T.A. is at increased risk of infections due to several factors. To start with, He admits smoking one pack of cigarettes per day. As a result, he is at risk of developing lung cancer and cancer of the mouth, throat, lips, kidney, stomach, and other organs. Furthermore, smoking leads to increased risk of the following conditions: heart attack, cerebrovascular disease, coronary heart disease, peripheral vascular disease, emphysema, chronic bronchitis. These conditions are likely to weaken his immune system. As a result, his is prone to infections. T.A.’s laboratory results also show hemoglobin A1C level of 7.9% and serum glucose level of 388mg/dL. The A1C of 7.9% implies that he has been hyperglycemic for the last three months. The prolonged hyperglycemia predisposes T.A. to the damage to the blood vessels and nerves. The damaged nerves in the feet can lead to serious infections. Such infections can even lead to amputations. T.A. is also obese as evidenced by the BMI of 33Kg/m2 (Ferrera, 2005). Some of the mechanisms by which obesity interferes with the immune system are; decreased cell-mediated immune responses, respiratory dysfunction, obesity-related dysregulation of the immune system, and co-morbidities related obesity (Huttunen and Syrjänen, 2013). Therefore, T.A. is at and an increased risk of infections due to his obesity.
Further interventions need to be performed in the case of T.A. some of the further assessments that should be performed include the assessment of total serum cholesterol and serum LDL. The serum triglyceride level should also be performed to determine the patient’s level of risk of obesity-related conditions. ECG should also be performed to assess the underlying causes of tachycardia in the patient. Further laboratory tests are also recommended. In this case, there is the need For FBC to determine whether anemia could be the cause of the low oxygen saturation level. Tests for diabetic retinopathy should also be conducted. The recommended tests, in this case, are; visual acuity testing, gonioscopy, ophthalmoscopy and slit-lamp exam, and tonometry.
The intervention that should be given the priority in the case of TA is the administration of supplemental oxygen to boost oxygen saturation level. Therefore, the supplementation of oxygen at 2L per nasal cannula should be the priority. The next intervention after oxygen supplementation should be aimed at lowering the glucose level. In this case, NovoLog (insulin aspart) sub cut per sliding scale ac/hrs is recommended.
If T.A. seeks to know why he is put on insulin in the hospital while he does not take the drug while at home, I would inform him that insulin is recommended whenever the control of blood sugar level remains inadequate despite the patient taking diabetic pills and adhering to lifestyle changes. I would inform him that his level of glycated hemoglobin has been found to be 7.9%, thus exceeding 7%, the maximum cutoff point for the normal level of glycated hemoglobin (Feinglos and Bethel, 2008). I would further explain to him that his previous medication, metformin, was intended to achieve an adequate level of blood glucose control. However, it did not meet that goal. Consequently, insulin is given to boost the blood glucose control.
In terms of foot care, I would emphasize on the measures to be taken to reduce the chances of the foot infection. In this case, I would tell him the measures to take while protecting his feet by wearing shoes and socks. Some of such measures include the need to avoid high-heeled shoes and avoiding tight socks. I would also teach the patient the need to and how to; wash and dry his feet daily, take care of his toenails, exercise carefully, and wash and dry his feet daily. Apart from teaching the patient about foot care, I would teach him on good nutritional practices, exercise, and lifestyle changes. In terms of lifestyle changes, I would teach him the need to stop smoking. In this case, I would tell him the approaches to take to drop the behavior.
Feinglos, M. N., & Bethel, M. A. (2008). Type 2 diabetes mellitus: An evidence-based approach to practical management. Totowa, NJ: Humana Press. P.102
Ferrera, L. A. (2005). Body mass index: New research. New York: Nova Biomedical Books. P.94
Huttunen, R., & Syrjänen, J. (2013). Obesity and the risk and outcome of infection. International journal of obesity, 37(3), 333-340.