Individual_Patient_Education_Plan

Individual Patient Education Plan Ceceilia R. Gee NUR 427 November 15,2010 Case Scenario Jeff is a 45- year old, obese, Caucasian male diagnosed with new onset Diabetes Mellitus Type II. Jeff sought medical attention because of a leg wound he received while at work that has failed to heal. Upon further investigation by his primary care physician he also admitted to increased thirst, excessive urination and recent weight gain. Jeff believed he has just been suffering from dehydration. He owns and operates a landscaping and lawn care business because of the recent economic downturn he was forced to lay off some of his workers and is now in the field. He has also been eating more recently and complained of being more tired. In both instances Jeff believed that the increased labor demands of his job were the cause. Jeff medical history is unremarkable. At 13 he suffered a broken wrist as a result of a snowboarding accident. He does not remember being ill often as a child and states he had the normal childhood illnesses such as the chicken pox. Both his parents are living and neither have any health issues. He denies any person in his family having had diabetes. Jeff is married and has three adult children. Neither Jeff nor his wife completed high school. Their first child was born during his senior year. Jeff has no formal college education; he is an avid reader and considers himself well informed on most current events and political issues. Jeff’s preferred form of learning is visually, as stated earlier he is an avid reader, he also likes to have his questions verbally explained. Jeff is normally an easygoing, fun loving guy, quick to laugh and until recently loved to hike, camp and ride dirt bikes with his family. The uncertainty of the cause of his leg wound not healing, his increased fatigue have caused Jeff to feel anxious and uncertain of his future and the future of his family. The recent diagnosis of Type II Diabetes has done nothing to alleviate his concerns. The Disease Process Type II diabetes is the most common form of diabetes world wide. 95% of persons diagnosed with diabetes fall into this category. Millions of American have been diagnosed with Type II diabetes and many more are unaware they are at either at high risk for the disease or actually have the disease (American Diabetes Association, 1995-2010). It is a chronic condition that affects the body’s uses sugar, its main source of fuel to create energy. Overweight persons are more apt to suffer from insulin resistance. Fat interferes with the body’s ability to use insulin. Type II diabetes is gradual in onset, with many of the symptoms ignored or explained by other factors as in the case with Jeff. Other risk factors for diabetes include: • Older than 45 years of age • HDL (good cholesterol) less than 35 or a triglyceride greater 250mg/dl • Hypertension • Race/ethnicity. African Americans, Native Americans and Hispanics have higher rates of diabetes than Caucasians. Impact on Quality of Life There is no cure for diabetes but it can be managed with diet and exercise. Diabetes affects many organs of the body including the heart, kidneys, blood vessels, nerves and the eyes. Good blood sugar control can help to prevent these complications. Long- term complications develop gradually, they can be disabling and even life threatening. Potential complications include: • Nephropathy, renal failure requiring transplant or dialysis. • Neuropathy, nerve damage in either the extremities or the nerves controlling digestion. In males erectile dysfunction may be a problem. • Diabetic retinopathy, damage to the vessels of retina eventually leading to blindness. • Heart and blood vessel disease including heart attack, coronary artery disease, stroke and atherosclerosis. • Damage to the feet resulting from either nerve or blood vessel damage or both. Left untreated, cuts and blisters may result in serious complications such as amputation. Physical Findings Upon examination Jeff is six foot- two, presently weighs 235 pounds. His BMI is 30.2, which falls in the obese category. His blood pressure is slightly elevated at 146/84, HgbA1c is 6.6, his fasting blood sugar 132 and his HDL cholesterol is 48 and triglycerides 265. It is important to make Jeff aware that all of these issues are modifiable. With diet and exercise he can reduce his weight, his BMI and his blood pressure. He may also be able to reduce his triglycerides and increase his HDL through dietary changes or the use of statins. Interview Information Jeff was first asked what he and his wife knew about diabetes. Unfortunately, his knowledge was limited to the horror stories both he and his wife heard about friends whose family members had lost limbs, were blind or on dialysis. This only added to their fear and anxiety. Both knew his diet would have to change but were unsure exactly what this would mean. His wife cooks most of the meals and does all of the shopping she is scared and overwhelmed about this new responsibility. Both are ready to make any changes needed to assist Jeff with adjusting to the disease. Needs and Readiness Assessment Both Jeff and his wife appeared willing to learn about diabetes and what is needed to manage it on a daily basis. It is important to remember Jeff is a visual learner preferring to read and then ask questions. Jeff will be provided with written educational materials he will be expected to read prior to attending Diabetic Education classes. The materials he will receive will teach him about diabetes, diet, medications, foot care and signs and symptoms of a low blood sugar. He will also be instructed what to do if he experiences such an event. He will be provided the number for the diabetic educator to answer any questions he may have prior to attending classes. Both he and his wife will meet with the dietician to review meal choices and how to prepare their meals. Samples of diabetic meals will be provided along with a diabetic exchange list to assist them informed food choices. The dietician will also assist Jeff in creating a diet plan to assist him in reducing his weight to a healthier level. Patient Perceived Challenges The patient perceived challenges may include erectile dysfunction, depression related to the potential loss of intimacy secondary to the loss of sexual function, cost of diabetic testing equipment and helping his children to understand his disease and the complications that may exist. In summary the purpose of the education plan for Jeff is to provide him with the information needed to overcome the challenges of diabetes and for him to understand that although diabetes cannot be cured it can be controlled by his commitment to his treatment options. References American Diabetes Association. (1995-2010). Diabetes Basics Type 2. Retrieved from http://www.diabetes.org  Everday Health . (2010). Type 2 Diabetes Basics. Retrieved from http://www.everydayhealth.com MayoClinic. (1996-2010). Type 2 Diabetes Definition. Retrieved from http://www.Mayoclinic.com/health New York Times. (2009). Type 2 Diabetes. Retrieved from http://health.nytimes.com/health Norman, J. (1997-2010). Symptoms, Diagnosis and Treatment of Type 2 Diabetes. Endocrineweb. Retrieved from http://www.endocrineweb.com