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Nursing Case Study

Irene Chapman is a 69 year old lady who has recently been diagnosed by her General Practitioner (GP) with type 2 diabetes. Although she was recently diagnosed, she feels that she has had symptoms of diabetes for at least five years.
Irene lives with her husband of 48 years and has two married children. Although both her mother and father had type 2 diabetes, Irene has limited knowledge regarding diabetes self-care management and states that she does not understand why she has diabetes since she never eats sugar. In the past, her husband has encouraged her to treat her diabetes with herbal remedies and weight-loss supplements, and she frequently scans the Internet for the latest diabetes remedies.
She had fasting blood glucose records indicating values of 5.5 and 6.9 mmol/L which were described to her as indicative of borderline diabetes. She also remembers past episodes of nocturia associated with large pasta meals and Italian pastries. She has been advised to lose weight, although she has tried for many years to do so, she is still gaining weight. She has also complained of recent foot pain, thirst, and lethargy, but thinks this is because of her nocturia.
She had been started on glicazide (Diamicron) 80 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon.
Irene also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia (elevated LDL cholesterol, low HDL cholesterol, and elevated triglycerides). She has always tolerated this medication and adheres to the daily schedule.
She has been educated by her General Practitioner (GP) about testing her blood glucose levels at home, but she does not do this because she doubts that this would help her improve her diabetes control. What would knowing the numbers do for me?, she asks. The doctor already knows the sugars are high.
Irene states that she has never been sick a day in my life.
Irene s diet history reveals excessive carbohydrate intake in the form of bread and pasta. Her normal dinners consist of 2 cups of cooked pasta with homemade sauce and three to four slices of Italian bread. During the day, she often has a slice or two of bread with butter or olive oil. She also eats eight to ten pieces of fresh fruit per day at meals and as snacks. She prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by pasta. Her husband has offered to make her plain grilled meats, but she finds them tasteless. She drinks 3 glasses of red wine with dinner each evening. After smoking for 30 years, she stopped smoking more than 10 years ago, when the cost of cigarettes became too expensive.

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