Med-Surg+Case+Study+2

Names: Kathleen Yearwood

Mr. Jeff Torres is a 45-year-old Hispanic man admitted to the medical unit with an infected arm wound. He has a history of [|diabetes]and has been taking an oral agent. He performs SMBG (self-monitoring of blood glucose) routinely, and his diabetes has been well controlled.
 * CASE STUDY **
 * Patient Profile**

· Alert and oriented, cooperative · Blood pressure 132/80, pulse 102, respirations 18, temperature 101.6° F · Open wound to left arm, sustained while working as a mechanic · Blood glucose on admission 360 mg/dl
 * Initial Objective Data**

· States he did not anticipate being admitted to the hospital · Worries about his family and his job · Expresses anxiety about the elevated blood glucose
 * Subjective Data**

1. Does Mr. Torres have type 1 or type 2 diabetes? How does the nurse make that decision? Mr. Torres appears to have Type 2 diabetes. He takes an oral agent, rather than injections which are the norm for Type 1 diabetes. His blood sugar level is elevated at 360 mg/dl which is greater than the non fasting glucose level of 200 mg/dl or less. He is Hispanic, which is a risk factor for metabolic syndrome; which is then a risk factor for Type 2 diabetes. His age may also be a factor.
 * Critical Thinking Questions**

2. What is the explanation for the increased blood glucose? The increase in blood glucose has to do with the body trying to fight the infection in his arm and its auto immune functions.

.3The nurse enters Mr. Torres’ room to administer an insulin injection to lower the blood glucose. Mr. Torres objects to the insulin saying, “I don’t use insulin.” What patient teaching is indicated? During such periods of illness and extreme stress, insulin therapy may be required to prevent or treat hyperglycemic symptoms (BS 360) and avoid hyperglycemic emergency || [|acruver] ||
 * The immediate teaching necessary is to explain the significance of his 360 mg/dl blood glucose reading and the necessity of supplying insulin to his blood stream to reduce the glucose level. The initial assessment states that Mr Torres performs SMBG routinely and his diabetes is controlled. The nurse could explain that the increased level at this time may be due to his body's reaction to the wound he currently has. After the patient agrees to and receives the insulin injection, further teaching can be made; such as the purpose of insulin in the body, that oral agents are also insulin, and that Type 2 diabetes is a progressive disease and that he may eventually require injected insulin to control his blood glucose levels. [[image:http://www.wikispaces.com/i/icon_16_page_link.gif width="12" height="12" caption="permalink" link="http://teamrednurses.wikispaces.com/message/view/Med-Surg+Case+Study+2/22986239"]] People with type 2 diabetes who are usually controlled with O/A's may require exogenous insulin temporarily during periods of severe stress such an illness or surgery
 * [[image:http://www.wikispaces.com/i/user_none_lg.jpg width="48" height="48" caption="acruver" link="http://www.wikispaces.com/user/view/acruver"]] || **re: #3**

4. What other laboratory test will help determine Mr. Torres’ risk for diabetes-associated retinopathy, nephropathy, and neuropathy? retinopathy- Funduscopic dialated eye exam anually Nephropathy- urinalysis for microalbuminaria , serum creatinine Neuropathy- visual examination of foot, Retinopathy; Patients with diabetes must have regular dilated eye examinations by an opthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter 5. What content should be included in patient teaching for Mr. Torres? Pt teaching should include instructions on glucose maintainance, including when and how to administer medications. Also the importance of exercise when and how. Lastly diet, eating proper meals. he should also be counseled on proper foot care, smoking, and alcohol consumption. Content for teaching should include: 1) blood glucose; Monitoring, taking insulin/OA as prescribed, obtain a hemoglobin A1C blood test every 3-6 months, carry some form of glucose, instruct family members on what to do in case of emergencies due to hypoglycemia. 2) Exercise: Learn how and what foods affect glucose levels, medically supervised exercise program 3) Diet: Meal plan by dietician, follow diet/ don't skip meals, eat slow/ chew food,limited alcohol drinks, learn cholesterol level 4) other: eye exams, annual urine test for protein, examine feet, wear comfortable well fitting shoes, medical alert bracelet, know symptoms of hyper and hypo, quit smoking


 * [|what is diabetes]**