Cultural and Social Considerations in the Aging Family

Cultural and Social Considerations in the Aging Family

Pertinent Positives

The patient is a 71-year-old male who is a known DM with neuropathy. He presented with an elevated blood glucose of 280-320. He says he’s not been checking his glucose lately due to a lack of testing strips. Reports an increase in thirst and urination. He is obese, with a BMI of 30.65. He has had numbness and tingling in his feet. Has a medical history of hypertension and hyperlipidemia. Drinks alcohol socially, and his BP is 130/757. Has a positive family history of heart disease and hyperlipidemia. His vitals are within the normal range. Peripheral pulses are normal. He is on Gabapentin, losartan, rosuvastatin, metformin, and insulin.

Pertinent Negatives.

No lightheadedness or dizziness. No wounds or cuts on the skin. No retinopathy or changes in vision. No chest pain, palpitations, edema, or shortness of breath with activity. No nausea and vomiting.

Missing Information

Signs of target organ damage such as hematuria. No comprehensive information on his diet and activity level. No information on his ketone levels.

List of Differential Diagnosis and Actual Diagnosis

1. Imbalanced nutrition: More than body requirements
2. Risk of unstable blood glucose

• Risk of disturbed sensory perception

1. Risk for deficient fluid volume
2. Risk for impaired skin integrity
3. Deficient knowledge

Plan for the Priority Diagnosis

Diagnosis: Imbalanced nutrition: More than body requirements related to lack of proper knowledge on his carbohydrate intake, as evidenced by his high BMI of 30.

Goals: The patient should embark on dietary and lifestyle modifications that will meet his individual needs and help in managing his condition and maintaining glucose levels in an acceptable range.

Outcome: The patient maintains optimal weight and blood glucose levels. The patient also understands methods to prevent further instabilities in his blood glucose.

Nursing intervention: 1.     Negotiate and discuss with the patient the aspects of his diet and lifestyle that need change. 2.     Advise the patient to measure his food more regularly 3.     Encourage the patient to lose weight and review the patient’s current exercise level. 4.     Refer the patient to a registered dietitian to assist in creating an individualized diet plan.

Rationales: 1.     Negotiation is more fruitful as it is a give-and-take discussion resulting in a more culturally harmonious plan. Maintaining a lean body should be a component of the plan for the lifestyle change. (Gulanick, 2016). 2.     Measuring food is important in ensuring the patient is alert to normal portions and keeping his carbohydrate intake in check. Estimating portions can be extremely inaccurate. 3.     Exercise is vital for weight loss and increased energy expenditure and will help keep his blood glucose levels in check. (Doenges, 2019). 4.     Individualized meal plans vary from patient to patient; therefore, they are modified differently to contribute to stable blood glucose levels (Gulanick, 2016).

Evaluation:

All the set goals and outcomes should be met after the completion of therapy. Evaluate the patient’s knowledge of the factors that lead to unstable blood glucose and ways to prevent unstable blood glucose. Evaluate the patient’s level of glucose and weight.

References

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.

Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences.

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Cultural and Social Considerations in the Aging Family

NU 627 DT 12 Instructions

Unit 12 Discussion – Cultural and Social Considerations in the Aging Family

Instructions

It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format.

Discussion Prompt

The geriatric population has a higher prevalence for endocrine/metabolic disorders like osteoporosis, diabetes and hypothyroidism.  As this population grows in numbers and their physiologic reserve diminished, how might be care for this vulnerable population.

Initial Post Instructions: 

• Please critically evaluate the subjective and objective information provided to you in the attached file below.
  The first part of the discussion board is to identify all pertinent positive and, negative information and list missing information.
• Then create a differential diagnosis list with at least 3 possibly actual diagnosis based on your findings.
  Second part is to create a plan utilizing clinical practice guidelines for the priority diagnosis.
• Be sure to utilize template, in-text citations and provide full reference citation at the end of the discussion.