Running

head: SERVICE LEARNING PROJECT PLAN 1

Your name:

Lyubov Kirillov

Date:

10/11/17

Community or population of interest:

According to American Diabetes Association (2017) 30.3 million Americans, or 9.4% of the
population had diabetes, and it remains the 7th leading cause of death in the United States in
2015. The prevalence of seniors age 65 and older with diabetes diagnosed and undiagnosed
remains high at 12 million or 25.2% (p. 1).
According to City of San Antonio Metropolitan Health District (2013) more than 1 in 7 San
Antonio (Bexar county) residents have been diagnosed with Diabetes type II, and 16% of people
in Bexar county have Diabetes type II compared to 10% in the state of Texas, and 9% in the
entire United States (p. 1). The prevalence of diabetes in Bexar county by race is as follows:
Whites 8%, Blacks 12%, and Hispanics 16%. The prevalence of diabetes in Bexar county by age
is as follows: age 25-34 2%, 35-44 11%, 45-54 12%, 55-64 25%, and 65+ 30%. Another note of
diabetes prevalence according to San Antonios Metropolitan Health District (2013), it is evident
that people who did not graduate from college are twice as likely to develop diabetes than people
who finished college. Only 7% of college graduates will get diabetes compared to 15% who
uttended some college or never attended college (p. 1).

Review of literature and health outcomes data:

Diabetes, especially uncontrolled diabetes can lead to serious health issues such as retinopathy,
diabetic foot ulcers, heart disease, kidney disease, and cognitive decline.
It is estimated that 93 million people suffer from diabetic retinopathy, 17 million with
proliferative diabetic retinopaty, 21 million with diabetic macular edema, and 28 million with
vision threatening diabetic retinopathy worldwide. The risk factors for diabetic retinopathy are
longer diabetes duration, poor glycemic control, and uncontrolled hypertension (Yau et al., 2012,
p. 565).
Diabetic foot ulcers lead to lower extremity infections that are hard to manage even with an
aggressive antibiotic treatment, which in the patients final outcome leads to amputations.
According to Dominic et al. (2015) Approximately 120,000 nontraumatic lower extremity
amputations are performed each year, with 80% preceded by a neuropathic foot ulcer (p. 299).

Patients with diabetes have comorbid factors such as hyperlipidemia-increased levels of LDL
cholesterol, and hypertension-high blood pressure, leading to cardiovascular events such as
myocardial infaction or heart attack. Most diabetic patients do not have A1C, hypertension, and
hyperlipidemia under control (Morrison et al., 2012, p. 334).
SERVICE LEARNING PROJECT PLAN 2

Your selected health concern focus:

Diabetic foot ulcers, skin integrity and amputations. Many times patients present on a med-surg
floor with a cellulitis in lower extremeties or an unhealing wound due to diabetes that turns out
to be gangrenous, this leads to incision and draninage, and placement of a wound vac, or below
knee amputation. The major risk factor for unhealing or slow healing wounds, or amputations is
an uncontrolled diabetes and knowledge deficit regarding the disease.

Three possible nursing interventions:

Skin integrity: teach the patient to care for his or her feet, not to go outside without shoes, advise
to see a Podiatrist regularly especially if patients begin to experience neuropathy. Dominic et al.
(2015) stressed that nurses are responsible in educating patients and family the disease
management, and are crucial in prevention of neuropathic ulcer prevention (p. 299). The
pathophysiology of diabtetic foot ulcers in MEDSURG Nursing, explained as Injury to the soft
tissue of the foot, compounded by vascular complications of diabetes, leads to decreased
perfusion and healing time of the lower extremity. This sequence of events eventually results in a
sharp increase of infection and subsequent neuropathic ulceration (Dominic et al., 2015, 300).

