Sherman Yoder Part 3.docx - Worksheets to Prepare for...

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Worksheets to Prepare for Simulation Cases Module – Gerontology vSim Scenario (Patient) – Sherman “Red” Yoder Part 3 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 Sherman “Red” Yoder is an 80-year-old farmer and war veteran who was admitted five days ago with sepsis caused by an infected wound on his right great toe. The wound has been treated with oral antibiotics, but he has been nonadherent with the medication. His current medical problems include type 2 diabetes. Mr. Yoder is alert and oriented, and vital signs are stable. Fasting blood glucose this morning is 118 mg/dL. He had his usual night of sleep. He was up several times to go to the bathroom, but he is very slow and weak. Since his catheter was removed yesterday he has urge incontinence. You need to assess his independence in activities of daily living and discuss living arrangements after discharge. He lives alone on a farm located 20 miles outside of town. His son and daughter-in-law, Jon and Judy, live nearby, and they have been helping him. Judy will participate in the discussion about living arrangements. Sherman Yoder was admitted 5 days ago due to an infected wound in his right great toe and is treated with oral antibiotics, but he has been non-compliant with the medication. He is diagnosed with type 2 diabetes. 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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