (Zip Code Area)
Nursing Diagnosis 1
Nursing Diagnosis 2
Nursing Diagnosis 3

As the Community Health Nurse for this client, use the Functional Health Status Approach method for Community Assessment list the agencies available in the zip-code area to facilitate partnering for care of the individual in their community: -

Answer 1

Diabetic ketoacidosis (DKA) is a life-threatening condition caused by dangerously high blood sugar levels. The lack of insulin (DM) forces your body to use fat instead of sugar for energy. As fats are broken down, they leave chemicals called ketones that build up in your blood. Ketones are dangerous at high levels.

PLAN OF CARE

Health teaching

Priority Nursing Diagnosis	Primary prevention needs	Secondary prevention needs	Tritiary prevention needs	SMART Objectives for each diagnosis
Risk For Fluid Volume Deficit due to decreased intake of fluids and  nausea and vomiting	Encourage the client to take plenty of oral fluids without sugar.	Monitor vital signs especialy for BP for orthostatic hypotension and blood sugar level to access hyperglycemia routinely.	Assess skin and mucus membrane for any signs of dehydration	Client will remain normovolemic as evidenced by urinary output greater than 30 ml/hr, normal skin turgor, good capillary refill, normal blood pressure, palpable peripheral pulses, and blood glucose levels between 70-200 mg/dL.
Risk For Infection due to high glucose levels	Assess for signs of infection such us fever, chills and dysuria.	Inspect for any foot ulcers, infected toe nails na dother medical problems	Encourage hand washing and provide skin care	Client will identify interventions to prevent reduce risk of infection and demonstrate techniques, lifestyle changes to prevent the development of infection.
Imbalanced Nutrition: Less Than Body Requirements due to decreased oral intake secondary to nausea and vomitting	Provide a diet plan with the help of a dietician.	Monitor weight daily or as indicated	Teach to perform fingerstick glucose monitoring,	Client will display normal energy level , take appropriate amounts of calories/nutrients and demonstrate stabilized weight gain.

FUNCTIONAL HEALTH STATUS APPROACH

Functional health status is often defined as one's ability to perform daily activities required to meet basic needs, fulfill usual roles, and maintain their health and well-being.