Question

Scenario 1

E.B., a 69-year-old man with type 1 diabetes mellitus (DM), is admitted to a large regional medical center complaining of severe pain in his right foot and lower leg. The right foot and lower leg are cool and with-out pulses (absent by Doppler). Arteriogram demonstrates severe atherosclerosis of the right popliteal artery with complete obstruction of blood flow. Despite attempts at endarterectomy and intravascular urokinase over several days, the foot and lower leg become necrotic. Finally, the decision is made to perform an AKA (above-the-knee amputation) on E.B.’s R leg. E.B. is recently widowed and has a son and daughter who live nearby. In preparation for E.B.’s surgery, the surgeons wish to spare as much viable tissue as possible. Hence, an order is written for E.B. to undergo 5 days of hyperbaric therapy for 20 minutes bid. As you prepare E.B. for surgery, he is quiet and withdrawn. He follows instructions quietly and slowly without asking questions. His son and daughter are at his bedside, and they also are very quiet. Finally, E.B. tells his family, “I don’t want to go like your mother did. She lingered on and had so much pain. I don’t want them to bring me back.” You have just returned from a 2-day workshop on guidelines for the care of surgical patients with IDDM. You notice that E.B.’s blood glucose has been running between 130 and 180. The sliding-scale insulin intervention does not begin until blood glucose values equal to or greater than 200 mg/dL is reported. You recognize that patients with blood glucose exceed 140 suffer from impaired wound healing. E.B. will be discharged to his daughter’s home with a wheelchair and crutches. He will be evaluated for a prosthesis and begin training when his stump is ready.

Question List all with a minimum of three (5) appropriate nursing diagnoses for this patient. Only one Risk Diagnosis allowed. for example Nursing Diagnosis

#1: Goal: ________________________________________________________________________________MET/NOT MET/PARTIALLY MET Outcome Criteria: (The goal has been met if the client…) 1. ______________________________________________________________________________________________________MET/NOT MET

2. ______________________________________________________________________________________________________MET/NOT MET

3. ______________________________________________________________________________________________________ MET/NOT MET

Priority Nursing Interventions Scientific Rationale For Every Intervention Evaluation of each Nursing Intervention 1. 2. 3. 4. 5. Care Plan to be continued: yes______ no_______ Revisions to plan of care: Reference (APA Format with pages numbers-Reference within last 5 years):

Answer 1

Nursing diagnosis

1)

• Unstable Blood Glucose level related to reduced insulin secretion due to IDDM as evidenced by blood glucose running between 130- 180 mg/ dl

Goal : blood sugar values will return back to less than 126 mg/ dl

MET/ NOT MET

Interventions: sliding scale insulin therapy can be started

Rationale - to reduce blood sugar

Exercise can be encouraged

Rationale- to increase glucose intake into muscle

• Deficient Knowledge related to disease condition as evidenced by uncontrolled blood sugar

Goal: patient gain enough knowledge on his disease condition and methods to reduce blood sugar

MET / NOT MET

• Risk for Infection related to surgical intervention

Goal: patient will be free from risk for infection

MET / NOT MET