• You should respond to your peers by extending, refuting/correcting, or adding additional nuance to their posts.
• All replies must be constructive and include at least two references.

Katia Gedeon

Module 2: Weekly Clinical Experience 2

Case

RM a 66-year-old male presents to the clinic for a diabetes follow-up. He has a 25-year history of DM that has been treated with insulin but has been complaining of medications. He monitors blood glucose levels twice a week. History of occasional episodes of palpations and diaphoresis that occur after missing meals and is resolved by drinking orange juice. Tingling and numbing in feet all time, especially at night, that has worsened over the past two months are also confirmed by the patient. The patient has also lost erections for two years with the absence of early morning erections.

Challenges and Success

Within the week I faced both challenges and success. One of the successes within the week was working with my preceptor in the proper environment where I was able to gain a lot of knowledge and skill. My preceptor helped me a lot as I gained experience and skill in safe and effective patient care. Moreover, I was able to interact with patients and I improved my patient assessment and diagnosis skills through proper communication and physical examination of the patients. However, I also faced several challenges. One of the challenges is associated with facing complex situations that I had not faced before. This meant that I needed the help of my preceptor which meant that sometimes the patient had to wait for long before my preceptor arrived. This reduced the quality of care the patients received.

Patient Assessment, Plan of Care, Differential Diagnoses, and Health Promotion Intervention

Assessment of the patient is essential. In this case, since it was a follow-up there is a need to consider the patient’s history of the condition and previous visits. Previous visits show that the patient was diagnosed with diabetes mellitus for twenty-five years. However, the medication used which is insulin management has led to an issue and the likely diagnosis is insulin-induced hypoglycemia. The signs and symptoms associated with the condition include episodes of palpation and diaphoresis that are being resolved with drinking orange juice and tight glycemic control (Shankar et al., 2019). DM Mellitus symptoms that the patient still shows include tingling and numbing in feet all time and loss of erection (Hamdy, 2021). These signs and symptoms, coupled with the history of DM and use of insulin mean that the patient’s most likely diagnosis insulin-induced hypoglycemia. The plan of care for the patient would include drinking or eating fast-acting carbohydrates without fat or protein of about 15 to 20 grams (Abraham et al., 2016). Blood sugar levels should be rechecked regularly which is about after every thirty minutes and if the level is still under the fast-acting carbohydrate is recommended as opposed to the insulin injection (Abraham et al., 2016). Patient education on recognizing and monitoring symptoms of hypoglycemia is also essential for the patient (Hamdy, 2021). One of the differential diagnoses is organic erectile dysfunction due to the symptoms including loss or erection for two years, history of diabetes mellitus, and history of alcohol use. Another differential diagnosis is diabetic peripheral neuropathy due to the history of diabetes mellitus and constant tingling and numbness in the feet. Another differential diagnosis is adrenal insufficiency which is due to symptoms including low blood pressure, which is hypoglycemia, and tingling and numbness in the feet. Health promotion intervention for the patient is dietary modification or changes and regular exercise for the patient since he does not exercise. This would help reduce dependence on insulin.

Lessons Learnt

During the week, there were important lessons learned. One of the lessons is the importance of collaboration in practice including physicians, nurses, pharmacists, and other special care providers. The collaboration improves the quality of care and patient outcomes (Kreps, 2016). Another lesson is the need for effective communication in practice, especially during assessment and provision of care. For proper diagnosis, effective communication between the provider and the patient is required to make the correct diagnosis. Effective communication amongst providers is also required to ensure that the care provided is safe (Kreps, 2016).

References

Abraham, M. B., de Bock, M., Paramalingam, N., O’Grady, M. J. et al. (2016). Prevention of Insulin-Induced Hypoglycemia in Type 1 Diabetes with Predictive Low Glucose Management System. Diabetes Technol Ther., 18(7), 436-43. doi:10.1089/dia.2015.0364.

Hamdy, O. (2021). Hypoglycemia. Medscape. Retrieved from https://emedicine.medscape.com/article/122122-overview (Links to an external site.)

Kreps GL (2016) Communication and Effective Interprofessional Health Care Teams. Int Arch Nurs Health Care, 2, 051. 10.23937/2469-5823/1510051 (Links to an external site.)

Shankar, K., Gupta, D., Mani, B. et al. (2019). Acyl-ghrelin is permissive for the normal counterregulatory response to insulin-induced hypoglycemia. Diabetes, 69(2), 228-237. https://doi.org/10.2337/db19-0438