The wife of an older man who has diabetes mellitus brings him to primary care. He has severe bilateral infections forming black rings around each ankle. He tells the nurse it is caused by tight shoes

Question

Which intervention should the nurse implement first to investigate this individual's health care regimen? a. Examine his health insurance coverage.
b. Question the man without the wife present.
c. Consult with social services about neglect.
d. Analyze his glycosylated hemoglobin lev-el.

Answer 1

D
Infected, black rings around both ankles of an individual who has diabetes is a potential clinical indicator of prolonged hyperglycemia because of nonadherence, neglect, or abuse. To begin the assessment of his health care regimen, the nurse checks his glycosylated hemoglobin to quantify his exposure to hyperglycemia. This is the best intervention because the nurse fulfills the duty owed to the patient by implementing a patient-focused action.
Although the nurse might be suspicious of potential abuse or neglect and because it is doubtful that tight shoes have caused the rings, the nurse's priority is the older adult. Information about his health insurance can provide clues about nonadherence to therapy if the insurance pro-vider denies coverage for diabetic supplies or other necessary health care services. Questioning the man without the wife present is a low priority for the nurse who is faced with a patient who has such a serious health problem. Although the nurse can gather clues concerning the origin of the patient's infection by questioning him without the wife present, talking to him in privacy does not guarantee that he will be forthcoming with information or will be a reliable source of information. Consulting with social services about neglect is secondary to his physical needs and a premature intervention because the nurse has not completed an assessment. However, when the nurse completes the patient assessment and gathers evidence supporting a claim of abuse or neg-lect, social services is a valuable resource for connecting the older adult to community services. The nurse should follow agency policy regarding abuse and neglect.