JOYCE WORKMAN
REPORT/ ACCUITY
Joyce Workman, Joyce Workman, 42- year old female who presents to the Diabetes Clinic with a new diagnosis of type II diabetes. She has been documented as being obese, new onset hypertension, polyuria, and a rash on her abdomen. She was asymptomatic upon arrival. She...
Swift River 2
JOYCE WORKMAN
REPORT/ ACCUITY
Joyce Workman, Joyce Workman, 42- year old female who presents to the Diabetes
Clinic with a new diagnosis of type II diabetes. She has been documented as being
obese, new onset hypertension, polyuria, and a rash on her abdomen. She was
asymptomatic upon arrival. She was admitted yesterday for stabilization of her glucose
levels, and assist her with lifestyle modification. She states she leads a sedentary
lifestyle as a bank officer. Her HbA1C is 10%.
SCENARIO 1:
Mrs. Workman presented to the diabetes clinic and provided a 24- hour food recall. She
was then sent to the lab for ordered lab tests. She is to notify the nurse upon return to
the clinic from the lab. Patient has requested more information on her diabetes and
states she does not understand why she "should be concerned" with blood glucose
control in both the short and long term.
SCENARIO 2:
The nurse is providing information on nutrition to assist Mrs. Workman in managing her
diabetes.
SCENARIO 3
Mrs. Workman presented to the Diabetes Clinic for further evaluation of her diabetes,
and lifestyle changes. She is planning on attending several of the classes that are being
offered. Patient is requesting information on appropriate exercise programs. She has
attended the Diabetic meal prep class, but still struggles with her diagnosis of diabetes.
SCENARIO 4
Day 3 of hospitalization at 12:30, Mrs. Workman calls the nurse and complains of cool
clammy skin, anxious, weak, hungry but nauseous, and slightly confused. April 10,
1245, Blood Glucose level: 40 mg/dL Healthcare Provider has ordered: 1.
Hypoglycemia protocol for BG level < 60 mg/dL 2. Regular insulin SQ 20 units for BG
level > 160 mg/dL 3. Monitor BG levels q 4 hours and PRN 4. IV fluids D5 0.45% NS at
125 mL/hour via peripheral line 5. 1800 calorie ADA diet and teach the patient about
diet changes.
SCENARIO 5:
3 months later, Mrs. Workman has returned to the Diabetes Clinic having lost 20
pounds and is requesting to stop taking the Metformin (Glucophage). HbA1C is 7.5 %.
She is also complaining of new onset diarrhea. - Answer Educational Needs increased
Fall Risk normal
Health increased
Neurological normal
Pain level normal
Psychological Needs normaL
sensorium normal
NURSING CONSIDERATIONS:
Physiological:
Enhanced readiness for learning T
, Ineffective health maintenance T
Safety:
Deficient fluid volume F
Imbalanced Nutrition T
Risk for injury T
Social isolation F
ACTIONS 1:
Ask Mrs. Workman to explain what she knows about diabetes.
Explain in layman terms what Diabetes is and how it can adversely affect the body if left
untreated.
Discuss lifestyle choices that can lead to type II diabetes.
Discuss lifestyle changes that can be beneficial in the management of type II diabetes.
Document teaching and understanding of teaching using teach back process.
ACTIONS 2:
Assess Mrs. Workman's knowledge of nutrition and preferred foods.
Ask Mrs. Workman for a 24- hour diet recall.
Educate Mrs. Workman on healthier options based on the 24-hour diet recall.
Provide Mrs. Workman with a Mediterranean style diet plan
Ask Mrs. Workman to demonstrate understanding using the teach back method.
ACTIONS 3:
Assess the patient's preferred exercise regimen.
Ensure the patient does not have pre-existing conditions that would limit exercise
routines.
Provide an exercise routine that has been developed in conjunction with Mrs. Workman.
Review with Mrs. Workman safety measures related to blood glucose levels when
exercising
Use teach back method and document education provided.
actions 4
Assess patient's blood glucose level.
Provide a 20 -gram carbohydrate liquid for consumption.
Provide another 20-gram carbohydrate liquid for consumption in 15 minutes for
unresolved symptoms.
Reassess the blood glucose level in 15 minutes.
Provide additional teaching to the patient regarding prevention strategies for
hypoglycemia.
ACTIONS5;
Assess Mrs. Workman' s understanding of her medication, diet, and exercise regimen
Explain to Mrs. Workman about carbohydrate foods causing GI upset.
Explore new ways of cooking for diabetes management
Provide information to Mrs. Workman on support groups for diabetes.
Document education provided
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