Diabetes patient
Reason for Referral: Carole Lund a 44 year old, mixed Native American and European descent, and a new mother. She is concerned that she is not recovering from gestational diabetes.
Situation:
Carole is here with her daughter, Kassandra, who is 10 weeks old. Carole was diagnosed with gestational diabetes at week 30 of her pregnancy. She has carefully logged her blood glucose since the diagnosis and it shows 150-200 fasting, over 200 following meals.
Assessment
Q- what diabetes treatments did you receive during your pregnancy?
A- Well, they gave me a glucometer, so I started using that. I could see right away that the way I was eating was a problem; I would usually work straight through the day and then have one big meal in the evening, and that was making my numbers bounce all over. So I set alarms on my laptop, so three times a day I would get interrupted, have a small meal, take a short walk, and then test my blood sugar. That helped. And then I stopped drinking juice and soda, which I should have done years ago, and that helped too. But I don’t think my numbers improved as much as my OB/GYN wanted them to, but she said my blood sugar should return to normal after delivery.
Q-Did your obstetrician advise you to take insulin during your pregnancy?
A- She did, yeah, and we talked about it. I don’t like the idea of being dependent on a drug. I called my mother. She’s still on the reservation, so she called the elders, and we all agreed that injecting my body with an animal hormone was a bad idea. But then the doctor told me that they make synthetic insulin now, but that means it’s made in a laboratory somewhere, and I’m not sure that’s any better. By then I was in my third trimester, and all the tests said Kassandra was big but healthy, so I thought we would just ride it out. It was supposed to clear up after she was born. But it hasn’t, and I know you must be careful having a baby my age. I want to do what’s best, but I don’t want to believe that insulin is my only option.
Q-Are there any challenges in your life that you think maybe interfere with your ability to follow a treatment plan?
A- It’s harder now than it was before she was born. It’s just the two of us in the apartment, which is wonderful, but I don’t remember the last time I had a good night’s sleep. A lot of my work is freelance, so I make my own hours, but that also means if I’m not working, I don’t get paid. I had family help while I was recovering from the C-section, and they helped cook healthy meals for me, and kept me on my schedule. Now it’s all on me — work, caring for my daughter, and managing my blood sugar. If I fall behind on anything, it will be looking after my health.
Q-Do you have any other concerns you would like to have addressed?
A- I worry about Kassandra. She’s healthy and perfect, but I know that she’s at a greater risk for developing Type 2 Diabetes. I want to do whatever I can to reduce that risk, to care for her, and as she grows, to teach her how to care for herself.
Concept Map
Based on the above patient information follow the following guidelines to complete the paper
Integrate relevant evidence from 3–5 current scholarly or professional sources to support your assertions.
Part 1: Concept Map
· Develop a graphical concept map for the patient based on the best available evidence for treating your patient’s health, economic, and cultural needs.
. Many organizations use the spider style of concept maps (see the Taylor and Littleton-Kearney article for an example)..
. If a particular style of the concept map is used in your current care setting, you may use it in this assessment.
