Sherman Yoder Part 1.docx - Worksheets to Prepare for...

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Worksheets to Prepare for Simulation Cases Module – Gerontology vSim Scenario (Patient) – Sherman “Red” Yoder Part 1 Part 1: Plan of Care Concept Map (adapted from vSim template) Simulation Patient Overview Client summary: presentation, medical history and background, physical assessment findings, medications, diagnostics brief summary of pathophysiology and rationale for clinical manifestations Red is an 80-year-old farmer and war veteran who lives by himself, 20 miles from the nearest city. He has been a widower for 10 years but his son and daughter-in-law, Jon and Judy, live nearby. He was diagnosed with type 2 diabetes about six months ago and recently began taking insulin. We (nurses from the home health agency) have been asked to see him to evaluate a wound caused by wearing shoes that were too tight. The toe was injured about three weeks ago. Red has been treating it by soaking his foot in water. His daughter-in-law, Judy, expressed concerns about his ability to manage diabetes self-care, and he has agreed that she can be present for the conversation. We know he is very independent, alert, and oriented. He drives himself into town at least once a week and spends a lot of time on his computer. In type 2 diabetes, there is a destruction of the beta cells that results in decreased insulin production, increased glucose production by the liver, and fasting hyperglycemia (Hinkle & Cheever, 2018). In the case of Skyler, he had been diagnosed with hypoglycemia. This was shown as he had a blood sugar of 39 mg/dL. According to Hinkle and Cheever (2018), severe hypoglycemia is when glucose levels are less than 40mg/dL. Furthermore, it can occur when there is too much insulin or oral hypoglycemic agents, too little food, or excessive physical activity. In Skyler’s case, he stated he only ate breakfast in the morning and began to play basketball, causing his hypoglycemia. Hypoglycemia can be further broken down into three type, mild, moderate and severe. With Skyler, he had been going through severe hypoglycemia where the CNS function is so impaired that the patient needs the assistance of another person (the nurse) for treatment of hypoglycemia and can be manifested by disoriented behaviour, seizures, difficulty arousing from sleep, or loss of consciousness (Hinkle & Cheever, 2018).

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