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Teaching / Learning Plan

Tara Pospeschil

March 7, 2016

SH is a 34 YO M with pneumonia, sepsis and hyperkalemia r/t diabetic

ketoacidosis brought on by an uncontrolled blood sugar of 892. His lab
showed an A1C of 14.4%. Patient stated that he was peeing a lot and
became very thirst before passing out and ended up at the hospital. Patient
has a history of drug dependency, UTI and mental health problems. He is a
newly diagnosed diabetic and stated, I dont know a lot about diabetes, just
what the diabetes educator told me. Patient is currently being monitored for
glucose control, fluid and electrolyte control as well as diabetic teaching.
In order to analyze his knowledge base, I asked his questions related to
diabetes knowledge, health problems, health beliefs, and his social support
system. During this interview, I was able to determine a baseline of
knowledge going forward with treatment.
I feel that SH is motivated and ready to learn how to manage his
diabetes. He realizes that this is a serious disease and needs to be controlled
to prevent future health problems.
Psychosocial issues that may arise are his difficulty consulting with his
parents who he feels are unsupportive of his lifestyle. He also struggles with
the fact that he may have to go back to jail temporarily, so he believes
diabetes management could be a potential problem. This patient also
struggles with ADHD, anxiety and bipolar disorder, so diabetes education
might not always become his top priority.
SHs abnormal S/Ss include: current blood glucose of 273 and bilateral
coarse lung sounds, but they did not interfere with our learning plan.
After completing my assessment, I determined that he feels that he will
learn the best by practicing giving himself insulin with the diabetes educator
and reading over his diabetes education booklet. He also learns better by
having a discussion about signs and symptoms of diabetes in real life rather
than just telling him about it.
From this assessment, I came up with some learning strengths and
weaknesses for his teaching plan:

Deficient knowledge r/t new diabetes diagnosis amb patient

stating I was peeing a lot and became very thirst before passing
out and ended up at the hospital, blood glucose level of 892 on
admission, and an A1C of 14.4%.

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o Patient will state the signs and symptoms of hyperglycemia

and hyperglycemia by 2200 on 3-8-16.
o Patient will state the differences between type 1 and type 2
diabetes by 2200 on 3-8-16.
o Patient will acknowledge the importance of taking his
prescribed insulin at the correct times each day by 2200 on
3-8-16.

Readiness for enhanced Knowledge (Diabetes Management):

expresses interest in learning.
o Patient will explain how he will incorporate his new insulin
therapy into his lifestyle by 2200 on 3-8-16.
o Patient will list sources that he can use to obtain
information about diabetes when needed by 2200 on 3-816.

In order to teach about diabetes management I found the following

information in the Aspirus hospital diabetes management booklet, on
the Aspirus hospital website and in our medical-surgical nursing book:
Diabetes: A chronic long term condition marked by abnormally high
levels of sugar (glucose) in the blood. People with diabetes do not
produce enough insulin to control their glucose levels. As a result
glucose builds up in the blood. If left untreated, it can lead to
blindness, kidney disease, neuropathy, heart disease and stroke.
Type 1 Diabetes: This is known as insulin dependent diabetes, and
occurs when the pancreas cells are destroyed and no longer make
insulin. As a result, the pancreas loses complete ability to regulate
blood sugar levels. This type of diabetes can be managed, but it
cannot be cured.
Type 2 Diabetes: This type makes up 90% or more of all cases of
diabetes and usually develops in adulthood. The pancreas cannot make
enough insulin to keep blood glucose levels normal and is made worse
by poor food choices, a sedentary lifestyle, and being overweight. This
type can be improved and sometimes reversed by adopting a healthy
diet, becoming more active, and losing excess weight.
Hypoglycemia: Glucose (sugar) is the primary fuel for your brain, so
your brain will feel the majority of the effects of hypoglycemia. Signs
and symptoms include: headache, diaphoresis, blurred vision,
trembling, depression, confusion, irritability, heart palpitations, slurred
speech, seizures, fatigue and coma. Some causes may be taking too

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much insulin, not eating or not eating enough, and certain

medications.
Hyperglycemia: High blood sugar occurs when the body makes too
little insulin or when the body is not able to use the insulin right away.
Insulin is a hormone that helps the body use glucose for energy. Signs
and symptoms include: being very thirsty (polydipsia), blurred vision,
dry skin, weakness, drowsiness, and needing to pee a lot (polyuria).
Some causes may be not taking the correct dose of insulin, eating too
much, stress, or certain medications.

