Med-Surg+Case+Study+2

Jay Rogers Sarah Scott
 * Names: ** Bill Leverenz

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? Type 2 because the patient takes non-insulin medications to control the diabetes; The sx were chronic and progressive; and a slow healing infected wound (jr) 2. What is the explanation for the increased blood glucose? his oral agent is not working. Over time the pancreas produces less insulin eventually failing. (jr) 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 oral medication is not keeping the BS low, (normal range 80-100). BS of 360 mg/dl will cause circulation problems, thus reduce healing of his infected wound. (jr) 4. What other laboratory test will help determine Mr. Torres’ risk for diabetes-associated retinopathy, nephropathy, and neuropathy? BUN, creatinine clearance, urine analysis- ketones, liver enzymes, serum protein and albumin levels, triglycerides, cholesterol. Microalbuminuria in the urine and serum creatinine is an indication of nephropathy. 5. What content should be included in patient teaching for Mr. Torres? Nutrition / Diet ; Nutritionist should be scheduled for consult. i.e.carbohydrates and monounsaturated fats should provide 45% - 65% of their total energy intake each day. Foods containing carbohydrtaes from whole grains, fruits, vegetables, and low-fat milk should be included as a health meal plan. Regular and consistent exercise ( monitor by physician) is considered an essential part of diabetes management, it does not have to be vigorous to be effective, exercise such as "brisk walking" is effective. SMBG - levels before, during and after exercise to determine the effect exercise has on the blood glucose levels at particular times of the day.
 * Critical Thinking Questions**


 * what is diabetes**