Question

A.J is a 62-year-old man with diabetes, diagnosed 3 years ago, who presents to the outpatient diabetes clinic for a routine preventive checkup. Subjective Data Complains of occasional dizziness when rising in the morning Follows 1,600-calorie diabetic diet Married with two grown children Retired construction worker Goes to the gym 3 times a week Objective Data Vital signs: T 37 P 118 R 18 BP 120/68 Glucose reading: 96 Weight: 165 HT: 5 feet. 8 inches. Questions: 1). What type of assessment should the nurse perform on this patient? 2). List the objective and subjective data? 3). What other prevention levels should be included in this patient's care?. 4). What step by step approach should the nurse take to identify and resolve this patient's problem? 5). What interventions might be included in the plan of care for this patient? ( please answer to all questions)

Answer 1

1) History collection,Blood test :- Fasting Blood Sugar,oral glucose tolerance test,glycosylated hemoglobin(glycohemoglobin test)assays,glycosylated serum proteins and albumin.
Weight, abdominal circumference, height and BMI. Urinalysis for ketones, protein and nitrite (evidence of infection). Inspect injection sites of patients with type 1 diabetes, looking for evidence of lipoatrophy and lipodystrophy/lipohypertrophy.The assessment is for people who have been diagnosed with diabetes It provides an annual assessment or check-up for either Type 1 or Type 2 diabetes, focusing on key risk factors for the development of complications. Patients can be newly diagnosed or have had diabetes for many years.
2) Subjective Data :- polyuria,polydipsia,polyphagia,
visual blurring,fatigue,weight loss,
Un-cordinated gait.
Objective Data :- Hypertension,right hand and right leg weakness,un-cordinate gait,color of injected site,anxiety.
3) 1. Make a commitment to managing your diabetes
Members of your diabetes care team — doctor or primary care provider, diabetes nurse educator, and dietitian, for example — can help you learn the basics of diabetes care and offer support along the way. But it's up to you to manage your condition.Learn all you can about diabetes. Make healthy eating and physical activity part of your daily routine. Maintain a healthy weight.Monitor your blood sugar, and follow your doctor's instructions for managing your blood sugar level. Take your medications as directed by your doctor. Ask your diabetes treatment team for help when you need it.

2. Don't smoke
Smoking increases your risk of type 2 diabetes and the risk of various diabetes complications, including:

1. Reduced blood flow in the legs and feet, which can lead to infections, ulcers and possible removal of a body part by surgery (amputation)

2. Heart disease

3. Stroke

4. Eye disease, which can lead to blindness

5. Nerve damage

6. Kidney disease

7. Premature death

Talk to your doctor about ways to help you stop smoking or using other types of tobacco.

3. Keep your blood pressure and cholesterol under control
Like diabetes, high blood pressure can damage your blood vessels. High cholesterol is a concern, too, since the damage is often worse and more rapid when you have diabetes. When these conditions team up, they can lead to a heart attack, stroke or other life-threatening conditions.Eating a healthy, reduced-fat diet and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Your doctor may also recommend taking prescription medication, if necessary.

4. Schedule regular physicals and eye exams
Schedule two to four diabetes checkups a year, in addition to your yearly physical and routine eye exams.During the physical, your doctor will ask about your nutrition and activity level and look for any diabetes-related complications — including signs of kidney damage, nerve damage and heart disease — as well as screen for other medical problems.Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.

5. Keep your vaccines up to date
Diabetes makes it more likely you'll get certain illnesses. Routine vaccines can help prevent them. Ask your doctor about:

Flu vaccine. A yearly flu vaccine can help you stay healthy during flu season as well as prevent serious complications from the flu.
Pneumonia vaccine.Sometimes the pneumonia vaccine requires only one shot. If you have diabetes complications or you're age 65 or older, you may need a booster shot.
Hepatitis B vaccine. The hepatitis B vaccine is recommended for adults with diabetes who haven't previously received the vaccine and are younger than 60. If you're age 60 or older and have never received the hepatitis B vaccine, talk to your doctor about whether it's right for you.
Other vaccines. Stay up to date with your tetanus shot (usually given every 10 years). Your doctor may recommend other vaccines as well.
6. Take care of your teeth
Diabetes may leave you prone to gum infections. Brush your teeth at least twice a day with a fluoride toothpaste, floss your teeth once a day and schedule dental exams at least twice a year. Call your dentist if your gums bleed or look red or swollen.

