case

22

State 3: Follow up at the homeless shelter clinic- 2 weeks after discharge

Vitals: Temp 37 C; HR 78; B/P 120/74; RR 20

Alert, oriented to person, place and time

Clear breath sounds

Normal bowel sounds

Appears clean and neat

Blood Glucose 105

Skin is intact, except for a 1 cm long approximated lesion to the R big toe along the nail border. The bandaged has been free of drainage and odor. The surrounding area is slightly pink. He denies pain, but again reports having minimal sensation to toes. He said he had been putting antibiotic cream on it and was changing the dressing twice a day.

He shows you a notebook with his blood sugar values and amount of insulin he administered. He did a diet recall of the last 48 hours.

He attended a diabetic help group the shelter sponsors but didn’t like the volunteer leading it. He said he “knew more than they did.”

Week 2 Assignments

Create a concept map for this case use the H&P/SBAR and State 1 & 2 information for your cues and evaluate using State 3.

Create a teaching plan specific for the homeless patient in this case.

The patient with diabetes or the significant other should be able to:

Explain why the diabetic regiment was chosen.

Name which insulin or a non-insulin antidiabetic drug is being prescribed, the dosage, and frequency of administration.

Discuss the relationship between mealtime and the action of insulin or the other antidiabetic agent.

Discuss plans to follow diabetic diet instructions.

Prepare and inject insulin accurately.

Test blood for glucose or state plans for having blood glucose levels monitored.

Test urine for ketones and state when this test should be done.

Describe how to store insulin.

List symptoms that indicate a hypoglycemic reaction.

Tell which carbohydrate sources are used to treat hypoglycemic reactions.

Tell which symptoms indicate hyperglycemia.

Tell which dietary changes are needed during illness.

State when to call the diabetes health care provider or the nurse.

Describe the procedures for proper foot care.

State when to call the diabetes health care provider or the nurse (frequent episodes of hypoglycemia, symptoms of hyperglycemia)

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Your teaching plan should include

1. Specific information regarding your patient’s assessment

2. Understanding Diabetes

3. Healthy Eating

4. Monitoring Blood Sugar Levels

5. Medication Management

6. Physical Activity

7. Foot Care

8. Managing Stress

9. Healthcare Resources (use resources in your community)

10. Emergency Preparedness

11. Follow-Up

12. Support Network (use resources in your community)

1. **Assessment:** Begin by assessing the individual's current knowledge about diabetes, their access to healthcare, and their living situation.

2. **Understanding Diabetes:** Explain what diabetes is, including the different types, causes, symptoms, and long-term effects if not managed properly.

3. **Healthy Eating:** Provide guidance on making healthier food choices despite limited resources. Emphasize the importance of balancing carbohydrates, proteins, and fats, and offer practical tips for finding nutritious options at food banks or soup kitchens.

4. **Monitoring Blood Sugar Levels:** Teach them how to monitor their blood sugar levels regularly using a glucose meter, and stress the importance of keeping track of their readings.

5. **Medication Management:** Explain the importance of taking medication as prescribed, including insulin injections if necessary, and provide strategies for obtaining medication consistently, such as seeking assistance from local clinics or charities.

6. **Physical Activity:** Encourage incorporating regular physical activity into their daily routine, even if it's just walking or simple exercises that can be done outdoors or in shelters.

7. **Foot Care:** Educate on the importance of daily foot inspections, proper footwear, and seeking prompt medical attention for any foot problems to prevent complications.

8. **Managing Stress:** Discuss the impact of stress on blood sugar levels and suggest coping strategies such as mindfulness exercises, deep breathing techniques, or seeking support from community resources.

9. **Seeking Healthcare:** Provide information on free or low-cost healthcare services available in the area, including clinics, community health centers, and outreach programs.

10. **Emergency Preparedness:** Teach them how to recognize and respond to diabetic emergencies such as hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), and provide information on where to seek help if needed.

11. **Follow-Up:** Schedule regular follow-up appointments to assess progress, address any concerns or barriers, and adjust the plan as needed.

12. **Support Network:** Encourage the individual to build a support network of friends, family, healthcare providers, and community resources to help them manage their diabetes effectively.

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