Question

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P.W. Is a 40-year old disabled man who recently lost his wife to metastatic breast cancer. His brother has taken him into his home. P.W. has a 22-year history of insulin-dependent diabetes mellitus (Type-1). Until recently, he has taken responsibility for the management of his disease and has been actively involved in the local chapter of the American Diabetic Association. PMH includes 2 amputated toes on his R foot, retinopathy and visual impairment in both eyes, and angina on exertion from coronary artery disease that severely restricts his activity. Since he began treatment with an Ace-inhibitor 2 years ago, his blood pressure has gone from 182/128 to 126/78 mm Hg. Currently, he is 71” tall and weighs 135 lb. P.W.’s sister-in-law, who is an LPN says P.W. has lost about 12 lbs in the past 3 weeks. Over the past few years, P.W. has been administering a multidose (3 injections) regimen of regular Humulin insulin to himself before meals and at night. Recently his BG levels have been increasingly inconsistent and labile, and he has been labeled “noncompliant.” It is Monday. You are the home care nurse assigned to visit P.W. 3 times per week for teaching and evaluation. P.W.’s brother and sister-in-law express concern that P.W. seems to be indifferent about his nutritional and pharmacologic regimens.

1. List the measures you normally would address in teaching for both hypoglycemia and hyperglycemia (6 each).

· Hyperglycemia

· Hypoglycemia

Answer 1

Answer - Nursing

* Teaching for Hyperglycemia :

- Teach client to maintain blood sugar diary : keppinh a diary can help client realize what symptoms are related to blood glucose readings as well as guide diabetes treatment .

- teach client who are treated with insulin that they may need to eat extra carbohydrate before exercise deoending on how exercise affects their blood glucose level .

- teach client that stopping insulin therapy can lead to hyperglycemic crisis : ketoacidosis , hyperosmolar hyperglycemia .

- ensure client receive insulin per order amd at order time

- Monitor blood glucose before meals and at bed time

- keep a healthy diet with frequent meals rather than full meal at a time with regular exerice .

- Monitor symptoms of hyperglycemia such as blurr vision , polydipsia , polyuria , polyphagia.

* Teaching for Hypoglycemia

- eat or drink fast acting carbohydrate

- recheck blood sugar level after 15 minutes after treatment .

- have a snack or meal : will help to stabilize the hypoglycemic condition .

- monitor the blood sugar

- dont skip or delay meals

- adjust your medication or increase additional snack if you increase physical activity.

- observe the symptoms like , drowsiness , confusion , unconciousness , difficult in speaking or slurred speech , jerky movements ets and immediately consult the physician .