Diabetic Teaching Plan for Alzheimer’s Patient

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A nurse doesn’t only provide nursing care. She also, in some cases, has to teach her patient and/or her patient’s relatives the basic nursing care needed to be perceived especially in the absence of a health care provider. It is a challenging experience for a nurse to give health teaching to an Alzheimer’s patient because these patients are totally disoriented and confused about the current setting, and have speech difficulties (Russell, et al, 2007).

This tells us that the possibility of a successful health education for an Alzheimer’s patient is a few percent lesser than a teaching plan for a patient without mental and psychological disturbances. That’s why it is important for us to assess first our patient, to know what, where and how to start conducting our teaching plan for them.

Assessment of Learner

The learner or the subject of this teaching plan is an Alzheimer’s patient with diabetes mellitus. He is 55-year-old man suffering from early stage or mild Alzheimer’s disease. His symptoms are: minor cognition and memory alteration as evidenced by confabulation (filling in memory gap), minor anterograde amnesia (forgets recent memory) and retrograde amnesia (forgets distant memory), and loss of orientation to some daily tasks like peeling an apple or changing a television channel. He also has communication problems, as evidenced by difficulty speaking and understanding complex instructions/materials (Russell, et al, 2007).

It is important to give health teaching to an Alzheimer’s patient with diabetes mellitus about diabetic glucose monitoring because Insulin metabolism is important for proper central nervous system functions because it acts on the neural impulse transfer, which affects the person’s sensory and motor abilities (Sabayan, et al, 2007), and through his independence in monitoring his blood glucose level, he will be able to help himself in getting reoriented with reality, practice performing his usual daily activities and watch his diet out to decrease elevation of blood glucose level.

Before conducting the teaching plan, the patient was assessed of his orientation to reality; when asked “Do you know where you are?” and “What time is it?” the patient responded correctly but it took him 2 minutes before he was able to answer my questions. His level of understanding was tested when he was asked, “If you are able to understand me, can you tell me why you need to monitor your blood glucose?” and answered that he needed the test to know if he’s gone beyond is allowable blood glucose level. His memory was tested when he was asked, “Can you tell me again where we are and what time it is?” and replied the same answer he gave me earlier. After these preliminary patient assessments, we were ready to proceed with the teaching plan.

Learner’s Prior Level of Knowledge

The patient is aware that he has an Alzheimer’s disease and diabetes mellitus. He knows that he had had previous blood glucose monitoring in the past that he does alone, but this ability had deteriorated ever since the presence of his disease. He knows the purposes and some of the steps and needs to be taught again to regain his independence in monitoring his blood glucose level.

Learner’s Perception of Learning Needs

The patient is suffering from early stage or mild Alzheimer’s disease, and given the symptoms mentioned in the previous pages, it is important to improve the areas where he is still capable to do independently. The patient knows that he needs to be taught again on how to monitor his blood glucose as he said that he would want to do it again if only he can remember the procedures.

Learner’s Attitude towards Learning

The patient was keen and observant during the entire duration of assessment and teaching plan. He is suggesting that he wants to regain his independence in monitoring his blood glucose, as he knows how important it is to maintain an allowable blood glucose level. The patient, although was very slow in responding in words and in actions, was seen with great interest, as he hasn’t shown any signs of irritability. He was anxious in the start upon knowing that he will be pricked, but his anxiety was alleviated when he knew that only a few drops of blood is needed to perform the actual monitoring.

Social, Cultural and Physical factors that may affect Learning

Some of the factors that will affect the patient’s learning are his minor cognition and memory alteration as evidenced by confabulation, minor anterograde amnesia and retrograde amnesia, and loss of orientation to some daily tasks. He also has communication problems, as evidenced by difficulty speaking and understanding complex instructions/materials (Russell, et al, 2007). The patient is a 55-year-old man that would require, plus his mental problems, the importance of giving slow instructions and using simple words. He is and American-speaking patient. His families regularly visit him and maintaining close family ties with strong faith in Catholicism. His hobby includes reading and watching movies, and is a former writer for a publication.

Nursing Diagnosis

Ineffective health maintenance related to cognitive impairment as evidenced by observed and reported inability to take responsibility for meeting basic health practices (Doenges, et al, 2004).

Learner Objectives

Short-term goal

After the teaching plan, the patient will describe the importance of and demonstrate the proper ways of monitoring his blood glucose level.

Intermediate goal

On the succeeding time when the patient is scheduled to monitor his blood glucose level, he will perform the procedure the right way with minimum supervision.

Long-term goal

On the succeeding times when the patient is scheduled to monitor his blood glucose level, he will perform the procedure the right way without any supervision at all.

Topic and Outline

The patient will be taught of the equipments and their uses. The equipments that were used were a carrying case (containing all the necessary equipments), lancing device (depresses the lancet onto the skin), lancet (pricks the skin), test strip (holds the blood before testing by meter), self-test logbook (for baseline data) and the glucometer (measures the blood glucose level). Other equipments include dry cotton, surgical tape and pen.
The patient will be taught of the preliminary preparations before proceeding with the procedure. The first thing to do before the actual monitoring is to prepare all the materials because he will need all the equipments near him at all times. The next thing is to tell the patient to clean the lancing device with an antiseptic solution. After he has prepared these things, the next thing to do is to ask him to wash his hands to keep clean the procedure.
The procedure will first be discussed, and then demonstrated to the patient. After the patient has attached the lancet to the lancing device, he will then prick his fingertip in a very light manner. He will be asked to get the test strip and allow a drop of blood onto its surface. Then, he needs to cover and put pressure on the prick site with dry cotton and surgical tape. He then has to put the test strip on the glucometer and wait for a few seconds. When the glucometer displays an unchanging value, this is already his blood glucose level. Before meals, the normal range is between 90 to 130 mg/dL. After meals, the normal values are 180 mg/dL and below. After the procedure, he needs to be sure to note on his self-test logbook the result as this provides the baseline data of his blood glucose monitoring.

