particularly trained diabetes educators, are able to assess
each person in the context of her or his environment
and overall health, taking into consideration
functional and cognitive status and recognizing barriers
to self-care. Educating the older adult with diabetes,
as well as caregivers and family, is important in
preventing hypoglycemic events and in identifying individuals
at increased risk for such potentially dangerous
events.
Returning to the case of Mr. J., there are several
areas where nursing intervention will be important
in helping him remain safely in the community while
minimizing his risk of hypoglycemia.
A comprehensive assessment will determine his current
diabetes knowledge and self-care skills. Evaluation
of his understanding of the need for consistent
carbohydrate intake and meal planning and of his
ability to shop and prepare meals will indicate areas
where additional education or support may be needed.
Demonstration of glucose level self-monitoring and assessment
of Mr. J.’s ability to explain what the results
mean will help in identifying areas where review or
further instruction may be needed. For example, does
Mr. J. understand his pre- and postmeal glycemic targets,
how results that fall above or below this range
may affect him, and what blood glucose levels indicate
hypoglycemic risk? According to the ADA, a one-totwo-
hour postmeal target blood glucose level of less
than 180 mg/dL is recommended for most people
with diabetes.16 The premeal blood glucose target has
been raised to 80 to 130 mg/dL, according to the most
recent ADA standards of diabetes care.16
Again, these recommendations may be adjusted
as part of an individualized diabetes care plan. Based
on the nurse’s assessment of Mr. J.’s diabetes selfmanagement
skills as well as the results of his blood
glucose testing, his health care providers may order
medication changes to support blood glucose control
while minimizing the risk of hypoglycemia. The
nurse will then be integral in helping Mr. J. implement
any changes to the diabetes care plan. Assessing both
his home environment (including home safety, adequate
lighting, and access to cooking facilities) and
his social and physical support (such as help with
shopping, meal preparation, and medications) will be
integral in helping to develop a plan for diabetes care
that Mr. J. agrees to and can execute. In addition, if
needed, a nurse can provide information about community
resources for ongoing diabetes support or education
through referral to an outpatient center. Mr. J.
needs to understand the signs and symptoms of hypoglycemia,
and how to recognize and treat them as well
as how to prevent them. The nurse, looking at the big
picture, may be the critical liaison between Mr. J. and
his family and health care providers. Recognizing
Mr. J.’s strengths and deficits, and working with Mr. J.
to meet his needs, will reduce his risk of future hypoglycemic
events
particularly trained diabetes educators, are able to assesseach person in the context of her or his environmentand overall health, taking into considerationfunctional and cognitive status and recognizing barriersto self-care. Educating the older adult with diabetes,as well as caregivers and family, is important inpreventing hypoglycemic events and in identifying individualsat increased risk for such potentially dangerousevents.Returning to the case of Mr. J., there are severalareas where nursing intervention will be importantin helping him remain safely in the community whileminimizing his risk of hypoglycemia.A comprehensive assessment will determine his currentdiabetes knowledge and self-care skills. Evaluationof his understanding of the need for consistentcarbohydrate intake and meal planning and of hisability to shop and prepare meals will indicate areaswhere additional education or support may be needed.Demonstration of glucose level self-monitoring and assessmentof Mr. J.’s ability to explain what the resultsmean will help in identifying areas where review orfurther instruction may be needed. For example, doesMr. J. understand his pre- and postmeal glycemic targets,how results that fall above or below this rangemay affect him, and what blood glucose levels indicatehypoglycemic risk? According to the ADA, a one-totwo-hour postmeal target blood glucose level of lessthan 180 mg/dL is recommended for most peoplewith diabetes.16 The premeal blood glucose target hasbeen raised to 80 to 130 mg/dL, according to the mostrecent ADA standards of diabetes care.16Again, these recommendations may be adjustedas part of an individualized diabetes care plan. Basedon the nurse’s assessment of Mr. J.’s diabetes selfmanagementskills as well as the results of his bloodglucose testing, his health care providers may ordermedication changes to support blood glucose controlwhile minimizing the risk of hypoglycemia. Thenurse will then be integral in helping Mr. J. implementany changes to the diabetes care plan. Assessing bothhis home environment (including home safety, adequatelighting, and access to cooking facilities) andhis social and physical support (such as help withshopping, meal preparation, and medications) will beintegral in helping to develop a plan for diabetes carethat Mr. J. agrees to and can execute. In addition, ifneeded, a nurse can provide information about communityresources for ongoing diabetes support or educationthrough referral to an outpatient center. Mr. J.needs to understand the signs and symptoms of hypoglycemia,and how to recognize and treat them as wellas how to prevent them. The nurse, looking at the bigpicture, may be the critical liaison between Mr. J. andhis family and health care providers. RecognizingMr. J.’s strengths and deficits, and working with Mr. J.to meet his needs, will reduce his risk of future hypoglycemicevents
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