[Verified Answer]: Concept 13 Glucose Regulation M.R

Concept 13 Glucose Regulation M.R. is a 43 year old Hispanic male who has a follow up appointment at the diabetic clinic. One and a half years ago, he was diagnosed with type 2 diabetes mellitus (DM). He has been to the emergency department twice in the past year for hyperglycemic episodes. M.R. is divorced and lives alone. He has a 16 year old son who he sees frequently. His family history includes type 2 diabetes in both his father and paternal grandfather. M.R. was raised Roman Catholic but currently does not attend church. He has no allergies. 1300 vital signs: Temp 36.5 C (97.7 F), BP 138/88, P 76 and regular, R 20 and unlabored. O2 96% on room air. Height 170.2 cm (67in), Weight 95.5 kh (210 lbs). Denies pain. A&Ox4. PERRLA. Head and neck exam are normal with no JVD. Apical pulse 76 and regular; lungs clear. Abdomen is soft and round with BS present in all four quadrants. Peripheral pulses 2+. No edema. Skin is dry and warm. Normal gait. Lab results: HbA1C 10% (this may vary by facility) Fingerstick blood glucose: 200 mg/dL Medications: Metformin 850mg PO BID 1. What known risk factors did M.R. have for developing type 2 DM? Explain. 2. What data in M.R.’s assessment are of concern to you as the diabetic clinic nurse? Why? 3. As the clinic nurse responsible for diabetic teaching, what questions will you ask M.R. to determine his symptoms and level of understanding of DM? M.R. states that he is monitoring his blood glucose levels “a couple of times a day”. He eats coffee and a muffin or bagel from the coffee shop for breakfast. Lunch is usually a sandwich and some chips delivered to his office, or a quick stop at a fast food restaurant. Dinner is something simple and quick if he is home or pizza if he is out. He admits to snacking frequently “things that probably aren’t good for me because I feel hungry all the time.” He states he does urinate frequently but thinks that it is probably because he drinks large quantities of water and diet pop. M.R. has been very busy at work and when he gets home, he often goes to the ball field to watch his son play baseball. He states that he is too exhausted after working and attending family stuff to exercise. M.R. has taken his medication twice most days. He thinks he has missed two or three doses in the past month but is not sure if the missed doses are related to any of his symptoms. He does not have any wounds that he knows of but has had some tingling in his feet. His vision is a bit blurry sometimes at work. He notices is especially in the afternoon when he is tired. He states that it is hard to follow all these instructions with no one to help him. At this clinic visit glipizide 5 mg PO daily is added to his diabetic regimen. Referrals are made to DM support group, counseling, dietician and ophthalmologist. 4. What are the major diabetic teaching points that you would like to get across to M.R. during this visit? Use terminology that the patient will understand and include teaching about DM, dietary considerations, exercise, medications, blood glucose monitoring, symptoms of hypoglycemia and hyperglycemia, and complications of DM.