Assignment Details

Diabetes Case Study

Chief Complaint

“My left foot feels weak and numb. I have a hard time pointing my toes up.”

History of Present Illness

D.T. is 42-year-old Caucasian woman who has had an elevated blood sugar and cholesterol 2 years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed her fasting blood sugar was 160 and her cholesterol was 250. However, she felt “perfectly fine at the time” and did not want to take any more medications. Except for a number of “female infections,” she has felt fine recently.

Today, she presents to the clinic complaining that her left foot has been weak and numb for nearly 3 weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. She does report that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 50 pounds since her last pregnancy 10 years ago, 20 pounds in the last 6 months alone.

Past Medical History

• Seasonal allergic rhinitis (since her early 20s)
• Breast biopsy positive for fibroadenoma at age 30
• Gestational diabetes with second child 10 years ago
• Multiple yeast infections during the past 3 years that she has self-treated with OTC antifungal creams and salt bath
• Hypertension for 10 years

Past Surgical History

C-section 14 years ago

OB-GYN History

• Menarche at age 11
• Last pap smear 3 years ago

Family History

• Type 2 DM present in older brother and maternal grandfather. Both were diagnosed in their late 40s. Brother takes both pills and shots.
• Mother alive and well
• Father has COPD
• Two other siblings alive and well
• All three children are alive and well

Social History

• Married 29 years with 3 children; husband is a school teacher
• Family lives in a four bedroom single family home
• Patient works as a seamstress
• Smokes 1 pack per day (since age 16) and drinks two alcoholic drinks 4 days per week
• Denies illegal drug uses
• Never exercises and has tried multiple fad diets for weight loss with little success. She now eats a diet rich in fats and refined sugars.

Allergies

NKDA

Medications

• Lisinopril 10 mg daily
• Loratadine 10 mg daily

Review of Systems

General

Admits to recent onset of fatigue

HEENT

Has awakened on several occasions with blurred vision and dizziness or lightheadedness upon standing: Denies vertigo, head trauma, ear pain, difficulty swallowing or speaking

Cardiac

Denies chest pain, palpitations, and difficulty breathing while lying down

Lungs

Denies cough, shortness of breath, and wheezing

GI

Denies nausea, vomiting, abdominal bloating or pain, diarrhea, or food intolerance, but admits occasional episodes of constipation

GU

Has experienced increased frequency and volumes of urination, but denies pain during urination, blood in the urine, or urinary incontinence

EXT

Denies leg cramps or swelling in the ankles and feet; has never experienced weakness, tingling or numbness in arms or legs prior to this episode

Neuro

Has never had a seizure and denies recent headaches

Derm

Has a rash under her bilateral breast and in groin area

Endocrine

Denies a history of goiter and has not experienced heat or cold intolerance

Vital Signs

BP 165/100, T 98 F, P 88 regular, HT 5 feet 4 inches, RR 20 non labored, WT 210 lbs

What you need to do:

• Develop an evidence-based management plan.
• Include any pertinent diagnostics.
• Describe the patient education plan.
• Include cultural and lifespan considerations.
• Provide information on health promotion or health care maintenance needs.
• Describe the follow-up and referral for this patient.
• Prepare a 3–5-page paper (not including the title page or reference page).

Format

The paper should be no more than 3–5 pages (not including the title page and reference pages.

Assignment Requirements:

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above);
• consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
• utilize spelling and grammar check to minimize errors.

Your writing Assignment should:

• follow the conventions of Standard American English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and
• use APA 6th Edition format as outlined in the APA Progression Ladder.

Before beginning this assignment, please visit two or three of the following websites to view You Tube video clips on the correct way to backboard an injured athlete.

Video link: http://www.youtube.com/watch?v=hmCzFe5Xz_4

Video link: http://www.youtube.com/watch?v=tR4O9pvnFuw

Video link: https://youtu.be/IUY9Fz1FdrY

Answer the following questions about the videos (copy and paste the questions into a word processing document and upload your completed response here as either Word or PDF–your similarity index may seem high, but should only be triggering on the questions themselves–this is ok and will not be penalized).

