Question

Carl Rogers is a 67-year-old African American male with a 20-year history of type II diabetes mellitus. On Tuesday at 1530, he was directly admitted from his physician’s office to the medical unit with a stage II nonhealing ulcer on his right heel. The nursing admission paperwork has been completed, and pain medication has been administered. Additional orders for a dressing change and insulin administration have been written but not yet implemented. The scenario takes place on Tuesday at 1700.

Answer 1

Type 2 diabetes mellitus;

A metabolic disorders characterized by the relative deficiency of insulin production and a Decreased insulin action and increased insulin resistance formerly called non insulin dependent diabetes, adult onset diabetes or type 2 diabetes

Clinical characteristics;

More then age 30

Obseity

Hereditary

Environmental factors

No islet cell antibodies

Decrease in endogenous insulin

Increased insulin resistance

Most patients can control blood glucose through weight loss if obese

Oral antidiabetic agents may improve blood glucose levels if dietary modifications and exercise are unsuccessful

May need insulin on a short or long term basis to prevent hyperglycaemia

Ketosis uncommon, except in stress or infection

Acute complications : hyperglycemic hyperosmolar syndrome

Two main problems :

Insulin resistance and Impaired insulin secretion. To overcome insulin resistance and to prevent the buildup of glucose in the blood, increased amount of insulin must be secreted to maintain the glucose levels at a normal or slightly elevated level.if the beta cells cannot keep up with the increased demand for insulin. The glucose levels rises and type 2 diabetes develop.

Diagnosis :

Laboratory blood test

Ophthalmoscope examination

Fasting Plasma glucose more than 126mg/dl

Random plasma glucose more then 120mg/dl

Two hours post load glucose equal to or greater than 200 mg/dl

Treatment;

The main goal of diabetes treatment is to normalize insulin activity and blood glucose levels to reduce the development of vascular and neuropathic complications. And also reduced the development and progression of complications such as retinopathy, Nephropathy, neuropathy.

NEGLIGENT CARE FOR THE PATIENT

Carl Rogers admitted on Tuesday at 1530 with complaints of 20 years of type 2 diabetes and stage 2 non healing wound in right heel .now doctor prescribed for the patient pain killer ,insulin, and wound dressing.

The nurse administer only a pain killer and she documented as done a dressing and given the insulin.but both she doesn't implemented.

So nurse done a malpractice with the patient and patient may leads to many complications because of the nurse. Wound related to infection,

tissue necrosis,

Gangrene

Periwound dermatitis

Periwound edema

Osteomyelitis

Hematomas

Dehiscence and also not given insulin related to serious illness and even death.

Acute and chronic problem.

Acute related to Diabetic keto acidosis, Hyperglycemic hyperosmolar non ketotic syndrome

Chronic :

Cardiovascular

Heart diseases

Stroke

Peripheral vascular disease

Eye:diabetes retinopathy

Cataract

Glaucoma

Nerve damage

Neuropathy

Nephropathy all the complications only responsible person nurse.documentation is essential. But document all care but not given means negligence care for the patient. Nurse must be assess wound classification ,colour of wound,careful assessment of the patient overall conditions, asses for possible dehiscence.monitor vital signs ,colour, level of pain ,give proper antibiotics and medication.

The primary issues in every case involving the failure to treat diabetes is whether the patient followed the proscribed course of treatment. Nurse blame to the patient in order to overcome these obstacles our DIABETES MEDICAL MALPRACTICE LAWYERS and Newyork city will fully investigate your medical record and course of treatment. Not give proper care to the patient claim for your demage. Foot ulcer not treated can eventually lead to amputation and even wrongful death occur.

NON negligent care for the patient;

Although an implausible excuse for what occured the nurse involved in this case could try and allege that the nursingredients care plan from the physician office. Nurse should be educate to medication, monitor your blood sugar, follow a sensible diet, do not skip meals,exercise regularly, monitor complications.

Conclusion :

Early identifications of risk factors and potential complications can mean the difference in whether a positive outcome is achieved. Using both the knowledge and resources and available is the starting point for early detection and management of this risk.