Assignment
Nellie Evans is a seventy-four-year-old woman that has just been referred to the Community Nurse by the GP for management of a diabetic foot ulcer. Review the referral from the GP and answer the questions below using literature to support all the answers.
Referral:
Dear Community Nursing Team
Thank you for accepting the referral for Nellie Evans 12/05/1943 to receive wound care to right diabetic foot ulcer and management of unstable diabetes. As per our phone conversation this afternoon, please find attached the health summary.
Do not hesitate to contact me with any further questions. I will review Nellie again in one month at the surgery.
Kind regards
Dr P Boulton
Patient health summary:
Name: Nellie Evans
Address: 65 Derby Road
DOB: 12/05/1943
Phone: 089333444
Allergies/Adverse reactions: Penicillin allergy, adverse reaction to micropore tape and most adhesive dressings.
Current Meds: Insulin - Humalog 75/25, 33 units before breakfast and 23 units before supper; Pioglitazone (Actos), 30 mg daily; furosemide (Lasix), 80 mg every morning; diltiazem (Cardizem CD), 180 mg daily (per cardiologist consult); Lanoxin (Digoxin), 0.25 mg daily (per cardiologist consult)
Active past Hx: Type 2 diabetic, hypertension, hyperlipidemia, coronary artery disease.
Inactive past Hx: Left knee replacement
Observations:
Height: 153cm
Weight: 136kg
Waist circumference: 98cm
Pulse: 88bpm
BP: 138/88
HbA1C: 8%
Lower leg assessment: pedal pulses weak bilaterally, poor sensation (monofilament test), cap refill >3 secs
Question I
Consider your client's medical history. Using your own words, explain in detail the underlying pathophysiological concerns of this client. Use literature to support your answer.
Question II
Calculate Nellie's Body Mass Index (BMI) and summarise the education you would provide to Nellie about her BMI result and waist circumference measurement, including the associated health risk factors. Provide references to at least two resources you would use in your education for Nellie and why you have chosen these particular resources for Nellie.
Question III
Using language and terminology that Nellie can understand, explain to Nellie what the HbA1C test is and how this differs from BGL readings. Then explain to Nellie what her result of 8% means about her diabetes control and suggest three ways of improving this. Please use literature to support your answer.
Question IV
Nellie tells you she is unsure which medications are for her diabetes. From the health summary above, identify the drug used for the management of diabetes and explain to Nellie the mode/mechanism of action and any side effects and contraindications that she should be aware of. Please use literature to support your answer.
Question V
Community Nurses often provide care to older adults who have peripheral vascular disease (PVD), discuss the pathophysiology, risk factors and symptoms involved in this condition and then provide a definition in your own words to explain the difference between Peripheral Arterial Disease (PAD) and Peripheral Vascular Disease (PVD) to your patient. Please use literature to support your answer.