Care of the Client with Diabetes. Introduction Go to www.diabetes.org Type “foot care” into the search box, and click on the first result. …
SAN JOSE STATE UNIVERSITY
School of Nursing
Nursing 155
Care of the Client with Diabetes
Introduction
This module is divided into four sections: Learning Resources, Independent
Learning Activities, Skills Lab Activities, and Critical Thinking
Activities Most of the activities in this module may be completed at a
time and place convenient for you, independently, with a partner, or in a
study group It is recommended that you complete each section of the
module in the order in which it is listed
Learning Resources comprise a list of the resources available to you that
pertain to the content of this module It is not required that you review
all the resources listed: choose those that best help you to complete the
activities in the module, and that best suit your learning style You may
use other, credible sources of information as well; check with your
instructor if you have questions about the usefulness of resources you
locate Keep in mind that you will most likely need to use multiple
sources to find all the information you need
Independent Learning Activities should be completed before going into the
Skills Lab to do the Lab Activities; they cover the theoretical
information you need to know about the subject of this module These
activities are not turned in or graded They are for your learning
benefit
You can validate your answers with the answer key in the NLRC Show your
instructor your completed activities and your instructor will sign the
first page Show the NLRC helper your instructors signature to gain
access to the key
MODULE KEYS MAY NOT BE COPIED OR REMOVED FROM THE NLRC
Skills Lab Learning Activities must be completed in the lab Practice
multiple times to gain proficiency; you will be expected to perform the
skills competently in your clinical courses during subsequent semesters
Critical Thinking Activities require that you apply the information you
have learned It is unlikely that you will find the answers to these
questions in your Learning Resources Feel free to discuss your answers
with your Lab instructor
Exams: Any content in this module may be tested in any of several ways:
written quiz or exam, lab exhibit, or practical demonstration
Copyright 2002, San Jose State University, School of
Nursing All
rights reserved A learning module developed by Christine Hooper, EdD,
RN, September 2002 Revised by Christine Hooper, EdD, RN, February 2006
SAN JOSE STATE UNIVERSITY
School of Nursing
Nursing 155
Care of the Client with Diabetes
Learning Resources
2 Elkin, M, Perry, A, Potter, P 2004 Nursing interventions
and clinical skills 3 rd ed St Louis, MO: Mosby pp 166, 187, 360-
365
3 Lewis, SM, Heitkemper, MM, Dirksen, S R 2004 Medical-
surgical nursing: Assessment and management of clinical problems 6th
ed St Louis: Mosby pp 1283-1284, 1299, 1682-1683
4 Potter, PA Perry; AG 2005 Fundamentals of nursing: Concepts,
process, and practice 6th ed St Louis, MO: Mosby pp 1038-1040,
1298, 1316-1317
5 wwwdiabetesscvorg [website for the Diabetes Society of Santa Clara
Valley]
6 wwwdiabetesorg [website for the American Diabetes Association]
7 wwwmypyramidorg [website for the new USDA Food Guide Pyramid]
Independent Learning Activities
Learning Outcomes
1 Discuss how often and why diabetic clients should inspect their feet
2 List 5 things that should be assessed in the
diabetic foot
3 Identify recommendations of the American Diabetes Association for
proper foot care
4 Discuss the importance of self blood glucose monitoring
5 Describe how to prepare the client for a fingerstick blood glucose
test
6 Put the steps for a fingerstick blood glucose test in correct order
7 State the overall goal for nutritional therapy for clients with
diabetes
8 Identify 4 different methods or systems recommended by the American
Diabetes Association clients can use to manage their diet
9 Determine onset, peak, and duration of Lispro, regular, NPH, and
Ultralente insulins
10 List four acceptable sites for subcutaneous insulin injections
11 Discuss the importance of proper bandaging of a post surgical
amputation
12 Discuss the need for prone positioning of the post surgical client
with an amputation of the lower extremity
13 Compare immediate post surgical and delayed fitting of a prosthesis
Learning Activities
1 Routine inspection of the feet is crucial for diabetic clients
a Why is it important for diabetic clients to inspect their feet?
b How often should diabetic clients
inspect their feet?
2 List 5 things to assess in the diabetic foot
a
b
c
d
e
3 In the space below, write the recommendations of the American
Diabetes Association for proper foot care Go to wwwdiabetesorg Type
foot care into the search box, and click on the first result This
information sheet can downloaded as a PDF file
4 In the space below, state why self blood glucose monitoring is
important
5 How does the nurse prepare the client for a finger stick blood
glucose test?
6 Following are steps for a finger stick blood glucose test Put the
steps in order, from 1-10
____Choose an appropriate site and cleanse with warm water or alcohol
____Confirm the correct code or lot number of the test strips and
glucometer
____Swab the site with alcohol
____Turn the glucometer on
____Apply the blood to the test strip
____Obtain a drop of the clients blood
____Gather supplies
____Insert the test strip into the glucometer and wait the correct
amount of time
____Record the result
____Take 1
reagent strip out of the bottle
7 What is the overall goal for nutritional therapy for clients with
diabetes?
