Nursing Care Plan for Diabetic Neuropathy Report
Jose is sixty-three years old, and he is suffering from diabetic neuropathy. According to the chief concerns, his diabetic neuropathy is classified as peripheral. Jose presents with severe pain in toes, feet, and legs. The major cause of pain is nerve damage in the legs which is evident through burning sensation, extreme sensitivity, and feet numbness. The healthcare provider has the mandate of maintaining the blood glucose levels close to the normal range in order to protect nerve damage throughout the body. Major diagnosis involves physical examination of blood pressure, temperature, heart rate, reflexes, and sensitivity. Medications that Jose received are pain relievers such as gabapentin, acetaminophen, and tramadol. Foot care involves quitting smoking and .
Jose is 63 years old, born in Portugal, and lives in Canada. Jose main health issues are leg pains, touch sensitivity, and feet numbness. History of illness shows that Jose had been diagnosed with Type II diabetes mellitus and . The patient has a sedentary lifestyle and uses tobacco.
Nursing diagnosis involves pain management in feet, obesity, coronary artery disease, and peripheral vascular disease. According to Perry and Potter (2009), frequent tests on blood glucose, urinalysis, and kidney biopsy are essential for early diagnosis of the diabetic neuropathy. Extreme sensitivity that Jose is experiencing is called hypersensitivity, and it occurs due to damage of nerve fibers. Jose is suffering from peripheral neuropathy. Peripheral neuropathy is caused by nerves damage that directly affects the toes, legs, arms, hands, and feet. Calf muscle pain is due to stretching of the calf muscle beyond the tension limit (Ackley & Ladwig, 2013).
Subjective and Objective Data
Subjective date involves examination of subjective symptoms such as nocturnal pain in the legs, nerve conduction on the lower limbs, and knee jack reflex effects. Objective data involve records of clinical evaluation such as parameters of good diabetic control. Some of the parameters of good diabetic control are daily monitoring of blood glucose, daily urine tests for glucose, and heart monitoring. Heart monitoring involves recording changes in the heart electric activity (Perry & Potter, 2009).
Healthcare provider identifies that Jose has normal blood pressure, regular pulse rate and a body temperature of 370C. The patient has complete loss of sensation in feet and is allergic to morphine sulfate. Ackley and Ladwig (2013) argue that, the reduction in tobacco intake will improve the . Physical exercises are essential for management of pain and increases nerve conduction.
The name and age of the patient are correctly addressed for easy identification and follow-up. According to Cross and Rimmer (2002), close monitoring of vital signs of peripheral neuropathy is essential in order to provide baseline of correct medication. The patient gets administered with acetaminophens, gabapentin, and amitriptyline to help in relieving diabetic nerve pain. After careful assessment, Jose should withdraw amitriptyline because he shows no signs of depression. There is a likelihood of the increase in dosage of gabapentin and acetaminophen to manage the increasing rate of pain.
Joses pain is mostly in the feet due to muscle weakening and his sedentary lifestyle after retiring from his factory duties. Additionally, some of the damaged nerves damage may be relating essential information to the feet. The major symptoms of peripheral neuropathy are severe pain in foot, circulation problem that result to feet numbness and reduced knee jack reflexes (Cross & Rimmer, 2002). Possible approached in management of Joses condition are physical therapy, massage, gabapentin, and tramadol medication.