Case Story

As you can tell, I am a senior nursing student that is passionate about making sure that my patients understand the information that I am educating them about. I have many situations that I have come across, whether in clinicals, at work at the hospital, and from hearing stories from friends and family about time when an elderly person was hospitalized or had their health threatened because they didn’t understand what the doctor said to them at their appointment.

                Let me tell you about a patient that I once cared for. I will name him AJ. AJ was a 76 year old male who suffered from many comorbidities, which included hypertension, diabetes, kidney failure, and a new-onset cancer diagnosis that involved metastasis to the liver and pancreas. AJ came to the Emergency Department via Ambulance because he was at home when he started to feel sweaty, had the chills, felt lethargic, had frequent urination, felt weak and had abdominal pain. He lived alone at home and rarely saw his physician because he never really understood what they were saying anyways. He also had limits resources, so paying for medical bills was difficult for him.

                So what was wrong with AJ? AJ’s cancer has spread to his pancreas and his insulin production and diffusion into his blood system was abnormal. AJ was never really given a thorough explanation about his metastasis diagnosis, was never explained what the pancreas was and what it contributed to his body. AJ was also told to monitor his blood sugar and was given a “sliding scale” for insulin injections, but was never educated to the fullest of his ability about how to take an accurate blood sugar, how to use the sliding scale, and how to give himself proper insulin injections. The lack of education that AJ was given and then sent home with a complex diagnosis and complex at-home health regimen, made him feel overwhelmed and that he would just “skip it all and hope all went well”. AJ was admitted to the hospital with Diabetic Ketoacidosis. According to MayoClinic.org, “Diabetic Ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours”. “You may notice: excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, and confusion.” Basically, AJ had an extremely high blood sugar that his pancreas was not able to decrease because it contained metastatic cancer prohibiting its functioning.

                But why did this happen? AJ had a low health literacy in the first place, but also because the physician and the nurse that was teaching AJ about his condition and his health maintenance never fully explained what his diagnosis meant, how to avoid health complications, and why it is so important for AJ to keep up with his blood sugars, as Diabetic Ketoacidosis can be life threatening.

                This is why I am so passionate about teaching the elderly population correctly and effectively about their health and their health maintenance regimen. If we can effectively teach the elderly population, we can avoid life-threatening situations like AJ’s. AJ obviously didn’t understand many teaching points that may or may not have been brought up at his doctor’s appointments. If he had, he could have monitored his blood glucose better, gave himself insulin correctly, avoided Diabetic Ketoacidosis, and avoided a hospital admission that comes with expenses and exposure to other pathogens while the body is immuno-compromised.

Resources:

Diabetic ketoacidosis. (n.d.). Retrieved September 21, 2015, from 

http://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/basics/symptoms/con-20026470