Question

Case Study:

52-year-old woman was diagnosed with type 2 diabetes 6 years ago.
Did not follow up with recommendations for care
Complaining of weakness in her right foot
Began 1 month ago
Difficult to dorsiflex and feels numb
Also complains of an itching rash in her groin area
Has had rash on and off for many years
Worse when weather is warm
Increased thirst and frequent nighttime urination
Denies other weakness, numbness, changes in vision
She works as a banking executive and gets little exercise.
She has gained 18 pounds over the past year and eats a high-fat diet.
BP 162/98
Sensory exam to light touch, proprioception, and vibration slightly diminished on both feet
Erythematous scaling rash in both inguinal areas and in axillae
Random glucose test 253 mg/dL
Hb A1C 9.1%
Urine dipstick positive for glucose and negative for protein
Wet prep of smear from rash consistent with Candida albicans
ECG with evidence of early ventricular hypertrophy by voltage
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1.She wants to know why all of these changes have been happening to her body. How would you explain this to her?
2. What is the priority nursing intervention?
3.What teaching should be done with her?

Answer 1

The physical changes the woman is experiencing are due to complications from unmanaged type 2 diabetes, resulting in neuropathy and fungal infections. The priority intervention is to stabilize her blood glucose and address immediate health risks, followed by patient education on managing diabetes through lifestyle modifications and vigilant monitoring of her condition.

Step-by-step explanation:

Explanation of Changes in the Body Due to Type 2 Diabetes

The changes happening in the body are largely due to poorly controlled type 2 diabetes. The weakness and numbness in the right foot are symptoms of diabetic neuropathy, a common complication caused by persistent high blood sugar levels damaging nerve fibers, particularly in extremities. The itching rash in the groin area is likely intertrigo complicated by a Candida albicans infection, which thrives in warm, moist environments and is more common in individuals with diabetes due to high sugar levels in skin tissues promoting fungal growth. Increased thirst and frequent nighttime urination are classic symptoms of diabetes and indicate that glucose is not being properly utilized by the body, leading to high blood sugar levels.

Priority Nursing Intervention

The priority nursing intervention is to provide immediate medical management to lower blood glucose levels and prevent acute and long-term complications. This would include administering insulin as needed, monitoring blood glucose levels, and addressing high blood pressure and other immediate health concerns.

Health Education for the Patient

Patient education should focus on lifestyle changes such as improving diet, increasing physical activity, and regularly monitoring blood glucose levels. Education on foot care is also essential to prevent further complications due to neuropathy. The patient should be advised to recognize signs of infections and seek medical help early. Additionally, understanding the importance of medication adherence and recognizing the signs of poor glucose control are vital.