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The diagnosis of diabetic neuropathy suggested in this post seems to be the most suitable condition for the case. The patient’s complaint of increasing tingling sensation in the lower extremities is one of the major signs of peripheral neuropathy (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). Moreover, his history of type 2 diabetes, obesity, and dyslipidemia are among the primary risk factors for this disorder (Pop-Busui et al., 2017). According to Pop-Busui et al. (2017), the diagnosis of diabetic neuropathy can be confirmed by exclusion, so many tests (that are listed in the post) should be performed before suggesting treatment options. However, some lifestyle changes and learning programs can be suggested immediately.
It is vital to note that the patient lost his medication and skipped a week’s worth of doses – all medications should be continued to control his hypertension, cholesterol levels, and diabetes. His attitude towards the medical plan shows that education about medication is necessary. Powers et al. (2017) outline the crucial role of diabetes self-management support (DSMS) and diabetes self-management education (DMSE) for patients with type 2 diabetes. Thus, the nurse should consider referring the patient to these programs for him to discuss his current needs. For example, he can talk about creating a support network since he lives alone and it may be challenging for him to get help or receive positive reinforcements. The initiatives centered on learning and support also address people’s health literacy and financial status. In this case, the patient’s lack of attention to his medication should be a priority since diabetic neuropathy requires strict glucose control apart from medical solutions (Pop-Busui et al., 2017). Additional advice includes a healthy diet (that aligns with considerations about glucose levels) and exercise.
The fact that the patient did not take any medications for a week may raise many concerns about his well-being. First of all, the diagnosis of diabetic neuropathy seems to correlate with all symptoms and the physical examination of the patient (Pop-Busui et al., 2017). The diagnostic tests suggested in the post will help the specialist to confirm the presence of neuropathy. The patient’s cholesterol levels have to be addressed primarily because the patient’s low adherence to controlling medications may raise his risk of heart problems (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). Reviewing the patient’s current medication plan and discussing it with him is essential. Perhaps, he will benefit from developing a system of reminders to take medication on time or keep it with him in a special container. The addition of pregabalin or duloxetine to the drug treatment is in line with the latest recommendations for relieving neuropathic pain (Pop-Busui et al., 2017). These medications are the first-line treatment for this condition.
Apart from revising the patient’s pharmacological treatment plans and suggesting educational programs, the nurse can advise the man on some lifestyle changes. For example, one may discuss the current diet with the patient and see whether any changes should be made. Other topics for discussion include his living conditions, physical activity, support networks, and counseling. According to Albers and Pop-Busui (2014), diet and exercise are connected to improvements in patients with diabetic neuropathy. The combination of education, lifestyle changes, and drug therapy should prepare the patient for further self-management efforts and strengthen his confidence and autonomy. The suggestion to refer the patient to a social worker is valid because another specialist will help the man to adapt to his new lifestyle.
References
Albers, J. W., & Pop-Busui, R. (2014). Diabetic neuropathy: Mechanisms, emerging treatments, and subtypes. Current Neurology and Neuroscience Reports, 14(8), 473.
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Pop-Busui, R., Boulton, A. J., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A.,… Ziegler, D. (2017). Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care, 40(1), 136-154.
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H.,… Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53.
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