NR 325 Pre-Simulation - Carl Rogers - Hire

Prof. Name

Date

Scenario Overview

Carl Rogers, a 67-year-old African American male with a 20-year history of type II diabetes mellitus, was directly admitted to the medical unit from his physician’s office on Tuesday at 1530. He has a stage II non-healing ulcer on his right heel, and upon arrival, his admission paperwork was completed, and pain medication administered. Additional medical orders include a dressing change and insulin administration, which have yet to be implemented. This scenario takes place at 1700 on Tuesday.

Comparison of Long- and Short-Acting Insulin

1. Long-Acting Insulin:

Long-acting insulin primarily controls hyperglycemia for both type 1 and type 2 diabetic patients. It aids in maintaining blood glucose levels between meals and overnight. The onset for long-acting insulin ranges from 0.8 to 4 hours. Unlike other forms, long-acting insulin does not have a defined peak, reducing the risk of hypoglycemia due to the absence of peak action time (Lewis et al., 2017). The duration spans from 16 to 24 hours. Common types include glargine (Lantus), detemir (Levemir), and degludec (Tresiba).

2. Short-Acting Insulin:

Known as mealtime or bolus insulin, short-acting insulin has a quick onset of action, supporting meal absorption during food intake. The onset ranges from 30 minutes to an hour, with a peak time of 2 to 5 hours and a duration of 5 to 8 hours. Administered 30 to 45 minutes before a meal, it aligns with meal absorption and has a higher risk of hypoglycemia due to its longer duration of action.

For individuals with Type II diabetes, maintaining a balanced diet is crucial. Weight management is often recommended, especially for those who are overweight or obese. A balanced intake of carbohydrates, fats, and protein is essential to help maintain blood glucose levels. Carbohydrates are an important source of energy, fiber, vitamins, and minerals, tailored individually to meet each patient’s needs. Fiber intake should ideally range from 25 to 30 grams per day. Fat intake, specifically trans-fat, should be minimized with cholesterol limited to 200 mg daily. Protein intake varies, but high-protein diets are typically discouraged for patients aiming for weight loss. Collaboration with a dietitian in meal planning enhances adherence, helping the patient establish realistic health goals (Lewis et al., 2017).

Wound Care Best Practices for Diabetic Foot Ulcers

Effective wound care for diabetic foot ulcers aims at promoting fast healing and preventing infection. Diabetic patients are at increased risk for complications, thus necessitating vigilant wound management. To prevent infection and subsequent complications like necrosis or amputation, wounds require regular, sterile dressing changes. Proper wound dimensions should be documented during initial assessment, establishing a baseline for monitoring healing progress. Hands should be washed, and gloves worn during care. Medicated dressings are sometimes prescribed to create a protective barrier and promote healing. Debridement may be necessary to remove dead tissue and support the growth of healthy tissue.

References

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). St. Louis: Elsevier.