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Diabetic Teaching Plan For Nurses

C.S. is a morbidly obese 32-year-old female admitted to the hospital on 8/26/05 with an admitting diagnosis of poly-drug overdose. According to the patient, the last thing she remembers is going to bed and then waking up in the hospital 2 days later without any recollection of what had happened. She has a history of suicide twice in the past, but denies suicidal ideations this time. C.S. also has a history of Diabetes type II that is normally controlled with oral medications. She states that she checks her blood glucose at home and it has been in the 200mg/dl range for the past month. Current blood glucose is 256mg/dl. C.S. is to be discharged tomorrow with a new prescription for insulin. Assessment data that indicates learning need: C.S. was diagnosed with Diabetes Mellitus (Type II) 3 years ago that has been controlled with the oral medication Glucotrol. She has no prior experience with the self-administration of insulin. Therefore, her nursing diagnosis would be: knowledge deficit related to unfamiliarity with Insulin and how to self-administer it, as evidenced by patient verbalizing and requesting that someone show her how to take insulin (Doenges, 2005 p.358). Goal for client teaching: by the end of this teaching, the patient will be able to describe the diabetic medications that she is on and how to properly take the medications. Assessment of learner: C.S. is alert and oriented to person, place, time, and event. She is very pleasant and open with information concerning her health and personal life. She states that she did not finish high school but just recently received her GED. During my time with her, I witnessed C.S. reading to her daughter, which indicates that she is literate. C.S. is very knowledgeable in regard to her diabetes and tracks her blood glucose levels on a daily basis. Due to her obesity, C.S. requires a walker to ambulate and reports that she tires easily. Her knowledge concerning Insulin self administration is absent but C.S. has a high motivation to learn as witnessed by her verbalization that someone teaches this skill to her. Specific learning objectives: Learning objective #1: (cognitive) patient will be able to verbalize the signs and symptoms of hyperglycemia and hypoglycemia and the actions to take with each situation. Learning objective #2: (Affective) patient will be able to verbalize the benefits of maintaining acceptable blood glucose levels and the importance of taking insulin exactly as prescribed. Learning objective #3: (Psychomotor) patient will demonstrate ability to self-administer Insulin with little, or no prompts. The estimated time for the teaching session is approximately 3 hours. In the first hour I will give a brief overview of what diabetes is and how it can be controlled with insulin. First I will include a very simple explanation of the pathophysiology of the disease and the signs and symptoms that are common. Next, I will explain that when controlling diabetes, her blood sugar can become too high or too low. High blood sugar, or hyperglycemia is caused by eating too much food, eating sugary foods, or by not taking insulin as prescribed. Signs of high blood sugar include: dry mouth, thirsty, having to urinate often, blurry vision, feeling tired, and weight loss. If high blood sugar is not treated, it can cause you to go into a coma (Aldridge, 2005 p.36-37). When you have high blood sugar, drink water and take your insulin according to the sliding scale your doctor has provided. Low blood sugar, or hypoglycemia, can occur from taking too much insulin, eating less or skipping a meal. Signs of low blood sugar include: sweating, shaking, feeling nervous, pounding heart, feeling faint or dizzy, confusion, headache, blurred vision, and slurred or slow speech. If you have low blood sugar, immediately eat or drink something that has fast-acting sugar in it. Some examples are: soda, candy bar, 2 teaspoons of sugar or honey, or a cup of fruit juice (Aldridge, 2005 p.36-38). The web site www.patient-education.com has an interactive video on the steps to take if your blood sugar is either high or low. In the last part of the first hour I would explain that keeping your blood sugar at constant acceptable levels allow you to enjoy a healthier and happier life. Some of the diseases associated with uncontrolled diabetes include: infections, blindness, strokes, heart attacks, and sensory and motor changes in the hands and feet. By monitoring blood glucose levels, taking your medication as prescribed and controlling fluctuations in blood glucose levels, you can delay and even prevent many of the diseases associated with diabetes. This will increase your ability to perform ADLs, decrease the possibility of future hospital stays and allow you to enjoy a healthier life (Daly, 2004 p.33-35). The last two hours

will be spent on how to give an insulin shot. First we will go over the parts of a syringe and needle. Next we will cover the type of insulin and how to draw it up into the syringe. Last, we will go over the sites of injection and administration. I will provide a visual aid on how to give a shot. This is copied from the web site: www.patienteducation.upmc.com The first possible barrier may be anxiety or fear that she has to give herself injections. I would provide positive reinforcement to stress that insulin shots are not painful since the needles are short and small, and go into areas with very little feeling. The second possible barrier to learning is the patients preferred learning mode. Before starting the teaching I would assess how the patient learns (e.g., auditory, visual, kinesthetic, one-on- one, etc.) (Doenges, 2005 p.360). The third possible barrier may be the ability of the patient to get to the pharmacy to get her medication and syringes. I would involve her family to help her in picking up her medications on a monthly basis if she was unable to get to the pharmacy. Through my assessment, I found that her sister is a strong source of social support, so she should be consulted about the possibility of helping with picking up C.S.s medications. The last possible barrier may be cost of the medication and syringes. I would asses the need for welfare. C.S. is on permanent disability, so she may already be on medi-cal. If she isnt, then I would provide information on how to apply for this type of health care aid. C.S. has a private room, which is perfect for decreasing the distractions from another patient. My teaching plan would begin after the patient had eaten, had a shower, and was rested and alert. I would make sure that there was adequate lighting and external noise such as the television or radio was turned off. I would go in having a positive attitude, and hopefully convey this attitude to the patient. I would encourage feedback and use positive reinforcement verbally and non-verbally to facilitate the patients interest in the subject matter. I would evaluate the patient by having her verbally describe the medication she is taking and how to self-administer the shot. After she verbalized the procedure, I would have her do a mock self-administration of her insulin.

References Aldridge,V. (2005). Facilitating self management for diabetes patients. Practice Nurse 29(11), 33-38. Daly, G. (2004). How a health prevention model reduces disabling complications of diabetes. Professional Nurse 20(2), 33-35. Doenges,M et.al. (2005). Nursing diagnosis manual. F.A. Davis Company. Patient Education Institute. www.patient-education.com

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