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November 20-26

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1 November 20-26 on Mon Nov 28, 2011 8:58 pm

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I have not had to be the sole bearer of bad news, but have been present during such occasions. I was intrigued by the fact that the blunt and forward way, is the way to go. I suppose my thought was that was we were to put a bandaid on things for them, so that the patient would not worry as much. I am releived to hear that from the other end that is not the truth. I am able to imagine the frustration and his reasoning for not wanted it sugar-coated, how is he to prepare for recovery? I am glad to hear that the simplest interventions are the best. I believe we worry so much how to "smooth" it over for them or how can we relate, be personal sometimes that we overlook the easiest things. I will definetly be more simple and forward with my patients, as well as maybe not overthink how to make them personal. I believe with being simple that will come along easy.

Med Classifications that could potentially cause hyperglycemia
1. Thiazide Diuretics: Hydrochlorothiazide(Microzide)
2. Anticonvulsants: Phenytoin(Dilantin)
3. Bronchodilators: Albuterol

Interventions/Rationales r/t perfusion, infection, immunity in a diabetic
1. I: Elevate feet when up in chair. Avoid long periods with feet in dependent position.
R: Minimizes interruption of blood flow and reduces venous pooling.
2. I: Assess for signs of dehydration. Monitor intake/output. Encourage oral fluids.
R: Glycosuria may result in dehydration with consequent reduction of circulating volume and further impairment of peripheral circulation.
3. I: Instruct client to avoid constricting clothing and socks and ill-fitting shoes.
R: Compromised circulation and decreased pain sensation may precipitate or aggravate tissue breakdown.
4. I: Recommend/Encourage smoking cessation, provide resources and support.
R: Vascular constriction associated with smoking and diabetes impairs peripheral circulation, adding to comprimissed immunity.
5. I: Provide teaching regarding proper foot care, including what changes need to be reported to avoid further severity of complications. Diabetic foot complications are the leading cause of non-traumatic lower extremity amputations. Note: Skin dry, cracked, scaly; feet cool; and pain when walking a distance suggest mild to moderate vascular disease (autonomic neuropathy) that can limit response to infection, impair wound healing, and increase risk of bony deformities.
R: Altered perfusion of lower extremities may lead to serious or persistent complications at the cellular level.
6. I: Observe and report signs of infection such as redness, warmth, discharge, and increased body temperature.
R: With the onset of infection the immune system is activated and signs of infection appear.
7. I: Assess skin for color, moisture, texture, and turgor (elasticity). Keep accurate, ongoing documentation of changes. Preventive skin assessment protocol, including documentation, assists in the prevention of skin breakdown.
R: Intact skin is nature's first line of defense against microorganisms entering the body.
8. I: Encourage a balanced diet, emphasizing proteins to feed the immune system. Immune function is affected by protein intake, a balance between omega-6 and omega-3 fatty acid intake; and adequate amounts of vitamins A, C, and E and the minerals zinc and iron.
R: A deficiency of these nutrients puts the client at an increased risk of infection.



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