1. Who is in charge when spineboarding an athlete and why?

2.  Describe 3 tools that can be used to remove a helmet and their role in its removal.

3.  Where do the assistants place their hands to perform a log roll and why? (Be very specific–consider the number of assistants, where their individual hands are placed, and why they put their hands in those spots.)

4.  If you were at the head, what commands would you provide to the assistants to perform a log roll?  Please write your response as if you were performing the roll in real time. (Be very specific–write your commands as if you were giving them to all of the assistants present to ensure a smooth/coordinated roll and placement onto the board.)

5.  Bullet point at minimum 12 key factors (total) that you feel are essential from two or three video clips. (For example: 4 for each video x 3 clips = total of minimum 12 key points -or- 6 from each video x 2 clips = total of minimum 12 points -or- 3 for each video x 4 clips = total minimum of 12 points.)

Comment1

My EBP project is on type 2 diabetes management through lifestyle changes. I have chosen my place of employment as a research facility being that huge percentage of the population is diabetic. Potential barriers that may prevent my EBP change proposal is the lack of knowledge and unpreparedness of the rest of the team. The company in which I work for has a total of 13 facilities. Each facility has at least one RN and various providers. In order for my EBP change proposal to be successful, the company will have to invest money in training the RNs. Budget is something that has to be meticulously analyzed before approving any type of training. However, the company believes in providing quality patient care and managing our patient’s diabetes will not only reflect in their blood glucose, but also their overall health. According to the article Budget Management Tips for New Managers, it is cost effective to invest time to learn right initially (McCarthy, 2018). At this time, the company is investing time and money to train all medical assistants into working universally throughout the 13 facilities. Being that diabetes is on the rise, and I have conducted evidence-based practice research, I have a good feeling that the company may want to invest time and money into training not only RNs in providing education to patients living with diabetes, but also mental health providers to support these patients.

comment2

Maintaining safe staffing is key.  Keeping staff engaged in the hourly rounding process and not accepting anything less as practice on our CLC is paramount to keeping the residents safe and continue to keep falls at a minimum.  Maintaining an alarm free environment, no matter what the staffing ratios are, will be important. If management is serious about the alarm free environment, then they will need to actively enforce the rounding and not allow it to slide. Lastly, to maintain staff compliance, on-going education needs to be reinforced regarding proper rounding and alarm/restraint statistics on alarm free environments.

 

Readings

1. Randolph, K. A. (2010). Logic models. In B. Thyer (Ed.). The handbook of social work research methods       (2nd ed., pp. 547-562). Thousand Oaks, CA: Sage 

2. Logan, T. K., & Royse, D. (2010). Program evaluation studies. In B. Thyer (Ed.). The handbook of social

work research methods (2nd ed., pp. 221-240). Thousand Oaks, CA: Sage.

You can also use Colleagues references in the attached document to refer to their response to the questions. 
COVID19

According to the American Diabetes Association (2011), 25.8 million children and adults have been diagnosed with diabetes in the United States. Approximately 2 million more are diagnosed every year, with another 79 million people considered to be in a pre-diabetes state. These millions of people are at risk of several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. Since diabetes has a major impact on the health of millions of people around the world, it is essential for nurses to understand the pathophysiology and associated alterations of this disorder. In this Discussion, you compare two types of diabetes—diabetes mellitus and diabetes insipidus.

To Prepare

• Review Chapter 19 in the Huether and McCance text and Chapter 18 in the Hammer and McPhee text. Identify the pathophysiology of diabetes mellitus and diabetes insipidus. Consider the similarities and differences between resulting alterations of hormonal regulation.
• Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Think about how the factors you selected might impact the diagnosis and prescription of treatment for these two types of diabetes.

By Day 3

Post an explanation of the pathophysiology of diabetes mellitus and diabetes insipidus. Describe the differences and similarities between resulting alterations of hormonal regulation. Then explain how the factors you selected might impact the diagnosis and prescription of treatment for these two types of diabetes.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

4 reference not more than five years

zero plagiarism