Methods and Materials

Resources used

The resources that were used were my knowledge and experience. We also used posted cardboard in his room with simplified step-by-step procedure of performing blood glucose level monitoring for his future reference, in case he gets lost along the middle of the procedure. A handout, especially prepared by myself, was given to the patient as a guide during the process of teaching plan.

Equipments used

The equipments that were used were a carrying case (containing all the necessary equipments), lancing device (depresses the lancet onto the skin), lancet (pricks the skin), test strip (holds the blood before testing by meter), self-test logbook (for baseline data) and the glucometer (measures the blood glucose level). Other equipments include dry cotton, surgical tape and pen.

Teaching strategies used

The teaching strategies that were used were discussion (before demonstration) and demonstration (actual return demonstration of the patient). The patient was given a cardboard of step-by-step procedure that he may need in the future.

Teaching sessions

The teaching session for the first encounter is approximately 20 minutes, covering all the activities from introducing myself to leaving the patient learned about the teaching plan. The succeeding meetings will depend on how quick the patient understands the teaching plan for the first time, and on how much memory he stores based on the discussion and demonstration.

Evaluation of Teaching Plan

From the first strategy of teaching that was used, which was discussion, the patient’s cognition was improved. His memory and understanding were given importance. From the demonstration strategy of teaching, the patient’s psychomotor was improved. His skills and ability to incorporate the discussion to the demonstration was given importance at this instance. Following the teaching plan, I made sure that I gave him the cardboard that contained a simplified step-by-step instructions that he might use for future references. The handout that we used during the duration of the teaching plan can be used by his accompanying relatives so they could guide the patient in the future in the absence of a health care provider.

Interpersonal Process Recording

Patient’s statement

My responses/comments

Analysis of the response/comment

“Good morning.”

“Yes, I’m in a clinic.

“Yes, it’s 8:00 in the morning.”

“I need the monitoring to be able to know if my blood sugar is still in the allowable range.”

“We’re in a clinic, and it’s 8:00 in the morning.”

“Ok, I prepare the things and wash my hands, then I’m ready for the procedure.”

“Yes they’re all clear, I’m ready to do it myself.”

“Sure.” (after a few minutes of demonstration…)

“Good morning, how are you today? My name is ______ and I’m about to teach you how to monitor your blood glucose level.”

“Do you know where you are?”

“Do you know what time it is?”

“If you are able to understand me, can you tell me why you need to monitor your blood glucose?”

“Can you tell me again where we are and what time it is?”

“Ok then, thank you. This is a handout; use this as we go on with this health teaching. So the first thing to do before the actual monitoring is to prepare all the materials because you’ll need all the equipments near you at all times. You’ll have to prepare a carrying case, lancing device, lancet, test strip, self-test logbook, and the glucometer. Other equipments include dry cotton, surgical tape and pen. Clean the lancing device with an antiseptic solution. After you prepare these things, the next thing is to wash your hands to keep clean the procedure.” (Hurd, 2007)

“That’s right, after the preliminary steps you’re now ready to prick the tip of your finger that’s most insensitive. After you attach the lancet to the lancing device, prick your fingertip in a very light manner. Get the test strip and allow a drop of blood onto its surface. Cover and put pressure on the prick site with dry cotton and surgical tape. Put the test strip on the glucometer and wait for a few seconds. When the glucometer displays an unchanging value, this is already your blood glucose level. Before meals, the normal range is between 90 to 130 mg/dL. After meals, the normal values are 180 mg/dL and below. After the procedure, be sure to note on your self-test logbook the result as this provides the baseline data of your blood glucose monitoring. (Hurd, 2007) Is the direction clear, or do you have clarifications?”

“That’s very good, can you demonstrate the procedure to me now?”

“You did well. Now, I have prepared a step-by-step instructions , all simplified, which you could hang in your room as your guide. You may keep your handout and give it to your immediate family member that provides you the primary care giving so she may also understand the procedure we have discussed.”

Builds rapport and reduces anxiety

Tests the patient’s orientation to reality

Tests the patient’s level of understanding

Tests the patient’s memory ability

Providing the patient a handout allows him to follow as you discuss the procedure. Assembling the equipments at the immediate reach of the patient saves time and effort. Performing hand washing keeps the sterility of the procedure.

Pricking the most insensitive tip of the finger and doing it lightly prevents hemorrhage. Putting pressure on the prick site promote blood clotting. Logging the result on the self-test logbook provides for future references. Clarifying for any questions allows the patient address questions that I might’ve skipped.

Allowing the patient to demonstrate the procedure tests his psychomotor improvement.

Providing the patient a simplified, step-by-step instructions will keep him on track in the future in case he gets lost in his self-blood glucose monitoring. Providing his immediate family member a copy of the handout lets them assist the patient in the future as he determines his blood glucose level.

References

Doenges, M., Moorhouse, M., Murr, A. (2004). “Nurses Pocket Guide: Diagnoses, Interventions and Rationales, 9^th Edition”. Philadelphia.

Hurd, R. (2007). Blood glucose monitoring. Retrieved October 7, 2008, from Healthline Networks. Web.

Russell, D., Segal, J., White, M., (2007). Alzheimer’s Disease: Signs, Symptoms and Stages. Web.

Sabayan, B., Foroughinia, F., Mowla, A., Borhanihaghighi, A. (2008). Role of Insulin Metabolism Disturbances in the Development of Alzheimer Disease: Mini Review. American Journal of Alzheimer’s Disease and Other Dementias, Vol. 23, No. 2.

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