7. Pay attention to your feet
High blood sugar can reduce blood flow and damage the nerves in your feet. Left untreated, cuts and blisters can lead to serious infections. Diabetes can lead to pain, tingling or loss of sensation in your feet.

To prevent foot problems:

Wash your feet daily in lukewarm water. Avoid soaking your feet, as this can lead to dry skin.
Dry your feet gently, especially between the toes.
Moisturize your feet and ankles with lotion or petroleum jelly. Do not put oils or creams between your toes — the extra moisture can lead to infection.
Check your feet daily for calluses, blisters, sores, redness or swelling.
Consult your doctor if you have a sore or other foot problem that doesn't start to heal within a few days. If you have a foot ulcer — an open sore — see your doctor right away.
Don't go barefoot, indoors or outdoors.
8. Consider a daily aspirin
If you have diabetes and other cardiovascular risk factors, such as smoking or high blood pressure, your doctor may recommend taking a low dose of aspirin every day to help reduce your risk of heart attack and stroke. If you don't have additional cardiovascular risk factors, the risk of bleeding from aspirin use likely outweighs any benefits of aspirin use. Ask your doctor whether daily aspirin therapy is appropriate for you, including which strength of aspirin would be best.

9. If you drink alcohol, do so responsibly
Alcohol can cause high or low blood sugar, depending on how much you drink and whether you eat at the same time. If you choose to drink, do so only in moderation, which means no more than one drink a day for women of all ages and men older than 65 and two drinks a day for men age 65 and younger.

Always drink with a meal or snack, and remember to include the calories from any alcohol you drink in your daily calorie count. Also, be aware that alcohol can lead to low blood sugar later, especially for people who use insulin.

10. Take stress seriously
If you're stressed, it's easy to neglect your usual diabetes care routine. To manage your stress, set limits. Prioritize your tasks. Learn relaxation techniques.

Get plenty of sleep. And above all, stay positive. Diabetes care is within your control. If you're willing to do your part, diabetes won't stand in the way of an active, healthy life.

4)
Step 1: Learn about diabetes.
There are three main types of diabetes:
Type 1 diabetes – Your body does not make insulin. This is a problem because you need insulin to take the sugar (glucose) from the foods you eat and turn it into energy for your body. You need to take insulin every day to live.
Type 2 diabetes – Your body does not make or use insulin well. You may need to take pills or insulin to help control your diabetes. Type 2 is the most common type of diabetes.
Gestational (jest-TAY-shun-al) diabetes – Some women get this kind of diabetes when they are pregnant. Most of the time, it goes away after the baby is born. But even if it goes away, these women and their children have a greater chance of getting diabetes later in life.
Talk to your doctor about how you can best care for your diabetes to stay healthy. Some others who can help are:
dentist
diabetes doctor
diabetes educator
dietitian
eye doctor
foot
doctor
friends and family
mental health counselor
nurse
nurse practitioner
pharmacist
social worker
How to learn more about diabetes.
Take classes to learn more about living with diabetes. To find a class, check with your health care team, hospital, or area health clinic. You can also search online.
Join a support group — in-person or online — to get peer support with managing your diabetes.
Read about diabetes online. Go to National Diabetes Education Program.

vaccine and are younger than 60. If you're age 60 or older and have never received the hepatitis B vaccine, talk blood flow and damage the nerves in your feet. Left untreated, cuts and blisters can lead to serious infections. Diabetes can lead
5) Nursing care planning goals for patients with diabetes include effective treatment to normalize blood glucose and decrease complications using insulin replacement, balanced diet, and exercise. The nurse should stress the importance of complying with the prescribed treatment program.