NUR 612CL W2 Treatment and Care for Patients with Diabetes Discussion

Module 2 Discussion

My challenges this week seemed to be nonexistent. It was a good start to the week for me in the clinical setting, with a smooth transition from adult practice to gerontology. The clinical time spent in the practice so far has provided me ample encounters with the geriatric population. The thing that I find to be most surprising about the patients that my precepting doctor sees, especially the elderly ones, is that the majority of them are seemingly healthier than the younger patients in his practice.  The overall atmosphere of the office seemed a little lighter for some unknown reason, and it definitely helped to set the tone for a less stressful work day and an easy clinical rotation transition.  

My chosen patient this week was an 89-year-old female who presented to the office to review her lab results, with her full-time caregiver present. She stated she had no complaints at the beginning of the visit. Her vitals were: T: 97.8*F, HR: 72, RR: 16, BP: 110/68 L arm sitting, O2: 98% room air. She currently takes metformin 500mg PO BID for her diabetes, lisinopril 5mg PO QD and toprol XL 25mg PO QAM for her hypertension. In reviewing her lab results, she was found to be WNL on all of her labs except her blood glucose, which was 102, and her A1C, which was 6.2. She stated she was very happy with her results and wanted to know if I wanted to change anything for her. I agreed that there was nothing wrong with her numbers, and felt that she needed no medication changes at this time. She did request a refill on her medications, and the request was sent directly to her pharmacy. The patient was commended on her current plan, and encouraged to continue with the same plan of care. There were no differential diagnoses for this particular visit. The American Diabetes Association (ADA) published a report on managing diabetes in older adults and the major consideration was given to coexisting medical conditions, presence of cognitive dysfunction, and the ability of the patient to perform normal daily activities (Leung et al., 2018). Based on those parameters, the patients were divided into healthy, complex, or very complex health categories, with the recommended A1C goals of <7.5, <8, and <8.5%, respectively (Leung et al., 2018). This particular patient fell well within the first goal range.

The patient then proceeded to speak of her upcoming 90th birthday and explain that her family was coming in from different parts of the country to celebrate together. She was looking forward to the event, as her children, grandchildren, and great-grandchildren had not all been together since before her husband passed away 7 years ago. It was at this point that the doctor walked into the room, and the patient then asked how we thought she was going to die. She said she was wondering if it would be painful like her husbands was, or if it might be more peaceful. Both the doctor and I started to speak at the same time, to inquire if she felt like she was nearing the end of her life. She stated she did not think so, but she was just curious about what she should be expecting. Now, this happens to be my current area of expertise, and I actually learned it from this particular doctor years ago when he used to work for hospice, so we both were well aware of changes, signs and symptoms that patients will experience as they are nearing the end of their life. We took turns explaining to her that even though she had no indications that she was going to be dying any time soon, it was something that no one could predict. We did explain about certain things to look for when the time came, like decreasing appetite, sleeping more, being less social, vital sign changes, increased weakness and confusion (Burgess, 2020). It was reiterated again that she appeared not to be close to passing any time soon, and her chronic disease processes would show changes as she did start to turn towards the end. I did inform her that she would most likely notice the changes herself when she started to make her decline towards the end of life. We did not go into the extreme changes, the things we explain to patient’s family members as they are transitioning to actively dying, as she did not need to know, or worry about the array of possibilities that could occur at the present time. She was happy that she appeared to be in good enough health that she would be able to enjoy her birthday next month, as well as her family.

What I learned on this particular day and visit is that in some situations you do not need to explain all of the intricate details to everyone, but by sharing a few truthful bits you may be able to satisfy their mild curiosity. Sometimes providing a little bit of knowledge can give the inquiring individual some comfort in the answer they are looking for, instead of overwhelming them with details that they may not be able to fully understand or accept at a given point in time.

References

Burgess, L. (2020, January 31). What are the signs that someone is close to death? https://www.medicalnewstoday.com/articles/320794

Leung, E., Wongrakpanich, S., & Munshi, M. N. (2018). Diabetes management in the elderly. Diabetes Spectrum : A Publication of the American Diabetes Association, 31(3), 245–253. https://doi.org/10.2337/ds18-0033

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