March 28, 2023

Case IV: An 80 year old female, who has difficulty seeing despite wearing glasses, is being discharged from the unit following treatment of a hyperglycemic crisis. Her history includes: NIDDM (non insulin dependent diabetes mellitus), HTN (hypertension), PVD (peripheral vascular disease), and retinal degeneration. Her physician writes prescriptions for Lasix 20mg PO daily, potassium 10mEq PO daily, and Vasotec 5mg PO daily and she will continue taking glipizide 10mg PO daily as she was taking at home. She tells you she has never taken these drugs before and also states, “Well, now that’s ten medications I’ll be taking.”

I know to versailles no i fear the birds i had such a good time i like all the food we had delicious food it was you should really stop smoking i don’t wanna eat you know what it’s so good after after dinner what what you just told me to stop smoking get me giving it wait you cut off another one looks little condom i do and go to remind you you remember when we

Used to feed each other you’re so sweet six years go oh that explains like it was yesterday i don’t think i’d figure so let’s all go get it it’s okay you can do it honey give me one give me give me give me food that’s mean won’t remember my favorite okay let’s go dance the root–so idea okay you wanted come in professor we look funny yes coming back hi how are

You today good that’s good um did you get enough sleep last night i want one year student i’m on your accelerator we need sleep ha ha ha ok i’m gonna give you an opportunity to teach patient about diabetes today she’s going to get discharged are you interested in that sure sounds great very good i’m gonna give you her report now ok ok so she’s an 80 year old

Hispanic female she has difficulty seeing even though she’s wearing glasses ok and she came with hypoglycemic crisis what aside uh some signs and symptoms of hypoglycemic crisis hmm the classic symptoms are polyuria polydipsia and polyuria is that right and for her past medical history she has type 2 diabetes hypertension and peripheral vascular disease and she’s

Also a smoker and has a retinal degeneration so make sure you do some teaching about her current medications interactions and any contraindications or complications okay and what else do you think you should teach her about diabetes hmm well a for diabetes patients lifestyle modifications important as well as died in exile including diet and exercise arm smoking

Cessation proper hygiene and i think that’s it do i forget anything good okay okay so i’ll give you a chart review it and when you’re ready let me know great hey carol i’m supposed to be on the bed you’re not supposed to be we’re gonna get in trouble you’re gonna get me in trouble again hi mrs. suarez shh yeah hi how are you hi i’m bob is gonna nursing this mine

Shocker how are you how are you – well i’m very good my husband donald okay i’d like to check our idea if i’m like of course you can okay can you tell me your full name ethel suarez okay and your breath date of birth me first nothing thirty-one okay very good i see that you’ve received our education education pamphlet i have and it’s very confusing if you ask me

Okay well first i’d like to talk about i’m sorry at first i’d like to talk about medications we’ll be taking your doctors prescribe you three new medications on the top of the metformin that you for your order to be taking i see so you’ll be taking lasix potassium chloride vasotec and then you’ll be taking your blood design whoa well i’ve never taken these drugs

Before that’s like 10 min occassions i’m taking now can you explain them to me just very briefly i know what they look for but just a little bit like this lace x1 well some people call it the water pill gp correct and i remember things you gotta watch out for is blurt blurt vision tinnitus which is ringing of the ears or hypotension so you might get a little dizzy

You might be one when you get up you want to get up school oh yes your brother takes that nice antics you remember your brother done of a broom yeah yup he’s so crazy he doesn’t know why are you here okay oh and then what’s the other one it’s it’s you’ll be also be taking potassium chloride uh reason you’re taking the potassium chloride is to counter in fact one of

The effects the lasix and what what that is is that you meet when you losing a lot of potassium so we’re going to supplement that by giving you potassium all right i see so then i have t1s petrest you run out of bananas i eat banana right wonderful sania i love bananas can i bananas unfortunately no are we detecting any bananas because bananas have high potassium

Which is good a good source of potassium unfortunately bananas also make you you’re going to be losing a lot of potassium but you’ll also be taking potassium orally so you might get either too much potassium into a little potassium mean scarred patient you know that is no bananas i can find you bring up an end note about this banana can’t have any bananas i do yes

You can okay donita in front is my favorite fruit as me that’s just so mean and then what else do i need to do well another thing you’ve got to be taking a new drug is basic technique haha and they so tech one of it’s an ace inhibitor and one of the side effects of that is that you can get a call so sometimes you may have to change your medication if your to get

In that coffin and of course hypotension which is ineffective that kind of that already what are you doing get off me embarrassing me why are you why are you saying about the base inside honey well they the busy tech is going to lower your blood pressure it’s an ace inhibitor and one of the side effects is a call so from getting a call we may need to meaning see

Your physician about change i see i see okay and there was one more call right right the last medication you’ll be taking is glucose i and that’s medication you were taking before okay do you remember how that works um i know it’s a pill might be white or blue i’m not sure but can you just tell me what it’s for blue posadas and roll hypoglycemic it lowers your

Blood glucose so that you don’t get the signs and symptoms diabetes so bob beside medication what else to control diabetes oh yes of course so you’re going to want to you’re going to have to do some lifestyle modifications and that’s going to include diet and exercise and in terms of diet you’re going to want to eat low carbs or low carbohydrates low sugars here

Avoid the cans and so on and you’re also going to want to eat healthy base more vegetables more fiber in your diet and including with the lifestyle month because you’re going to want to get some regular exercise brisk walking in the morning is great for a person you wanted to raise that car at that heart rate up okay take a walk with my dog that’s a good idea i see

Ok um other things of course is going to be you’re going to have to have proper hygiene and proper hygiene especially of the lower extremity such as your feet there’s a lot of diabetics experience what they call neuropathy so their legs or their extremities become numb and not feel when they get an injury and that’s a good source of infection you understand that’s

Not good yes i understand i understand and i think we’ve covered everything um if you have any other questions there’s just one thing you forgot to mention smoking oh yes smoking that’s right wait i can’t i can’t smoke give that what you’re saying yes morning nice well you taught me how to smoke yeah you did you smoke he’s a chronic small guys fault because of

Them small useful cause it your voice can’t you hear it kid you’re cooking that’s not how i met you you stink – i had a can’t look at all i know you’re gonna have to quit smoking because smoking is going to cause you all the same symptoms at driving hypertension which is our theorists grossest you can have a hyper you’re going to also get hyperglycemia from smoking

So one we’re going to have to quit this movie you’re gonna have to do it with me move you’re gonna have to you’re the one that makes me smell i can’t happen smoke anymore okay anything else i think that’s all that’s that’s everything if you have any questions i don’t you’ve been so great thank you so much good luck in your career son thank you oh yeah son he’s a

Good job hey can i have a diaper change you know what it is diabetes diabetes diabetes diabetes yeah ah you know what it is type ii diabetes type ii diabetes you know what it is diabetes

Transcribed from video
Diabetic Patient Teaching By Shermeds