8 List 4 different methods or systems recommended by the American
Diabetes Association that clients can use to manage their diet Go to
wwwdiabetesorg On the left side of the page, move the cursor to
Nutrition and Recipes From the pull-down menu, choose Making Health
Food Choices
a
b
c
d
9 Determine onset, peak, and duration of Lispro, regular, NPH, and
Ultralente insulins
|Insulin |Onset |Peak |Duration |
|Lispro | | | |
|Regular | | | |
|NPH | | | |
|Ultralente | | | |
Source: Lewis, Heitkemper, Dirksen 2004 Other sources may offer
somewhat different time frames
10 List four acceptable sites for subcutaneous insulin injections
a
b
c
d
11 Why is it important to bandage the residual limb with a compression
bandage after amputation?
12 Why is it important to periodically position the post surgical
amputation client prone?
13 Compare immediate post surgical and delayed fitting of a prosthesis
by completing the following table
| |Immediate Post |Delayed Fitting |
| |surgical Fitting | |
|Advantages | | |
| | | |
| | | |
|Disadvantages | | |
| | | |
| | | |
| | | |
Skills Lab Activities
Learning Outcomes
1 Demonstrate accurate foot assessment on a peer partner
2 Perform visual and glucometer blood glucose monitoring
3 Identify appropriate injection sites for insulin injections
4 Demonstrate mixing 2 types of insulin in the same syringe
5
Demonstrate bandaging a stump using the figure-8 technique
Learning Activities
1 Gather the following supplies:
|STUDENT BRINGS |LAB PROVIDES |
|Diabetic Care module|chux |clean gloves |
| |glucometer with matching |insulin syringe |
| |test strips |practice regular and NPH |
| |alcohol wipes |insulin vials |
| |cotton balls |stump mannequin |
| | |ace wrap |
2 On a peer partner, examine their feet as you would a diabetic client
Be sure to inform your client about the principles of good foot care
3 Wash your hands, and swab one finger with alcohol Then, using a
disposable lancet obtain a drop of your own blood and place it on a
Chemstrip Wait the appropriate amount of time Then swab the blood off
the test strip and visually compare it to the Chemstrip bottle to
determine your blood glucose measurement
4 Following the criteria listed on the Fingerstick Blood Glucose
Demonstration Criteria Sheet, complete the following activities using the
assembled supplies: Using a sample of your own blood, perform a
fingerstick blood glucose measurement using one of the glucometers in the
Skills Lab
Practice as many times as you need Be sure to ask for help as you need
it You should be ready to demonstrate the technique accurately and
smoothly before seeking to be checked off on the skill Graded
demonstrations are not practice sessions
5 On a peer partner or Lab mannequin find 4 potential injection sites
for insulin injections
6 The MD order reads: NPH 12units and regular insulin 8 units SQ
QAM
Using the practice insulin in the Lab, practice drawing up these
insulin doses in the same syringe Remember, this is a review from
N54
7 Using the stump mannequin in the Lab, practice bandaging the stump
using an ace wrap and the figure 8 technique
SAN JOSE STATE UNIVERSITY
School of Nursing
Nursing 155
Care of the Client with Diabetes
Fingerstick Blood Glucose Measurement Demonstration Criteria
10 Points
Name
Lab Section
Turn in this sheet to your lab instructor when you perform your fingerstick
demonstration If you complete the demonstration with the lab facilitator,
turn in the sheet to your lab instructor after the lab facilitator has
evaluated your performance
The physicians order reads: FSBG ac and HS
|Criterion |Points |Points |
| |Possible|Earned |
|Wears clean gloves |1 | |
|Maintains aseptic technique at all times | | |
|Chooses one test strip Checks expiration date |1 | |
|and makes sure test strip and glucometer codes | | |
|match | | |
|Chooses an appropriate site for the fingerstick |1 | |
|Cleans site with antimicrobial or washes hand |1 | |
|with warm water and soap Allows site to dry | | |
|Using a disposable lancet, obtains an |1 | |
|appropriate amount of blood, either directly | | |
|onto the test strip, or into a
capillary tube | | |
|Places drop of blood on test strip |1 | |
|Inserts test strip into glucometer at |1 | |
|appropriate time Blots excess blood off test | | |
|strip if appropriate | | |
|Reads glucometer result at appropriate time |1 | |
|States normal blood glucose level and compares |1 | |
|to glucometer reading | | |
|Disposes of lancet in sharps container |1 | |
|TOTAL POINTS |10 | |
Critical Thinking Activities
Learning Outcomes
1 Plan lunch for a simulated clients using the new Food Guide Pyramid
2 Investigate nutrition and meal-planning resources for diabetic
clients on the web
Learning Activities
1 Use the new Food Guide Pyramid to plan lunch for each of the
following clients Go to wwwmypyramidgov The home page of the Pyramid
allows you to enter the age, gender, and activity level of each client
and receive a sample food guide
a Jennifer is a 14 year-old adolescent girl, recently
diagnosed with
Insulin Dependent Diabetes Mellitus IDDM She plays soccer after
school every day, and bikes on the weekends
b Mr Roberts is 52 years old and recently diagnosed with type II
diabetes mellitus Mr Roberts retrieves the mail and the newspaper
from the front of his house every day Otherwise, he engages in little
or no activity
2 Mrs Sawyer was diagnosed with Type II diabetes 1 year ago She is
having some difficulty managing her 2000 calorie meal plan, and has
gained 18lb Investigate the resources offered by the American Diabetes
Association, wwwdiabetesorg or the Santa Clara Valley Diabetes Society,
wwwdiabetesscvorg, to find nutrition counseling or a nutrition support
group Write your results below
