Elder: Patricia Giles

Visit #4

11-15-18

In my last visit with Pat, I focused on patient education. The specifics of the education
were focused on her diabetes because I felt that this aspect of her health was of primary
importance with day to day well-being as well as long term complications. Before teaching her
about ways to care for her diabetes and other methods of self-care that were diabetes related, I
talked to her about how she felt about the disease at first. When visiting her on prior visits, she
seemed to dislike the disease, or simply not care for the complications of mismanagement. I
asked her why she didn’t care for the disease. When asked, she responded with “I’m too old to
care about how my diabetes will affect me in 10 years and it’s tiresome”. Being able to connect
with her on that, I addressed those feelings with her first, then moved onto more positive
teaching by talking to her about the benefits of taking care of herself. This is where my patient
education started. I first sat down with her and pulled out my computer, starting my teaching
with foot care and proper footwear for diabetics. I gave her a guidelines sheet for foot care and
we discussed the guidelines together. At first, she was against it and said that she didn’t have
time in the day to follow all of the guidelines. I took that in and told her that although it would be
best she followed the routine every day, she could simply choose a few things to do. After
talking about the most important actions, she agreed to doing 3 things every day: 1) inspecting
her feet for sores, cuts, or blisters, 2) wear supportive shoes, and 3) never walk around barefoot.
After agreeing to those, I talked to her about the importance of good shoes. She said she had
some tennis shoes, but her feet still hurt at times from the neuropathy. I showed her different
insoles that she could put in her shoes to make walking more comfortable. Once we discussed
that, I shared with her some methods for remembering to check her blood and record her blood
sugar levels, carbohydrate intake, and insulin dosage by using a journal. She liked the idea, so we
looked up different diabetic journals and got ideas for a journal that she knew she would use.
Afterwards, we didn’t have much time left, so I decided to talk to her about exercise and eating
right. I told her that even going on a 15 minute walk each day would help her feel much better. I
also stressed the importance of drinking water. I educated her on the benefits of being active as a
diabetic and made sure she knew that she would feel much more energized and healthier if she
utilized this teaching and used these tools to manage her diabetes better. To assist with this, I
shared my personal diabetic journal with her to let her know how much it helped me. At the end
of my visit, I thanked her for letting me visit her each week. Looking back on the past few
weeks, I feel proud to have gathered so much information on a person and to have created a way
to help her better care for herself to provide her with a better lifestyle. I feel as though I helped
her learn more about the benefits of taking care of herself and helped her see that taking care of
her disease isn’t necessarily for the future, but simply for her day-to-day well-being.

Physical Assessment:
Skin: Warm, no lesions on arms or legs
Respiratory: Normal, no labor
Gastrointestinal: Colostomy last emptied 3 days ago, Low carb diet (diabetic diet)
Genitourinary: Nocturia, polyuria
Cardiovascular: Normal heartbeat, radial pulse 2+
Neurological: Oriented, PERRLA, clear speech, slightly agitated at beginning of assessment
Musculoskeletal: able to walk independently, numbness in toes (2/10 pain because of morning
administration of ibuprofen)
Pain: 2/10
Glucose Level: 311