Question

Joyce Workman, 42- year old female who presents to the Diabetes Clinic with a new diagnosis of type II diabetes. She has been documented as being obese, new onset hypertension, polyuria, and a rash on her abdomen. She was asymptomatic upon arrival. She was admitted yesterday for stabilization of her glucose levels, and assist her with lifestyle modification. She states she leads a sedentary lifestyle as a bank officer. Her HbA1C is 10%.

Mrs. Workman calls the nurse and complains of cool clammy skin, anxious, weak, hungry but nauseous, and slightly confused.

Perform a focused assessment on Mrs. Workman.

Answer 1

JOYCE WORKMAN IS A DIABETIC PATIENT WITH NEWLY DIAGNOSED TYPE 2 DIABETES .

THE DATA ABOUT HER MEDICAL CONDITION IS GIVEN BELOW

SHE IS 42 TEARS OLD,OBESE,ONSET OF HYPERTENSION,POLYURIA,RASH ON ABDOMEN.

SHE LIVED A SEDENTARY LIFE.

AYMPTOMATIC AND HBA1C IS 10 %.

AFTER ADMISSION LIFESTYLE CHANGES ARE ADVICED AND SHE COMPLAINED OF COOL CLAMMY SKIN,ANXIOUS,HUNGRY BUT NAUSEOUS,WEAK AND SLIGHTLY CONFUSED.THE ABOVE MENTIONED NEWLY DEVELOPED SYMPTOMS ARE INDICATING HYPOGLYCEMIA.IT IS OF A MILD HYPOGLYCEMIC EPISODE.SO A DETAILED ASSESSMENT SHOULD BE DONE FOR THE PROPER CARE OF THE PATIENT.THE LIFESTYLE MODIFICATION OR MEDICATION CAUSED HER BLOOD SUGAR LEVEL COME DOWN AND CAUSED HYPOGLYCEMIC EPISODES.

AIMS OF ASSESSMENT OF DIABETIC PATIENT

• FOR EDUCATING AND REINFORCING HEALTHY LIFESTYLE
• TO ASSESS ANY PROBLEMS IN GLYCEMIC CONTROL AND ADDRESS THEM TO IMPROVE IT.
• TO DETECT ANY COMPLICATIONS OF DIABETES AND TREAT THEM AS APPROPRIATE.
• TO EDUCATE THE PATIENT AND ENABLE THEM TO MONITOR AND MANAGE THEIR DIABETES AS WELL AS POSSIBLE.
• TO ASSESS PATIENTS OVERALL HEALTH AND TO TREAT ANY ASSOCIATED OR COINCIDENTAL ILLNESS.

TO PROVIDE SUPPORT AND ADVICE TO THE PATIENT ON HOW TO COPE WITH LIVING WITH A CHRONIC ILLNESS.

DETAILED ASSESSMENT

• FIRST THING IS TAKING OF HISTORY-ALL THE AVIALABLE DATA WILL BE COLLECTED.
• EDUCATION AND SELF MANAGEMENT-HOW MUCH PATIENT IS EDUCATED AND HOW MUCH ABLE TO SELF MANAGE THE CHRONIC ILLNESS SHOULD BE ASSESSED.
• DIET SHOULD BE ASSESSED CAREFULLY-WHEATHER THE PATIENT EAT A HEALTHY DIABETIC DIET.MANAGEMENT OF DIET AND INSULIN REGIMEN AND THEIR RELATION SHIP SHOLUD BE ASSESSD AND IF NEEDED EDUCATE THE PATIENT.
• SMOKING HISTORY ASSESSED AND EDUCATION OF IMPORTANCE OF STOP SMOKING.
• COMPLICATIONS OF THE DIABETES SHOLUD BE ASSESSED.IN CASE OF WORKMAN THERE DEVELOPED COMPLICATION THAT IS HYPOGLYCEMIC EPISODE.BY ASSESSING THE COMPLICATION PATIENT SHOULD BE EDUCATED ABOUT ALL THE POSSIBLE COMPLICATIONS.
• PRECEEDING YREATMENT HISTORY OF OTHER ILLNESS SHOULD BE NOTED AND THE FAMILY HISTORY OF HEART DISEASE ,DIABETES ARE NOTED SO THAT THE UPCOMING COMPLICATIONS ARE TO BE UNDERSTAND.
• ASSESS THE SYMPTOMS OF CARDIOVASCULAR,CEREBROVASCULAR,RENAL,OPTHALMOLOGIC OR NEUROLOGICAL SYMPTOMS.
• ASSESS THE SEXUAL FUNCTION.
• ASSESS THEIR MOOD ,IS THERE ANY DEPRESSION.
• ASSESSING THE CURRENT TREATMENT PLAN- MEDICATIONS,INSULIN THERAPY AND LIFESTYLE CHANGES.AND ASSESS HOW IT AFFECTED THE PATIENT.HOW THE PATIENT IS COPING WITH AND COMPLYING WITH THEIR MEDICATION REGIMEN FOR DIABETES.
• MONITORING SHOLUD BE DONE CAREFULLY.ASSESSING THE BLOOD GLUCOSE LEVEL IMMEDIATELY AFTER COMPLAINIG OF HYPOGLYCEMIC SYMPTOMS.CORRECT MONITORING OF BLOOD GLUCOSE LEVELS AND MANAGEMENT ACCORINGLY.
• EXAMINATION DONE TO ASSESS WEIGHT,ABDOMINAL CIRCUMFRANCE,HEIGHT AND BMI.
• ASSESSMENT OF URINE ANALYSIS FOR KETONE BODY,PROTEIN,NITRITE ANS ASSESSMENT OF INFECTION .
• ASSESS CARDIOVASCULAR SYSYEM- CHECK PUKSE AND BP,LISTEN FOR CARDIAC BRUITS,HEART SOUNDSAND HISTORY OF CARDIAC ILLNESS.
• ASSESS THE PERIPHERAL PULSES BY PALPATION.
• ASSESSMENTS OF EYE FUNCTION-REGULAR ATTENDANCE AND APPROPRIATE FOLLOW UP FOR DIABETES EYE SCREENING.
• ASSESSMENT OF NERVOUS SYSTEM-DEVELOPMENT OF NEUROPATHY.
• ASSESSMENT OF BLOOD AND URINE RESULRS-HBA1C,CAPILLARY GLUCOSE MONITORING,NON FASTING LIPID PROFIKES.
• ASSESS FREQUENCY AND SEVERITY OF HYPOGLYCEMIC EPISODES.
• ASSESSING OF KIDNEY FUNCTION-GLOMERULAR FILTRATION ESTIMATE,AND THE DEVELOPMENT OF DIABETIC NEPHROPATHY.MICRO ALBUMINURIA AND ALBUMIN CREATININE RATIO ARE TO BE TESTED.
• ASSESSING PATIENTS PHYSICAL ACTIVITY LEVEL AND EDUCATE ABOUT THE NEED OF HEALTHY LIFESTYLE INCLYDES THE DIABETIC DIET,EXERCISE ETC.
• ASSESSMENT OF MODIFYABLE RISK FACTORS-BP,HYPER LIPIDEMIA ETC.
• ASSESSMENT OF PATIENT SATISFACTION ABOUT THE TREATING PLAN.AFTER EDUCATING THE PATIENT ABOUT THE TREATMENT AND LIFESTE CHANGES ACCEPTANCE OF THE PATIENT MUST BE ASSESSED.