What type of education would be appropriate for you to provide for Mrs Afualo and her family prior to her discharge?
A 60-year-old female patient, Mrs Teuila Afualo, presents at the day surgery unit (DSU) for an open repair of an umbilical hernia at 8 am. She is of Islander background and has brought several of her family members with her. On admission, you calculate her body mass index (BMI) to be 38, note that her respirations are shallow and rapid, and that she appears to be extremely anxious.
Her medical history highlights that she has type 2 diabetes, which is managed with metformin, although she tells you that she has not been diligent about taking or recording her blood glucose level (BGL) regularly. She also informs you that a ‘couple of months ago' her GP prescribed tablets to treat her cholesterol and her blood pressure but she can't remember the names of them, and her son doesn't know them either. She has not taken any of these medications prior to her admission, her reason being that she was fasting. Her BP is 160/90 mmHg and her fasting BGL is found to be 12 mmol/L.
You also identify that Mrs Afualo did not attend the preadmission clinic. She explains that she could not attend because her son was not available to drive her. Consequently, she has not had a preoperative chest X-ray (CXR) or any blood tests as per her surgeon's protocols. A check of Mrs Afualo's consent form in the presence of her son reveals it has not been signed and that she is somewhat confused about her intended surgery.
What will be an ideal response?
Answer:
You need to consider several aspects of Mrs Afualo's health. The immediate postoperative surgical issues include appropriate wound care and ensuring that she has an appointment to see her surgeon post-discharge.
You could discuss the need for Mrs Afualo to see a diabetes educator and dietician. If possible, make appointments for her with one or both of these health professionals, to occur on the same day she sees her surgeon. Discuss this with her son present, as he will need to bring her to these appointments.
The importance of exercise strategies should be stressed, and Mrs Afualo provided with appropriate/achievable exercise activities.
Regular testing and recording of her BGL needs to be reinforced—discuss with Mrs Afualo an approach to this that she finds acceptable.
Likewise, it is necessary for you to emphasise the need for her to take her medications daily, and indicate that, depending on the medications, taking them at the same time each day (usually breakfast time) is a good approach. Remind her (and her son) to check her medications as soon as she gets home, write down their names and keep the information (say) in her purse.
The following day, you make the postoperative phone call to Mrs Afualo. During this conversation, she states she was very grateful for all of the care that was provided prior to her surgery and how she felt she had been a burden to everyone.
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