Discharge/Planning Patient/ Family
Luckily, J.B. came into the clinic before he needed to be hospitalized for his Type 2 diabetes or complications. The nurse at the clinic continues with the nursing process in planning care for J.B. before he is sent home to be cared for on an outpatient basis, involving his wife as a back up caregiver as well. The nurse identifies these goals:
(1) Blood glucose level will be within a desired range within two weeks.
(2) J.B. and caregiver will verbalize knowledge of basics of dietary regime by end of clinic visit.
(3) J.B. and caregiver will verbalize understanding of complications & preventative measures by followup visit in one week.
(4) J.B will be competent, evidenced by return demonstration and verbalization, in med administration and glucose monitor within one week/ time of next appointment.
(5) J.B. will verbalize understanding of lower extremity care within one week.
J.B. is in need of special resources such as a diabetes educator, a dietician, a physical therapist, and chooses to join a Diabetes and weight loss support group. He is also given a list of online and community resources, where he can obtain more information and support.
A week later, at his follow up visit, the nurse assesses his vitals, blood glucose, and asks him how he is doing. J.B. replies, “I am learning as much as I can about the management of Diabetes. It is hard for me to change my diet but I am determined to lose weight and not have to use insulin injections or antidiabetic pills.” He reports that he has increased his intake of vegetables and decreased simple carbohydrates and completely stopped drinking soda. His wife is supporting him and following the diet herself. J.B has a random blood glucose reading of 120 mg/dL, 1.5 hours after breakfast, and his log shows random readings from 140-195mg/dL. J.B has lost five pounds in one week, and states he is meeting with a physical therapist and walking for fifteen minutes a day. The nurse praises him on the lifestyle changes he has made, noting he seems very motivated. She answers any questions he has, and instructs him about the importance of adherence and consequences of noncompliance in diabetic management. J.B. has met the goals (2), (3), (4), (5), and needs more time to fulfill (1). J.B. states he now wears slippers in the home, and washes his feet everyday, examining his lower extremity skin for breaks.
A few months later, J.B. gets an unnoticed scratch on his foot from a new kitten. A large, painful lump soon forms on his foot, oozing purulent drainage and interfering with walking. J.B. ends up in the hospital with an abscess in his foot that requires surgical incision and debridement, and IV antibiotics. After 6 days, J.B. is going to be discharged home and the nurse is planning his care. In talking with him while recovering, the nurse learns that J.B. has had to travel often for work lately, is under stress, and has “slipped a little” with his meal plan. He states his blood glucose readings have been always under 300 mg/dL, so he never notified his physician. He can count five times in the weeks prior when his reading was above 260 mg/dL. J.B. explains that although he has lost a total of twenty-five pounds, he is still having trouble with meal planning. The nurse decides to suggest he and his wife attend another session with a dietician. The nurse asks if there is anything else he is having concerns about and he relates that he feels overwhelmed with his diabetes management and that he “still doesn’t know enough.” The nurse decides that J.B. should be referred to home care when he returns home, so that he can be monitored and assessed in the home environment, and given more instruction on the disease process of Type 2 Diabetes. The nurse also instructs J.B. about foot care and hygiene, stressing again the importance of monitoring for lower extremity lesions. The nurse instructs about the effects of stress on glucose and teaches him some simple stress management skills such as mindful deep breathing, journal writing, daily walking, and supportive relationships. The nurse also determines that the wife needs support and offers her information about a Diabetes caregiver support group. Lastly, the nurse stresses that he must follow up with his physician for all appointments and follow medication regime to decrease exacerbations.
Conclusions
In conclusion, Type 2 Diabetes is a national and global health issue and affects all cultures. With high rates of obesity in the United States, an aging population, and high healthcare costs, Type 2 Diabetes is a disease we need to fight. Nurses can play a tremendous role in determining a positive outcome of patients through interventions and education. Nurses can make a huge difference in the life of every diabetic patient through using evidenced-based practice and individualized teaching centered on the common goal of health.
