TEACHING PLAN 1.

Teaching plan for patients with DIABETE MELLITUS TYPE 2 DESCRIPTION OF THE LEARNER: The client is Mrs. LEV (Patients Initials), a 66 year old female who was recently diagnosed of having Diabetes Mellitus Type 2. She is a retired government employee and prefers to eat lots of meat. The client verbalizes that she lacks in-depth knowledge on her case and on its proper management. She has no visual or hearing problems that may interfere with the learning process. Tagalog and English are the preferred media of instruction. LEARNING NEED: Overview of Diabetes Mellitus Type 2, also the management and importance of adhering to DM treatment regimen. LEARNING DIAGNOSIS: Deficient Knowledge: Overview, management and importance of adhering to DM treatment regimen related to unfamiliarity if information resources as manifested by Hindi ko alam na diabetic pala ako, Bakit ganito ang pinapakain sa akin? as verbalized by the client. GOAL: After 1-2 hours of health education, the learner will be able to know the overview of her case, its management and the importance of compliance to treatment regimen. Learning Objectives Upon completion on the overview of DM Type 2, management and importance of adhering to DM treatment regimen, the learner will be able to: State in her own words what Diabetes Mellitus Type 2 is. Enumerate 4 symptoms of DM Type 2 correctly. Learning Content Learning Strategies and Activities Time Allotment and Resources Needed Outcome Criteria Method of Evaluation

Brief and concise definition of DM Type 2.

LectureDiscussion

Different symptoms of DM Type 2 (at least 5).

LectureDiscussion

Time allotted for health education is 12 hours. Use of brochure. Time and effort of both the learner and the student nurse.

FULLY MET if: The learner will be able to state what DM type 2 is in her own words, enumerate 4/4 symptoms of DM type 2 correctly, cite 4/4 management approaches to DM type 2, properly demonstrate SMBG and identify 3/3 complications of DM type 2.

Instant Oral Feedback; the learner will be able to give feedbacks on the topics to be discussed. Question and

 Cite 4 management approaches to DM Type 2 accurately. Properly returndemonstrate self-monitoring of blood glucose (SMBG) with use of Capillary Blood Glucose (CBG) kit. Identify 3 complications of DM Type 2.

Management approaches to DM Type 2 including diet. Demonstrate how to monitor blood glucose with the use of CBG kit.

LectureDiscussion

Return Demonstration

PARTIALLY MET if: The learner will be able to state DM type 2 in her own words, enumerate 2/4 symptoms of DM type 2, cite 2/4 management approaches to DM type 2, properly return demonstrate SMBG and identify 1/2 complications of DM type 2. NOT MET if: The learner will not be able to state what DM type 2 is in her own words, enumerate 0/4 symptom of DM type 2, cite 0/4 management approaches to DM type 2, not able to properly demonstrate SMBG and identifies 0/3 complications of DM type 2.

Answer; the learner will be able to answer the questions to be asked during the health teaching. Return Demonstrati on; the learner will be able to redemonstrate the procedure done by the health educator.

Complications of DM Type 2.

LectureDiscussion

Learning Content: I. OVERVIEW OF DIABETES MELLITUS TYPE 2 Unlike people with type 1 diabetes, the bodies of people with type 2 diabetes make insulin. But either their pancreas does not make enough insulin or the body cannot use the insulin well enough. This is called insulin resistance. When there isn't enough insulin or the insulin is not used as it should be, glucose (sugar) can't get into the body's cells. When glucose builds up in the blood instead of going into cells, the body's cells are on properly. Other problems associated with the buildup of glucose in the blood include:

