Med-Surg+Case+Study+2

​​Names:

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 must have type 2 diabetes because he is using and oral agent to control his blood sugar. His body is still producing some insulin but it is either not enough, or his body is not able to utilize it properly. In people with type 1 diabetes, the pancreas no longer produces any insulin. These people will require insulin on a permanent basis. 2. What is the explanation for the increased blood glucose? The body's response to increases stress, is to release hormones that counteract the action of insulin, to supply the body with extra energy to aid in a fight or flight response, causing a rise in the blood glucose 3. The 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? The patient needs to be taught that insulin comes in may different forms and that the oral agent he is taking is insulin. He also needs to be taught that his glucose is high and needs to be brought down before he become hyperglycemic. Also by the patient receiving the insulin as and injection rather than an oral form it will act faster to bring down his glucose level. 4. What other laboratory test will help determine Mr. Torres’ risk for diabetes-associated retinopathy, nephropathy, and neuropathy? HbA1C- A measurement of gylcosylated hemoglobin that is useful for determining glycemic levels over a period of time. Shows the amount of glucose attached to hemoglobin molecules over their lifespan (approx. 90-120 days). So this test can indicate overall glucose control over the previous 90-120 days. Patients who are able to maintain near-normal A1C levels over time have a greatly decreased risk for retinopathy, nephropathy, and neuropathy.
 * Critical Thinking Questions**

5. What content should be included in patient teaching for Mr. Torres? I would inform the patient of the sources that are available with ADA. They could send a nurse to his hometo help him with meal planning and managing insulin and medications when needed. I would teach him to rotate injection sites to prevent scar tissue from forming. ​ i would ask Mr Torres about his diet and go over a meal plan with him. He should be instructed that a diabetic's nutritional energy intake should be constantly balanced with the energy output of the individual. This means the more he exercises the more he needs to ingest energy foods. They should be a balance of carbohydrates fats and proteins. 45-65% of his daily intake should be carbohydrates, this includes sugars starches and fiber. I would explain Glycemic index to Mr Torres. All carbohydrates have a GI and the higher the GI the sharper the rise in blood glucose. Those with a lower GI have steady increase of blood glucose over a longer period of time. 25-30% of his daily intake should be fats. Try not to eat more than 7% of saturated fats and eat foods low in cholesterol. 10% of his daily intake should be made up of protein. It adds saturated fat to your diet and unnecessary stress on the kidneys to excrete nitrogen.