Evaluation:
Patient will state the signs and symptoms of hyperglycemia and
hyperglycemia by 2200 on 3-8-16.
Goal met (2030 on 3-7-16)
Patient stated he knows he wont forget what hyperglycemia is
because he was peeing a lot and was really thirsty before he
passed out and ended up at the hospital. He also was able to
recall that signs of hypoglycemia included feeling really weak,
confused and sweating a lot.
Patient will state the differences between type 1 and type 2
diabetes by 2200 on 3-8-16.
Goal partially met (2030 on 3-7-16)
Patient stated that he understands in type 1 diabetes the body
cannot make insulin at all and in type 2 diabetes the body either
stops making it or cannot keep up with the high sugar. He stated,
he is feeling overwhelmed with all the information given to him
after being newly diagnosed, so he will read more about it later.
Patient will acknowledge the importance of taking his prescribed
insulin at the correct times each day by 2200 on 3-8-16.
Goal partially met (2030 on 3-7-16)
Patient stated it is important for him to take his insulin as
prescribed at the correct times each day to prevent long term
complications. He also stated that he know realizes he can stay
healthy and avoid problems if he keeps his glucose in control.
Patient will explain how he will incorporate his new insulin
therapy into his lifestyle by 2200 on 3-8-16.
Goal met (2030 on 3-7-16)

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Patient stated that although it will be a difficult transition for him

to go back to jail with this new diagnosis, he will make sure he
controls his glucose levels with the help from nurses there. He
also stated that when he is back home, that he will make sure to
take his insulin at the correct times and always check his blood
sugar levels.

Patient will list sources that he can use to obtain information

about diabetes as needed by 2200 on 3-8-16.
Goal met (2030 on 3-7-16)
Patient stated that he can refer to a social worker for questions
and the nurse at the jail. He also stated he can call his doctor
with any questions or problems he may have.
SH was very receptive to the teaching plan. He maintained eye contact
and asked many questions about his health. He seemed upset about why this
would happen to him, but was very adamant about getting his health back
on track. He realizes that with good control of his diabetes he can avoid long
term complications and seems willing to maintain compliancy. He does
however seem concerned about his health when he goes back to jail for a
short time. Although, he knows there are nurses that will help him and get
him through this tough time.
The written booklet provided by Aspirus hospital will be a great
resource for SH to use at home. He stated that he is overwhelmed by all the
information right away with a new diagnosis, but he will be able to learn it on
his own time at home and at a slower pace. Also, he stated that he really
likes how the book describes signs and symptoms in a simple way and what
to do if his blood sugar gets too high or too low.
During this teaching plan, I did have to make some adaptations to
meet his learning needs. The first adaptation was that we needed to start
with very small ideas and work broader. Since he did not know anything
about diabetes, I started out by explaining how his body needs to use
glucose for energy and you need insulin to drive the glucose into the
muscles. If insulin is not present then glucose builds up in the body and can
lead to the signs and symptoms of hyperglycemia. Then from there we
expanded eventually into signs of hypoglycemia and hyperglycemia and why

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its important to watch for them. He seemed very receptive of the basic
information, but a little bit overwhelmed and tired because he went through
some information with the diabetes educator earlier in the day.
Overall, this was a really good learning opportunity. It helped me
understand my patient better and how overwhelming a new diagnosis like
this can really be. I am glad that I could help make a little bit of a difference
in his life and let him know he will be okay and just needs to keep up with
this medications and insulin therapy.

The following is an FDAR note that I created while working with SH:
F: Deficient knowledge r/t new diabetes diagnosis amb patient stating I was
peeing a lot and became very thirst before passing out and ended up at the
hospital, blood glucose level of 892 on admission, and an A1C of 14.4% on
admission.-----------------------------------------------------------D: Patient is a newly diagnosed diabetic. Patient stated, I dont know a lot
about diabetes, just what the diabetes educator told me. Blood sugar on
admission was 892 and patient was in DKA r/t pneumonia and sepsis. Current
blood glucose level is 273. On admission his arterial blood gases were PCO2:
15, pH: 6.88, HCO3: 3 indicative of metabolic acidosis.--------------------A: Administered Novolog Insulin for blood sugar 273. Educated patient on the
differences between type 1 and type 2 diabetes. Educated patient on signs
and symptoms of hyperglycemia and hypoglycemia and the importance of
monitoring these symptoms.--------------------------------R: Patient stated, I know the symptoms of hyperglycemia because I was
peeing a lot more than normal and I was really thirsty. Then I blacked out and
work up in the hospital. This was very helpful and Im sure I will learn more
tomorrow from the diabetes
educator.---------------------------------------------------------------------------------------------------------------------------T. Pospeschil SN NTC

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