Grand theories

Mr. Juan Duran is a 60-year-old patient who has been coming to the diabetes clinic at the VA for a few months. One day, the clinic director, Jim Carlson, finds him wandering the hallway, appearing somewhat dazed, with a bag of supplies for blood glucose testing and insulin administration. Mr. Duran tells him that he has been instructed to start insulin for his diabetes but doesn’t know how. He doesn’t recall receiving any appointment or instructions. Mr. Carlson finds the diabetes nurse educator, Jenny O’Connell, and asks her to fit Mr. Duran in for an unscheduled appointment.

Jenny O’Connell starts the appointment with a thorough assessment of Mr. Duran. In addition to the physical assessment, she covers psycho-social-spiritual issues. She discovers that Mr. Duran has had diabetes for about 10 years, and, recently, his blood glucose levels and HgbA1c cannot be controlled with oral medications and exercise. The physician wants to start him on insulin. Here are notes that she


 

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