Responses
- Number: A Minimum of 2 to Peer Posts, at least one on a different day than the main post
- Length: A minimum of 150 words per post, not including references
- Citations: At least one high-level scholarly reference in APA per post from within the last 5 ye
This week I encountered a difficult situation where my patient came for a follow up visit regarding his diabetes management. Patient S.M. was a 52-year old Armenian male, new to the country, who presented to the clinic with complaints regarding his type II diabetes mellitus. Patient S.M. did not a see a doctor or an endocrinologist in his country back home and had no idea he had diabetes until her was hospitalized one time here in the United States a few months back. Ever since he has received the news about his diabetes diagnosis, S.M. has not been able to control his blood glucose levels appropriately. The patient’s most recent hemoglobin A1C level was 8%, meaning that the patient was not compliant with his diabetes management and diet regimen. When talking to this patient, gathered that the patient was drinking at least 4-5 cans of soda each day and is not compliant with his diabetic diet regimen the nurse practitioner had educated him on the last time he was at the clinic. The way I handled this situation was to stop for a moment and think about the bigger issue. My goal as a future nurse practitioner, is to improve the overall health outcomes of my patients. Diagnoses such as diabetes mellitus can be chronic, and sometimes patients have a hard accepting the reality of it, and that they need to be reminded that this is a chronic condition and that self-care is necessary. It’s often difficult because patients sometimes don’t follow the recommended path, such as diabetes non-compliance. According to an article published by the National Library of Medicine, clinical management of diabetes and teaching diabetes self-management skills are necessary for optimal type 2 diabetes control (Chester et al., 2019). After a thorough assessment and continuous education with this patient, we referred this patient to a dietician or a diabetes education facility for further diabetes management education. As stated by Chester et al., the 2017 Standards of Medical Care in Diabetes Care in Diabetes recommends that each person with diabetes should be actively engaged in education, self-management, and treatment planning with his or her health care team, including the collaborative development of an individualized eating plan (Chester et al., 2019). Surprisingly, after appropriate education about diet, and self-glucose monitoring, I was able to get through to this patient. I also explained to him that in 3-months, we want to see a significant decline in his Hgb A1C levels, and he seemed to agree.
Reference
Chester, B., Stanley, G. W., & Geetha, T. (2019). Quick guide to type 2 diabetes self-management education: creating an interdisciplinary diabetes management team. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199222/
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An interesting case that I encountered this week was a 10-year-old female pediatric patient, who was accompanied by her mother to the clinic due to a recent motor vehicle accident where she was behind the passenger’s seat. The mother had described the incident as a head-on collision with a bus due to black ice near the Grand Canyon. At the hospital, surgical removal of about 10 to 20 centimeters of the ileum was done along with repair of a duodenum rupture. The patient also had a brace for a L4 vertebral fracture, a seatbelt injury on her bilateral hips, and loss of three teeth all from the car accident.
I used evidence to support my actions by considering that the ileum affects the following: vitamin B12, bile acids, iron, passive absorption of water, cholesterol, and several immune-protective functions (Bisgin et al., 2022). Therefore, as part of the patient’s treatment plan, vitamin B12 and iron levels are to be drawn once the patient feels better. For the spinal fracture, a brace was placed by the neurosurgeons in the hospital; moreover, follow up with the neurosurgery team is scheduled within one to two weeks to reassess stability or continued need for the brace (Healthwise, 2022). A referral was made to the dentist for repair and further plans for tooth loss. Ultimately, as the patient was involved in a traumatic incident, it is common to develop post-traumatic stress disorder (Mental Health America of Eastern Missouri, 2021). With post-traumatic stress disorder, a child can re-experience the incident through nightmares or consistent thoughts (Mental Health America of Eastern Missouri, 2021). Therefore, referral to a psychologist was recommended for behavioral therapy, psychotherapy, and further psychological diagnostic evaluation (Mental Health America of Eastern Missouri, 2021).
References
Bisgin, T., Sokmen, S., Manoglu, B., Ozkardesler, S., Sarioglu, S., & Ellidokuz, H. (2022).
Neglected prognostic importance of ileal resection in patients with peritoneal metastasis. Scientific Reports, 12. https://doi.org/10.1038/s41598-022-16100-x
Healthwise. (2022). Compression fracture of the spine in children: Care instructions.
https://myhealth.alberta.ca/health/AfterCareInformation/pages/conditions.aspx?hwid=ug5400&
Mental Health America of Eastern Missouri. (2021). Anxiety disorders and kids.
https://www.mha-em.org/im-looking-for/mental-health-knowledge-base/demographic-children-teens/9-anxiety-disorders-and-kids