Question

Patient Profile: Mr. Torres is a 45-year-old Hispanic man admitted to the medical unit with an infected arm wound. He has a history of diabetes and has been taking an oral agent. He performs SMBG (self-monitoring of blood glucose) routinely, and his diabetes has been well controlled.

Initial Objective Data:

Alert and oriented, cooperative
Blood pressure 132/80, pulse 102, respirations 18, temperature 101.6° F
Open wound to left arm, sustained while working as a mechanic
Blood glucose on admission 360 mg/dl

Subjective Data:

States he did not anticipate being admitted to the hospital
Worries about his family and his job
Expresses anxiety about the elevated blood glucose

1) Does Mr. Torres have type 1 or type 2 diabetes? How does the nurse make that decision?

2) What is the explanation for the increased blood glucose?

3) The nurse enters Mr. Torres’ room to administer an insulin injection to lower the blood glucose. Mr. Torres objects to the insulin saying, “I don’t use insulin.” What patient teaching is indicated?

4) What test will help determine Mr. Torres’ risk for diabetes-associated retinopathy, nephropathy, and neuropathy?

5). What content should be included in patient teaching for Mr. Torres?

Answer 1

1.  Mr. Torres has Type 2 Diabetes mellitus.

Its because he is taking OHA (Oral hypoglycemic agent). In type II diabetes Mellitus there is insulin secretion but that insulin is resistant to the body or there is a decreased amount of insulin secretion. OHA can increases insulin creation and can decrease insulin resistance.

In Type I Diabetes mellitus there is no insulin secretion due to the destruction of beta-cell in the pancreas due to various reasons.

2.

Mr. Torres's blood glucose level was 360 mg/dl on admission. There is 2 reason for increases blood glucose level

1. It may be stress-induced hyperglycemia ( Mr. Torres is ver stressed due to wound infection on his arm)
2. It may be due to the skipped dose of OHA.

3.

The nurse enters Mr. Torres’ room to administer an insulin injection to lower the blood glucose. Mr. Torres objects to the insulin saying, “I don’t use insulin.”

Then the nurse should make him understand that his blood glucose level is very high it can be controlled by oral hypoglycemic agents so, he should take insulin to better control of blood glucose level for now.

The nurse should also say that now he is given Insulin that does not mean that, at home also he required Insulin to control his blood glucose.

4.

Diabetic retinopathy can be diagnosed by - Dilated eye exam, angiogram, and OCT(Ocular coherence tomography)

Diabetic nephropathy can be diagnosed by - KFT(Kidney functioning test includes Serum creat and Serum urea, BUN and Electrolytes), Urine analysis, Imaging test of Kidney.

Diabetic neuropathy can be diagnosed by- Physical examination and neurological examination, Muscle strength, and reflexes test, Filament tweet, Nerve conduction test.

5.

Patient teaching

1. Poor blood glucose control increases the risk of diabetes complications so, always monitor the blood glucose level and take medications regularly.
2. Diet plays the main role in blood glucose control, (Eat fewer carbohydrate foods, eliminate trans fat and saturated fat from your diet and eat more proteins)
3. Daily mild to moderate exercise can be very beneficial in blood glucose control.
4. Do regular follow up visits and health check-up.