Teaching Project
My client is a 48 year old male who came in with a right lower extremist limb threatening ischemia. He had his 2-5 digits on his foot amputated due to a toe ulcer. He has small vessel disease and uncontrolled diabetes. Small vessel disease is a condition in which the small arteries in the heart become narrowed. This narrowing would not allow appropriate profusion to surrounding tissues and is usually common with those who have diabetes. Small vessel disease is hard to detect and symptoms often correlate with that of heart disease. With this you might experience shortness of breath, sweating, fatigue, dizziness, and chest pain. My client also has type 2 diabetes that is uncontrolled. Type 2 diabetes is a condition that affects the way your body metabolizes sugar. When you have type 2 diabetes, your body is resistant to the effects of insulin. There is no cure for Type diabetes but it can be managed through proper diet, exercise and insulin management. The usual signs of diabetes include, polyuria, polyphagia, fatigue, slow healing of wounds or sores, and excessive hunger. His recent episode included stepping on a sharp object that he didn’t feel, poor wound management and diabetes management led to the amputation of his digits on his foot. He does not eat a proper diet and does not have a routine insulin schedule leading to the uncontrolled aspect of his diabetes. He currently has a heel ulcer on his right foot that if not managed may be amputated. The goal of his treatment is to help control what he eats, prevent future sores that may lead to future amputations, and have the diabetes clinician consult him with his management.
My client lives in the Ozark area with his wife. They currently have a horse farm that has about 20 quarter horses. He enjoys going to church and attends every Sunday for Mass and every Wednesday for bible study. He has his left leg amputated just below the knee with a prosthesis. He has limited mobility but will try and help out a much as possible on the farm. He brother often comes to help out if he is not able to. My client often eats unhealthy snacks when hungry or at church. His support network included his wife, brother, mother and father and members from his church. His usual routine is to get up early feed the horses do chores around the farm and then sit and watch TV until something else needs to be done. He has had passive suicidal ideation and a family history of depression. He has had no suicidal attempts however. When amputating the digits on his foot, he did state “I just want the whole leg off, just cut it off.” After consultation they explained to him why only the digits need to be amputated and the effects of having the leg amputated. When I assessed the client he had a lot of questions for the doctor and was very knowledgeable about what was going on. I asked if I could do some teaching for an assignment and he was very accepting of that. After talking to my client I realize that he does not understand the importance of maintaining a proper blood glucose level. He was aware of the condition on the basic pathophysiology of the disease. I decided to get several brochures that the hospital had as well as a booklet. I also utilized a mirror and testing string that my professor had on site. These references would help to explain the diet management, checking for possible sores and understanding why sometimes you get sores without feeling anything. He does have a high school education but no further education from college. He does read and do research on the internet. He often reads from the bible about 2 hours a day. When asked what the most important thing to teach him was, he responded with food he can eat, and how to know if he has a sore. When doing this I asked to shut off the television to provide and environment with limited distractions. He said that was fine and that the silence will help him to focus. My client did state “it would be way easier if someone was always around to tell him or help him.” I asked about his wife helping him and he said between her job as a secretary and helping on the farm she doesn’t have time. The wife was not going to visit today but teaching could help her as well.