Monitor the effects of diabetes on cardiovascular, nervous, and renal systems: recommend to the
patient to see an ophthalmologist on a regular basis. The American Society of Ophthalmic
Registered Nurses recommends for patients with diabetes to adhere to eye appointments because
it it allows them access to vision saving, evidence-based care for diabetic retinopathy (Catalan et
al., 2015, p. 15).

Teach: signs and symptoms of hyperglycemia and hypoglycemia, and the effects of extra insulin
or the lack of insulin. Educate on benefits of lifestyle changes to include diet and exercise that
will help control hyperglycemia, hypertension, and hyperlipidemia. According to Morrison et al.
(2012) lifestyle counseling is associated with faster achievement of A1C, blood pressure, and
LDL cholesterol control in routine patient care (p. 340).

Your selected nursing intervention:

Education on skin integrity and glycemia control. The three goals of the skin integrity and
glycemia control education are: 1) to increase patients compliance with their health care
regimen by creating a customized health plan for each patient based on the shared goals between
patients and their healthcare team, 2) to improve compliance with all diabetic related
appointments over a period of one year, and 3) to decrease the risk of amputations, diabetic foot
ulcers, and diabetic related events such as diabetes ketoacidosis, or hypoglycemia related coma
or death.

Brief plan for conducting nursing intervention:

SERVICE LEARNING PROJECT PLAN 2

Assess patients diabetic medication regimen. What kind of medication and how much does the
patient take? Teach the effects of taking extra units of insulin, or the consequences of not taking
insulin, or taking insulin without eating a meal. Teach about the events that can happen in case of
uncontrolled diabetes.
Educate patients on skin integrity and stress the importance of foot wear especially when going
outside, and seeing a Podiatrist regularly specifically when the patient begins to feel neuropathy
in lower extremities. Provide information on foot ulcers prevention and care, and the outcome of
unmanaged foot ulcers. Asses patients understanding of teaching by requesting a patient to
demonstrate return education on skin integrity and glycemia control. Once the patient
demonstrates understanding of the teaching, customize a care plan based on the patients shared
goals.

References
Catalan, N., Jackson, D., Greenberg, P. (2014, October 1). Patient-centered care for diabetic

retinopathy: A nursing initiative for patient education. The Journal of the American

Society of Ophthalmic Registered Nurses, p. 15-17. Retrieved from

http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=30&sid=fdbf4ecc-1884-4ad2-

ad75-6fc5602f32a7%40sessionmgr4006

Chronic disease prevention program: Type 2 diabetes in Bexar county. (2013). City of San

Antonio Metropolitan Health District. Retrieved from

https://www.sanantonio.gov/Portals/0/Files/health/HealthyLiving/FactSheet-Diabetes.pdf

Dominic, S., Visovsky, C., Rice, J. (2015, September 1). A Nurses Guide to the Prevention of

Neuropathic Ulcers in Patients with Diabetes. MEDSURG Nursing, 24(5): 299-308.

Retrieved from

http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?vid=14&sid=d61ab7b2-3714-49aa-

ba4d-d52f6f78d70b%40sessionmgr103

Morrison, F., Shubina, M., Turchin, A. (2012). Lifestyle counseling in routine care and long-

term glucose, blood pressure, and cholesterol control in patients with diabetes. Diabetic

Care, 35(2): 334-341. n doi:10.2337/dc11-1635. Retrieved from

SERVICE LEARNING PROJECT PLAN 2

https://dash.harvard.edu/bitstream/handle/1/10594299/3263885.pdf?sequence=1

Statistics about diabetes. (2017, July 19). American Diabetes Association. Retrieved from

http://www.diabetes.org/diabetes-basics/statistics/?referrer=https://www.google.com/

Yau, J., Rogers, S., Kawasaki, R., Lamoureux, E., Kowalski, J., Bek, T., . . . Wong, T. (2012).

Global prevalence and major risk factors of diabetic retinopathy. Epidemiology/Health

Services Research, 35:556-564. Retrieved from

http://care.diabetesjournals.org/content/diacare/35/3/556.full.pdf