Type 2 diabetes concept map

Nursing Assignment

Virtual Clinical Assignment Fall 2020

Laboure College

Fall 2020

Virtual Clinical Assignment Metabolism

Course: NUR ____1025_____ Concept/Exemplar: ___Metabolism/Diabetes T2_______________ Hours: _8.5___

Student Learning Outcomes (SLOs): See CLM concept/exemplar for SLOs.

Scenario: Please use your Pearson Text as reference

Date

Identify the 4 Top client findings requiring immediate follow-up

Y.L., a 34-year-old Southern Asian woman, comes to the clinic with chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination. She tells you she has a vaginal yeast infection that she has treated many times with over-the-counter medication. She works full time as a clerk in a loan company and states she has difficulty reading numbers and reports, resulting in her making frequent mistakes. She says, “By the time I get home and make supper for my family, then put my child to bed, I am too tired to exercise.” She reports her feet hurt; they often “burn or feel like there are pins in them.” She has a history of gestational diabetes and reports following a traditional eating pattern, which is high in carbohydrates. In reviewing Y.L.’s chart, you note she last saw the provider 6 years ago after the delivery of her last child. She has gained considerable weight; her current weight is 173 pounds (78.5 kg). Today her BP is 152/97, and a random plasma glucose level is 291 mg/dL (16.2 mmol/L). The provider suspects she has developed type 2 diabetes mellitus (DM) and orders the lab studies shown in the chart.

(NG NCLEX What matters most? Noticing) Tanner’s Clinical Judgement model

Tanner’s Reflective Journal and Next Gen NCLEX

Lab results

Fasting glucose

Hemoglobin A1c (A1C)

Total cholesterol

Triglycerides

Low-density lipoprotein (LDL)

High-density lipoprotein (HDL)

Urinalysis (UA)

184 mg/dL (10.2 mmol/L)

8.8%

256 mg/dL (6.6 mmol/L)

346 mg/dL (3.91 mmol/L)

155 mg/dL (4.01 mmol/L)

32 mg/dL (0.83 mmol/L)

+ glucose, − ketones

1. Interpret Y.L.’s lab results.

2. Identify 3 methods used to diagnose diabetes mellitus (DM).

3. Describe the major pathophysiologic difference between Type 1 and Type 2 DM. Can create a Venn diagram.

4. Name 6 risk factors for type 2 DM. Underline those that are consistent with Y.L.’s case.

CASE STUDY PROGRESS

Y.L. is diagnosed with type 2 DM. The provider starts her on metformin (Glucophage) 500 mg, glipizide (Glucotrol) 5 mg, orally each day at breakfast and atorvastatin 20 mg orally at bedtime. She is referred to the dietitian for instructions on starting a 1200-calorie diet using an exchange system to facilitate weight loss and lower blood glucose, cholesterol, and triglyceride levels. You are to provide teaching about pharmacotherapy and exercise.

5. How can you incorporate Y.L.’s cultural preferences as you develop her teaching plan?

6. What is the reason for starting Y.L. on metformin and glipizide? (Deliverable)

7. Outline the teaching you need to provide to Y.L. about oral hypoglycemic therapy. (What can I do? Generating solutions: Interpreting)

8. What are teaching priorities for Y.L. if she becomes ill with the flu or viral illness?

9. Which statement by the client demonstrates an understanding of treating hypoglycemia? She states, “If my blood sugar is low, I should first have:

a. an apple with milk.”

b. peanut butter sandwich.”

c. fruit juice or regular soda.”

d. crackers with cheese slices.”

10. What benefits does Y.L. receive from exercising?

11. What key points does the nurse need to teach Y.L. about exercise?

12. Besides the dietitian, what interprofessional and community referrals may be appropriate for Y.L.?

CASE STUDY PROGRESS

Y.L. comments, “I’ve heard many people with diabetes lose their toes or even their feet.” The nurse takes this opportunity to teach her about neuropathy and foot care.

13. Which of Y.L. symptoms leads the nurse to believe she has some form of neuropathy?

14. What other findings in Y.L.’s history increased her risk for developing neuropathy?

15. What Top 4 points does the nurse include in the teaching to Y.L. about neuropathy?

CASE STUDY PROGRESS

Because Y.L. has symptoms of neuropathy, placing her at risk for foot complications, the nurse realizes need for proper foot care.

16. Outline a teaching plan with 6 priority points on proper diabetic foot care taking into consideration lifestyle, culture and preferences. (What specific items will you teach the client? Responding)

(Safety)

17. What monitoring will Y.L. need for nephropathy and retinopathy?

CASE STUDY OUTCOME

Y.L. returns to the clinic 6 weeks later. Her BP is 130/78 and fasting glucose level is 153 mg/dL (8.5 mmol/L). She says she has not had any episodes of tingling in her toes or blurred vision lately. She did meet with the Certified Diabetic Nurse Educator. She is making changes to her eating, has started walking, and is happy to have lost 6 pounds (2.7 kg).

18. Complete a concept map on Y.L. care from admission to discharge. (Deliverable)

Reflection:

For each client finding below, specify the finding consistent with the process of aging, Type 2 DM and Type 1 DM. (NG NCLEX What could it mean? Noticing/Analyzing, What specific items will you teach the client? Responding/Taking action)

Time

Client Findings (above)

Aging

Type 2 DM

Type 1 DM

Constipation

Dry skin

Itching

Mood swings

Polyuria

Slow wound healing

Thirst change

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Top 3 interventions (teaching) and why?

Harding and Snyder (2020) CS 91

Learning activities

Concept map

Reflective Journal

Active Learning Medication Template

“Think like a Nurse” questions

· How has this assignment on the concept of metabolism and Type 2 diabetes enhanced your understanding of the disease and the impact on the client and family?

· What do you know now that you did not know prior to this assignment?

Submit Assignment: Upload deliverables to eLearning under the Coursework tab, labeled Non-COVID Clinical Assignment.

· Assignment/scenario

· ALT medication template

· Concept map

· Reflective journal

Rubric Criteria

Pass

Not Pass

Case

assignment

Student demonstrates an understanding of the concept through complete and thoughtful answers to scenario questions and to the content within the deliverables.

Student does not demonstrate completion of scenario questions and deliverables.

Professionalism

Student completes and uploads virtual case assignments and deliverables in a timely manner.

Student does not complete and or uploads the virtual case assignment.

Comments,

Signatures and

Dates

Student

Faculty