Diabetic Teaching Plan for Nurses

C.S. is a morbidly obese 32-year-old female admitted to the hospital on 8/26/05 with an admitting diagnosis of poly-drug overdose. According to the patient, the last thing she remembers is going to bed and then waking up in the hospital 2 days later without any recollection of what had happened. She has a history of suicide twice in the past, but denies suicidal ideations this time. C.S. also has a history of Diabetes type II that is normally controlled with oral medications. She states that she checks her blood glucose at home and it has been in the 200mg/dl range for the past month. Current blood glucose is 256mg/dl. C.S. is to be discharged tomorrow with a new prescription for insulin.

Assessment data that indicates learning need:

C.S. was diagnosed with Diabetes Mellitus (Type II) 3 years ago that has been controlled with the oral medication Glucotrol. She has no prior experience with the self-administration of insulin. Therefore, her nursing diagnosis would be: knowledge deficit related to unfamiliarity with Insulin and how to self-administer it, as evidenced by patient verbalizing and requesting that someone show her how to take insulin (Doenges, 2005 p.358).

Goal for client teaching: by the end of this teaching, the patient will be able to describe the diabetic medications that she is on and how to properly take the medications.

Assessment of learner: C.S. is alert and oriented to person, place, time, and event. She is very pleasant and open with information concerning her health and personal life. She states that she did not finish high school but just recently received her GED. During my time with her, I witnessed C.S. reading to her daughter, which indicates that she is literate. C.S. is very knowledgeable in regard to her diabetes and tracks her blood glucose levels on a daily basis. Due to her obesity, C.S. requires a walker to ambulate and reports that she tires easily. Her knowledge concerning Insulin self-administration is absent but C.S. has a high motivation to learn as witnessed by her verbalization that someone teaches this skill to her.

Specific learning objectives:

Learning objective #1: (cognitive) patient will be able to verbalize the signs and symptoms of hyperglycemia and hypoglycemia and the actions to take with each situation.

Learning objective #2: (Affective) patient will be able to verbalize the benefits of maintaining acceptable blood glucose levels and the importance of taking insulin exactly as prescribed.

Learning objective #3: (Psychomotor) patient will demonstrate ability to self-administer Insulin with little, or no prompts.

The estimated time for the teaching session is approximately 3 hours. In the first hour I will give a brief overview of what diabetes is and how it can be controlled with insulin. First I will include a very simple explanation of the pathophysiology of the disease and the signs and symptoms that are common. Next, I will explain that when controlling diabetes, her blood sugar can become too high or too low. High blood sugar, or hyperglycemia is caused by eating too much food, eating sugary foods, or by not taking insulin as prescribed. Signs of high blood sugar include: dry mouth, thirsty, having to urinate often, blurry vision, feeling tired, and weight loss. If high blood sugar is not treated, it can cause you to go into a coma (Aldridge, 2005 p.36-37). When you have high blood sugar, drink water and take your insulin according to the sliding scale your doctor has provided. Low blood sugar, or hypoglycemia, can occur from taking too much insulin, eating less or skipping a meal. Signs of low blood sugar include: sweating, shaking, feeling nervous, pounding heart, feeling faint or dizzy, confusion, headache, blurred vision, and slurred or slow speech. If you have low blood sugar, immediately eat or drink something that has fast-acting sugar in it. Some examples are: soda, candy bar, 2 teaspoons of sugar or honey, or a cup of fruit juice (Aldridge, 2005 p.36-38). The web site www.patient-education.com has an interactive video on the steps to take if your blood sugar is either high or low. In the last part of the first hour I would explain that keeping your blood sugar at constant acceptable levels allow you to enjoy a healthier and happier life. Some of the diseases associated with uncontrolled diabetes include: infections, blindness, strokes, heart attacks, and sensory and motor changes in the hands and feet. By monitoring blood glucose levels, taking your medication as prescribed and controlling fluctuations in blood glucose levels, you can delay and even prevent many of the diseases associated with diabetes. This will increase your ability to perform ADL's, decrease the possibility