Question

SCENARIO OVERVIEW:
Carl Rogers is a 67-year-old African American male with a 20-year history of type II diabetes mellitus. On Tuesday at 1530, he was directly admitted from his physician’s office to the medical unit with a stage II non-healing ulcer on his right heel. The nursing admission paperwork has been completed, and pain medication has been administered. Additional orders for a dressing change and insulin administration have been written but not yet implemented. The scenario takes place on Tuesday at 1700.

REVIEW AND COMPLETE PRIOR TO THE START OF PRE-BRIEFING:
In order to prepare for the simulation, you should complete your assigned reading for the course. In addition, you should be prepared to complete and document a thorough nursing assessment along with completing the following skills:
 Endocrine system alterations
 Urinary and renal system alterations
Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills.
Therefore, in order to prepare for the simulation, you are required to complete the pre-briefing questions below and submit to the faculty facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted to participate in the simulation.

1. Compare and contrast the onset, peak, and duration of long and short acting insulin.
2. What dietary teaching points can the nurse discuss with their patient with Type II Diabetes Mellitus?
3. Describe best practices when providing wound care for diabetic foot ulcers.

Answer 1

1) Long acting insulin

• Onset = insulin glargine - 2 to 4 hrs
• Insulin detemir - 1 to 4 hrs
• Peak of long acting insulin is minimal
• Duration of action = 20 to 24 hrs

Short acting insulin

• It is soluble crystalline zinc solution
• Onset of action is 30 mins to 1 hr after injection,, usually taken before meal
• Peak effect is after 2 to 4 hrs
• Duration of action is 6 to 8 hrs
• Usually taken 30 to 45 mins before meal .

2)DIETARY TEACHING POINTS ON TYPE 2 DIABETES :

• Apart from medications taken diet and physical activity is important for a healthy lifestyle,, our aim is to maintain a stable glucose level and prevent further complications of diabetes
• 30 mins of walk morning and evening is necessary because it burns extra calories , lowers blood glucose , maintain blood pressure , improve mood and help to sleep better .
• FOODS TO BE ADDED OR TAKEN:
• Vegetables - non starchy includes broccoli, carrots , greens and tomatoes ,, starch includes corns and peas .
• Fruits - oranges , melons , berries , banana and grapes
• Whole grains including oats, corn meals , wheat , quinoa
• Olive oil , healthy fish like salmon ,tuna , mackerel.  
• FOODS TO BE AVOIDED:
• Fried foods and foods high in saturated fat and trans fat
• Avoid candies , ice cream, beverages with added sugars like juice , soda
• If the person is alcoholic ,, alcohol must be avoided ,, and should not be taken if he or she takes insulin ,, because it leads to hypoglycemia states .

WOUND CARE FOR DIABETIC FOOT ULCER

• Alteration in arterial supply leads to ischemia , due to increased blood glucose levels in blood the area is prone to infections by bacteria  
• It leads to neuropathic changes and leads to reduce moisture levels resulting in dry skin which is prone to cracks and fissures .
• Sometimes it can also lead to charcoats foot which causes weakening due to significant nerve damage .
• Care must be taken to avoid these situations and prevent further complications
• Aseptic management with clean washed hands with gloves must be preffered to prevent infections
• Debridement means removal of dead tissues, which may aggravate the existing situation
• debridement can be surgical or autolytic
• Autolytic methods include hydrogel , hydrocolloid sheets , polysaccharide pastes
• once debridement is done and a clean wound is made dressing is carried out
• Dressing can be 2 ways , one which maintains moisture (hydrogel and hydrocolloids ) and the other which absorbs moisture (spun hydrocolloids and alginates )
• Additional dressing inervations that include antimicrobial can be used .
• Care must be taken till the wound heals .