Running head: TEACHING PLAN 1
West Coast University N110
May 15, 2020
Running head: TEACHING PLAN 2
Ms. Maria Ramirez is a 59-year-old female that was admitted to the hospital after found
home unresponsive and unarousable. She was diagnosed with DKA, patient was not aware she
was diabetic and will need extensive education before discharge and follow up with home health
because of a non healing wound to her left foot.
The patient is 5”2” and weights 163 pounds, she lives home with her only son age 36
who works all day and comes home late. She lives in an apartment building in the 3rd floor and
often takes the stairs because the elevators don’t work. She admits that she has not visited a PCP
in the last couple of years due to her economic circumstances. She has a history of HTN and
hyperlipidemia and currently is not compliant with medications. Maria has been unemployed due
to her inability to perform activities for a long period of time. She mentioned she becomes SOB
when performing minimal activity like walking or standing too long. Lives a sedentary lifestyle
and poor nutrition over the last years.
Maria is very anxious regarding her current diagnosis and is afraid that if she continues
with her lifestyle, she will develop certain complications. Upon admission to the hospital a
consult with a diabetic specialist, endocrinologist (Levine,2015) and physicians were arranged.
The patient would have to be evaluated with PT in order to better understand the endurance with
physical activity. Social worker has been consulted to assist patient with medical coverage
through a charity program because patient stated monetary problems increased her anxiety.
Patient will also be sent home with home health that would provide wound care to the non-
Running head: TEACHING PLAN 3
healing wound due to her diabetes. Maria will ne educated while in the hospital on the severity of
her diagnosis and the importance to learn how to self-administer and measure insulin. Ms.
Ramirez will be educated to check blood glucose levels before each meal (<120) and keep a log
for her provider. Visual demonstrations will be provided for better understanding along with
written instructions that are easy to comprehend. Maria only attended 7th grade and reads at a 3rd
grade level. Maria will also be prompted to include exercise and promote a good diet in order to
modify weight and decrease cholesterol levels<200. Maria has communicated with the nursing
staff that she tends to concentrate better after breakfast. Therefor teaching should be conducted
after morning meal. Patient and son are eager to learn how to cope better with the new diagnosis
and make positive lifestyle changes that can benefit over all condition.
Ms. Ramirez enjoys visual learning as she enjoys doing arts and crafts to ease boredom,
she enjoys reading comic books which tends to read on free times. Maria enjoys hands on
activities such and baking and pottery. The appropriate leaning style would be visual along with
written instructions that are easy to understand.
Provide patient with diabetes education on how to measure blood glucose levels (<120)
before meals (Levine,2015). Demonstrate how to self-administer insulin before being discharge
from hospital. Teach patient on proper nutrition to normalize blood sugar levels. Diminish the
intake of carbs to <40% and intake more protein base foods along with vegetables. Provide an
exercise routine to patient and encourage exercise for at least 30 min daily (ODC,2010).
Encourage family to integrate in the care of the patient to allow better compliance.
Running head: TEACHING PLAN 4
By following a strict regimen and compliance patient would be able to control blood
sugar levels and normalize readings. Promotion of exercise will help with obesity, HTN, and
high cholesterol levels that were present. Encouraging Maria to promote exercise will benefit
diabetes and insulin resistance. Lower blood glucose levels will help with the non-healing
wound. Evidence based research showed that increased blood glucose levels tend to make
leukocytes rigid and stiff, making these useless to fight any infection (Levine,2015). As well as
tissue perfusion decreases when there is an uncontrolled blood glucose reading.
Running head: TEACHING PLAN 5
1. Check blood sugars daily before eating meals
2. Blood sugar levels targeted are <120
3. If necessary, administer insulin follow regimen table provided.
4. To administer insulin carefully measure insulin units and administer in fatty areas
like abdomen, back of the arm and always rotate sites.
5. Always eat a balanced meal
6. Exercise at least 30 min daily
7. Take medications prescribed
8. Increase activity levels.
9. Follow with PCP in 3 months to re check A1C levels. Target is to be at least 7%.
Time and resources
Maria Ramirez would undergo a strict insulin regimen along with increased activity after
wound heals in order to stabilize glucose levels. Within 3 months Maria A1C levels would be
reevaluated, the social worker would be working with Maria to find places that she can attend as
an outpatient physical therapy center. All this will be under charity and Maria will be encouraged
to find a health insurance that fits her needs and accommodates to her low income. Ms. Ramirez
would have services from a wound care nurse to take care of the wound in her foot to accelerate
proper healing. Resources are available upon request if patient needs further assistance to obtain
Running head: TEACHING PLAN 6
Patient was reevaluated after 3 months; wound has healed properly with no deterioration
of mobility to that extremity. Blood glucose levels have continued to drop and Maria’s A1C is at
8.4% which is not ideal but is great improvement compared to previous readings of 10.4%.
Patient is currently taking medications as ordered, family has become vital part of the
achievements since they encourage patient to eat healthy and take measures on disease process
seriously. Marias weight decreased and is now 148lbs and no longer complains of SOB. Patient
currently taking Lipitor, Novolog, Lantus, Metoprolol (ODC,2010).
Running head: TEACHING PLAN 7
“Diabetes: Symptoms, Causes, Treatment, Prevention, and More.” Accessed March 19, 2020. https://www.healthline.com/health/diabetes.
Levine, Michelle. Diabetes. Mankato, MN: Amicus High Interest, 2015.
“Organization of Diabetes Care: Diabetes Specialist Nursing, Diabetes Education and General Practice.” Handbook of Diabetes, 2010, 224–28. https://doi.org/10.1002/9781444391374.ch31.