Damage to the body. Over time, the high glucose levels in the blood can damage the nerves and small blood vessels of the eyes, kidneys, and heart and lead to atherosclerosis, or hardening of the arteries that can cause heart attack and stroke. Dehydration. The buildup of sugar in the blood can cause an increase in urination, causing dehydration. II. SYMPTOMS OF DIABETES MELLITUS TYPE 2 Very often, people with type 2 diabetes will have no symptoms. When symptoms of type 2 diabetes happen, they vary from person to person and include: 1. Increased thirst 2. Increased hunger (especially after eating) 3. Increased urination 4. Numbness or tingling of the hands or feet III. MANAGEMENT APPROACHES TO DIABETES MELLITUS TYPE 2 1. Appropriate goal setting - to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction, through control of glycemia. 2. Dietary and exercise modifications - Modest weight losses of 5-10% have been associated with significant improvements in cardiovascular disease risk factors. 8 principles of low-glycemic eating 1. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts. 2. Eat grains in the least-processed state possible: unbroken, such as whole-kernel bread, brown rice, and whole barley, millet, and wheat berries; or traditionally processed, such as stone-ground bread, steel-cut oats, and natural granola or muesli breakfast cereals.

3. Limit white potatoes and refined grain products such as white breads and white pasta to small side dishes. 4. Limit concentrated sweetsincluding high-calorie foods with a low glycemic index, such as ice cream to occasional treats. Reduce fruit juice to no more than one cup a day. Completely eliminate sugar-sweetened drinks. 5. Eat a healthful type of protein at most meals, such as beans, fish, or skinless chicken. 6. Choose foods with healthful fats, such as olive oil, nuts (almonds, walnuts, pecans), and avocados. Limit saturated fats from dairy and other animal products. Completely eliminate partially hydrogenated fats (trans fats), which are in fast food and many packaged foods. 7. Have three meals and one or two snacks each day, and dont skip breakfast. 8. Eat slowly and stop when full.
Adapted from Ending the Food Fight, by David Ludwig with Suzanne Rostler (Houghton Mifflin, 2008).

3. Medications 4. Appropriate self-monitoring of blood glucose (SMBG) IV. SELF MONITORING OF BLOOD GLUCOSE 1. Wash your hands and dry them well before doing the test. 2. Use an alcohol pad to clean the area that you're going to prick. For most glucose meters, you will prick your fingertip. However, with some meters, you can also use your forearm, thigh or the fleshy part of your hand. Ask your doctor what area you should use with your meter. 3. Prick yourself with a sterile lancet to get a drop of blood. (If you prick your fingertip, it may be easier and less painful to prick it on one side, not on the pad.) 4. Place the drop of blood on the test strip. 5. Follow the instructions for inserting the test strip into your glucose meter. 6. The meter will give you a number for your blood sugar level. For someone who has severe diabetes, continuous blood sugar monitoring may be a viable option.

V.

COMPLICATIONS OF DIABETES MELLITUS TYPE 2 If your type 2 diabetes isn't well controlled, there are a number of serious or life-threatening problems you may have, including: Retinopathy . People with type 2 diabetes may already have eye problems related to diabetes. Over time, more and more people who initially do not have eye problems related to the disease will develop some form of eye problem. It is important to control not only blood sugar but also blood pressure and cholesterol to prevent eye disease from getting worse. Fortunately, the eye problems aren't bad in most people. 2. Kidney damage . The risk of kidney disease gets worse over time, meaning the longer you have diabetes, the greater your risk. If not caught early, kidney damage can lead to kidney failure. 3. Poor blood circulation and nerve damage. Damage to the blood vessels can lead to a higher risk of stroke and heart attack as well as peripheral artery disease. Damage to nerves and hardening of the arteries leads to worse sensation and poor blood circulation in the feet. This can lead to more infections and a higher risk of skin ulcers, which significantly raise the risk of amputation. Damage to nerves may also lead to digestive problems, such as nausea, vomiting, and diarrhea.
1.

Sources:
http://www.helpguide.org/life/healthy_diet_diabetes.htm http://diabetes.webmd.com/guide/type-2-diabetes?page=2 http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes/treatment/monitoring-your-blood-sugar-level.html