Answer

Case Study: Self-Monitoring of Blood Glucose

            The areas of concern in Patient J’s case living arrangements, risk of recurrence of hyperosmolar non-ketotic syndrome (HHNS), and poor adherence to treatment plan. Patient J perhaps lives alone may be at risk of forgetting to take medications or adopt recommended dietary plans may be due to lack of social companion at home and/or his age. Since type-2 diabetes mellitus is not curable, there is a risk of recurrence of HHNS in the future perhaps due to poor management of the condition. Similarly, the patient is relatively old in age (60 years); hence, he may forget to take medications or adhere to the treatment plan as intended. 

            A holistic care approach together with aggressive management of type-2 diabetes is required. Holistic care implies that the functioning of the pulmonary, cardiovascular, the central nervous systems and the renal system must be monitored and supported since HHNS can have negative impacts in these organ systems. If HHNS is left untreated is may lead to death due to extreme dehydration. Evidence-based management of HHNS includes resuscitation with aggressive administration of intravenous fluids, heparin, and insulin (Hazmi & Manning, 2018).  Besides, a homecare nurse should educate and monitor the patient’s self-management and monitor capable daily. Dietary knowledge, disease self-management capacity, and good adherence to the treatment plan can be reinforced through a continuous patient-education program (Polonsky  et  al., 2011). The homecare nurse should evaluate the patient and determine on whether he is capable of self-managing, self-monitoring, and deciding on which particular situations in which he consult ambulance or care services.  If patient J demonstrates self-monitorimg capacity he should be provided the blood glucose strips to monitor his blood glucose level on a daily basis (Kerr, 2011). However, if her is not capable some else will have to do it for him; perhaps, the homecare nurse.

List of open-ended questions to be asked by the home health care nurse

1. Do you have any other underlying chronic or acute illness apart from typ-2 diabetes mellitus since it may affect treatment plan decisions?
2. Are you taking other applications; if so, how many types so as to prevent possibly of polypharmacy issues?

• Are you capable of adoption the dietary and behavioral intervention plans as advised by the diabetes educator? Was the education your received relating to management of the condition helpful?          

1. Have many episodes o HHNS has occurred in your life?
2. How have you been managing type-2 diabetes mellitus?