You are an Enrolled nurse working in primary health care. A new referral to your clinic, Mr. McFarlane, has recently been diagnosed Type 2 diabetes.

As part of your role, you are working with a Registered Nurse to assess the client and develop a care plan appropriate for the client with both short- and long-term objectives and goals.

 

 

Character Briefs:

Mr. George McFarlane. Male aged 53 years. Married for 5 years with 3 children.

Mr. McFarlane’s background includes:

• Second marriage – first wife died of cancer 8 years previously
• Occupation – Long haul truck driver
• Earns good money
• Away from home a lot – not there to support the family
• Overweight – 135kg
• Hypertension
• Uses watching television and beer to cope with stress
• Smoker
• Diet preferences are Australian. Often has a poor diet when on the road for work including ‘fatty food from truck stops’
• Has a 26-year-old son from his first marriage who has severe depression and uses illicit drugs, he visits on occasion (very disruptive when he does visit)
• Unknown social support and external interests
• Has osteoarthritis in (L) knee
• Reliant on their wife, Yu Yang does all domestic duties as he is not self-sufficient.

Mrs. Yu Yang McFarlane is Mr. McFarlane’s wife. She is 38 years old.

Mrs. McFarlane’s background includes:

• Came to Australia as a university student
• Fell pregnant at the age of 19 – did not marry
• Married George 5 years ago
• Has 3-year-old twins at home
• One twin has a developmental disorder
• The English language is good
• Was/Is isolated with no extended family
• Her issues will be those of isolated immigrant
• Prefers to cook Asian food
• Needed help with raising a child and so she invited her Chinese mother to come to Australia to help out
• Needed help with raising a child and invited a Chinese mother to Australia to help out

 

Questions.

1. Mr. McFarlane has recently been diagnosed with Type 2 diabetes. Discuss the pathophysiology of Type 2 diabetes.

Include in your response:

1. Your understanding of Type 2 diabetes
2. Possible causes of Type 2 diabetes
3. Possible risk factors for Mr. McFarlane

2. Discuss the difference between Type 1, Type 2, and gestational diabetes.

Include in your response:

• anatomy, physiology, and pathophysiology of each type

3. Consider each of the following potential problems associated with diabetes:

1. hypoglycemia
2. hyperglycemia
3. ketoacidosis
4. Hyperosmolar non-ketonic coma

4.  Discuss your understanding of each of these potential problems.

Include in your response:

1. Signs and symptoms of each potential problem
2. What assessments/ examinations would determine if the client is suffering from the potential problem
3. Possible treatment options including any emergency care required
4. nursing care of a client

 

 

ASSESSING THE PERIPHERAL VASCULAR SYSTEM. Prior to performing the procedure, introduce yourself and verify the client’s identity using agency protocol. Explain to the client what you are going to do, why it is necessary, and how he or she can participate. Discuss how the results will be used in planning further care or treatments.

 

2. Perform hand hygiene and observe other appropriate infection prevention procedures.

 

3. Provide for client privacy.

 

4. Inquire if the client has any of the following: past history of heart disorders, varicosities, arterial disease, and hypertension; lifestyle habits such as exercise patterns, activity patterns and tolerance, smoking, and use of alcohol.

 

 

5. Palpate the peripheral pulses on both sides of the client’s body individually, simultaneously (except the carotid pulse), and systematically to determine the symmetry of pulse volume. If you have difficulty palpating some of the peripheral pulses, use a Doppler ultrasound probe.

 

6.  Inspect the peripheral veins in the arms and legs for the presence and/or appearance of superficial veins when limbs are dependent and when limbs are elevated.

 

7. Assess the peripheral leg veins for signs of phlebitis. Inspect the calves for redness and swelling over vein sites.

• Palpate the calves for firmness or tension of the muscles, the presence of edema over the dorsum of the foot, and areas of localized warmth. Push the calves from side to side to test for tenderness.
• Firmly dorsiflex the client’s foot while supporting the entire leg in extension (Homans’ test), or have the person stand or walk.

 

8. Inspect the skin of the hands and feet for color, temperature, edema, and skin changes.

 

9. Assess the adequacy of arterial flow if arterial insufficiency is suspected.

• Press at least one nail on each hand and foot between your thumb and index finger sufficiently to cause blanching (about5 seconds).
• Release the pressure, and observe how quickly normal color returns (less than 2 seconds).
• Inspect the fingernails for changes indicative of circulatory impairment. See the section on assessment of nails earlier in this chapter.
• See also peripheral pulse assessment earlier

 

10. Document findings in the client record using printed or electronic forms or checklists supplemented by narrative notes when appropriate.