CASE STUDY

Mrs. S, a 45-year-old black woman, came to your doctor’s office because she had a sore that would not heal on her leg. She is 5 ft 5
in., and weighs 200 lb. (body mass index [BMI] = 33.5). Vital signs are temperature 98.6°F, pulse 70 beats per minute, respirations 16
breaths per minute, and blood pressure 160/95 mm Hg.

Mrs. S reports a gradual increase in her weight since her third child was born 20 years ago. That baby weighed 12 lb. Two previous
pregnancies produced infants weighing 10 and 11 lb. She has no known allergies. None of the children live at home. Mrs. S lives with
her husband, who works as a construction laborer. She has been seasonally employed as a hotel maid at a nearby resort. Health
insurance coverage is sporadic. They have a new insurance policy now

Mrs. S is the oldest of six children. Her father died of a heart attack at age 60. Her mother died of a stroke at age 62. Both parents
reportedly “had a little sugar.” The sister who is closest to Mrs. S in age developed diabetes 3 years ago and is being treated with
oral medication. Their youngest sister was diagnosed with type 1 diabetes at age 18 after an episode of mumps.

Mrs. S reports a good appetite and a fluid intake of about 3 quarts per day. Her favorite beverage is iced tea with sugar and lemon.
She does most of the grocery shopping and cooking.

Mrs. S hit her left ankle with the screen door about 2 months ago. The resulting sore has not healed but has gotten worse. Mrs. S
knows that a sore that does not heal is a sign of cancer, which is why she sought medical attention. The ankle now has an open
lesion 5 cm in diameter over the lateral ankle bone. The entire foot is swollen to twice the size of the right foot. The bandage over
the sore had greenish-yellow drainage on it. A random blood glucose test 3 hours after her last meal shows a glucose level of 400
mg/dL. Her urine glucose was negative for ketones. The physician diagnoses Mrs. S with type 2 diabetes.

The physician prescribed the following care for Mrs. S:

 Bed rest with the left leg elevated
 Diet assessment and teaching
 Multivitamin, 1 capsule daily
 Culture and sensitivity of drainage from the left leg
 Cefuroxime, 250 mg, orally every 12 hours
 Warm, moist dressing to left leg ulcer four times per day
  Fasting blood sugar (FBS), electrolytes
 Metformin, 500 mg with breakfast and dinner

Care Plan
ASSESSMENT DIAGNOSIS OUTCOMES INTERVENTION EVALUATION
Subjective:
 Family history of  Newly diagnosed  Client will  Briefly discuss type 2  Client understand
diabetes mellitus type 2 diabetes understand type 2 diabetes causes, about the disease
 diabetes effect on the body,
Large appetite  Possible
and tools for
 Large fluid intake hypertension
management of the
 Delay in seeking  Open lesion 5 cm disease.
diameter over left
medical attention  SMBG will be taught  Client become
lateral ankle  Client will verbalize aware of BG goals
using a glucometer. A
 Purulent discharge self-care measures blood glucose log will and self-
Objective:
related to type 2 be given to client and management
 Obesity: Height 5 ft diabetes techniques to
asked to bring to
5 in manage her
next appointment.
 Weight 200 lb diabetes.
 Refer to dietitian for
 BMI: 33.5 nutritional
 Temperature: 98.6°F assessment and
 Pulse 70 beats per education.
minute  Ask the client what
 RR: 16 breaths per her interests are for
her management of
 minute  Client will verbalize the diabetes, help
 BP: 160/95 mm Hg willingness to her set achievable  Client feel more
continue goals that she can empowered and is
 Newly diagnosed
nursing/medical work on. more likely to work
type 2 diabetes
regimen  Teach principles of towards goals she
 Possible
wound care, help set. This can be
hypertension
including effect of done over time if
 Open lesion 5 cm high blood sugar on the client is able to
diameter over left infection. return for follow-up.
lateral ankle
 Mrs. S review
 Purulent discharge MyPlate for diabetes
and the reason why
it is important to
follow  Mrs. S understands
that high blood
 Mrs. S describe the
sugar feeds the
meal plan she
bacteria causing the
follows.
infection, and she
more willing to work
hard to control the
diabetes