Question

Develop a nursing care plan with a priority diagnosis, outcomes, and interventions. Be sure to include patient teaching, growth and development, self-concept, and lifestyle issues both in the present and going forward.

You are the RN assigned to George, age 62, who was admitted to the hospital with hyperglycemia and a diabetic foot ulcer. His medical history includes diabetes Type 2 (diagnosed 15 years ago) and pre-proliferative retinopathy. He is obese but states, “I am working really hard to keep my weight down.” Two weeks ago, he noted a red, open sore on the medial aspect of his left foot. He states he has many problems with his feet and has “shooting pains in my feet and legs at night.” He reports thirst and frequent urination. He says he is sometimes unable to get to the toilet on time. He adds that, “My days of being physically intimate with my wife are over." Medications he takes at home: glipizide, metformin, sitagliptin, and acarbose. He states he does not want his foot amputated because of the sore on his foot. “I’ll do anything I am supposed to do to get better and have this foot heal.” The UAP reports the following: FSBS 390, oral temp. 100.7, pulse 98, RR 20, & BP 158/82. The health care provider orders the following tests: CBC, HgA1C, metabolic panel, wound C&S, urinalysis & 24-hour urine for microalbumin and creatinine clearance.

Answer 1

Patient diagnosis

Thepatient is suffering from type 2 diabetes mellitus and its serious complication as diabetic retinopathy and progressing toward distal symmetric sensorimotor plyneuropathy as he is complaining of shooting pain in feet and legs at night . Patient also develop dermatological complication as diabetic ulcer in foot (red open sore in left foot) due to peripheral neuropathy and ischemia.

Outcome

Patient is on oral antidiabetic drugs but still his blood sugar is not in control as FSBS 390 according to report and this wil results in progressive worsening of diabetes outcome and its complications as diabetic nephropathy , severe diabetic retinopathy and gradually loss of vision . Diabetic neuropathy will also going to be severe with disturbances in autonomis nerve supply also and dermatological complications also . Cardiovascular complication as atherosclerosis and increased platelet adhesiveness results in intermittent cludication , gangrene , and impotence .

Intervention

1- Patient should have proper dietary regimen which involves estimation of total daily calorie requirement which is approx - 30-40 kcal/kg/day according to lifestyle of individual as sendentary -39 , moderate -35 & heavy active individual - 40kcal/kg/day

2- patient should have proper proportion of carbohydrates , protein and fat

Carbohydrate - 50-65%

Protein - 10-20%

Saturated fat - <7%

Polyunsaturated fat < 10%

Monounsaturated fat -10-15%

Protein requirement 0.9mg/kg/day

Fish oils is advised as it contains omega-3 fatty acids which is antiatherogenic

3- nutrition diet and physical exercise is the mainstay treatment for intial prevention of diabetes.

3- oral antidiabetic drugs

4- diabetic retinopathy can be treated by control on diabetes and hypertension . And later on photocoagulation

5- pain in legs are treated by NSAIDs , phenytoin , carbamazepine , gabapentin , amitriptyline .

6 - Renoving the pressure from foot to prevent ulcer and dressing the part.  

7- use of microcellular rubber footwear is effective from prevention from recurrent foot ulcers .

8- strict control of glucose level is necessary .