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Before you begin your teaching plan be sure to define the characteristics of the clinical site and patient population. The teaching plan should be customized to this population. This is a sample teaching plan that you can use and customize to your needs. You may want to design a pre-test and post-test to give your patients would are attending the teaching program. Based on statistics from the Centers for Disease Control website, 17.0 million people in the United States, approximately 6.2% of the population, have diabetes. Of this 17 million people, 11.1 million are diagnosed and 5.9 million are undiagnosed. In the different age groups, about 151,000 people less than 20 years of age have diabetes, approximately 0.19% of people in this age group. In the 20 and older age group 16.9 million and 8.6% of people have diabetes. The 65 and older age group has 7.0 million and 20.1% of all people with diabetes (www.cdc.gov/diabetes).
2. The patient will be able to demonstrate proper skin and foot care. 3. The patient will be able to perform self-monitoring of blood glucose using a blood glucose meter as evidenced by demonstration of the technique to the nurse or nurse practitioner. 4. The patient will be able to describe the benefits of regular exercise and how regular exercise can improve blood glucose control.
Teaching Plan
The diabetes teaching plan is aimed at helping the patient make educated lifestyle choices and changes that will promote health and promote a stable blood sugar. Each patient needs a comprehensive treatment approach. This includes: (a) an individualized food/meal plan appropriate for his/her lifestyle, (b) education related to diabetes and nutrition therapy, and (c) mutually agreed-upon short term and long term goals for lifestyle changes. The teaching plan should stress the importance of complying with the prescribed treatment program. This teaching plan should be tailored to the patients needs, abilities, and developmental stage. The teaching plan for a patient with diabetes should include: diet, administration, possible adverse effects of medication, exercise, blood glucose monitoring, hygiene, and the prevention and recognition of hypoglycemia and hyperglycemia (McGovern, 2002). The teaching plan is an education program designed to help patients with newly diagnosed diabetes or patients who need a review of concepts for managing their diabetes. However, diabetes management requires ongoing education and nutritional advice with regular review and modification as the disease process progresses and the needs of the patient changes. This continued education can take place as needed on a one-onone basis and can be included with the routine office visit or at a separate time that is convenient for the patient and health care practitioner. The teaching plan can be tailored to the needs of the patients who will be attending the classes. It can be tailored to the patients abilities, developmental stage and learning styles. The teaching plan can be a combination of lecture format, handouts, videos, powerpoint presentations, demonstrations and group discussion. The fee charged for the teaching program has to be determined by the person, group or facility offering the teaching program. Many insurances do not reimburse for this
type of education. This has to be taken into consideration with the intended audience.
Day 1
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Blood glucose monitoring and goals of blood glucose monitoring (3 hours)
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Complications from Diabetes (1 hour) Skin and Foot Care (0.5 hour) Exercise and Diabetes (1.5 hour)
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Day 6
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Questions and Answers (1 hour) Review of any concepts requested by patients (1 hour)
for the patient. A simple method to describe the HbA1c is to tell the patient that the test measures the amount of sugar that attaches to the protein in the red blood cell. The test shows the average blood sugar during the last three months. The higher the blood sugar the higher the HbA1c. The high blood sugar over a long period of time causes damage to the large and small blood vessels therefore increasing the risk of complications from diabetes.
disease. Diabetes is also the leading cause of new blindness (McGovern, 2002). Patients with diabetes should also receive education on the importance of smoking cessation, cholesterol and lipid management, blood pressure monitoring and management and management of other disease processes. Skin and Foot Care Teach the patient to care for his feet by washing them daily, drying them carefully particularly between the toes, and inspecting for corns, calluses, redness, swelling, bruises, blisters, and breaks in the skin. The patient should be encouraged to report any changes to his/her health care provider as soon as possible. Advise the patient to wear non-constricting shoes and to avoid walking barefoot. The patient may use over-the-counter athletes foot remedies to cure foot fungal infections and should be encouraged to call their health care provider if the athletes foot doesnt improve (McGovern, 2002). The patient should be reminded that he/she needs to treat all injuries, cuts and blisters particularly on the legs or feet carefully. Patients should be aware that foot problems are a common problem for patients with diabetes. Informing them of what to look for is an important teaching concern. The signs and symptoms of foot problems to emphasize are: feet that are cold, blue or black in color, feet that are warm and red in color, foot swelling, foot pain when resting or with activity, weak pulses in the feet, not feeling pain although there is a cut or sore on the foot, shiny smooth skin on the feet and lower legs
insulin sensitivity as well as lipid profiles. The benefits from exercise result from regular, long term, and aerobic exercise. Exercise used to increase muscle strength is an important means of preserving and increasing muscular strength and endurance and is useful in helping to prevent falls and increase mobility among the elderly (Franz, 2001). Regular exercise can improve the functioning of the cardiovascular system, improve strength and flexibility, improve lipid levels, improve glycemic control, help decrease weight, and improve quality of life and self-esteem. Exercise increases the cellular glucose uptake by increasing the number of cell receptors. The following points should be considered in educating patients regarding beginning an exercise program. Exercise program must be individualized and built up slowly. Insulin is more rapidly absorbed when injected into a limb that is exercised, therefore can result in hypoglycemia (Ferri, 1999). "Patients need to be informed that exercise of a high intensity can also cause blood glucose levels to be higher after exercise than before, even though blood glucose levels are in the normal range before beginning exercise. This hyperglycemia can also extend into the post-exercise state and is mediated by the counter-regulatory hormones (Franz, 2001, p. 62)." The exercise program should include a five to ten minute warm-up and cool-down session. The warm-up increases core body temperature and prevents muscle injury and the cool-down session prevents blood pooling in the extremities and facilitates removal of metabolic by-products. Research studies show there are similar cardiorespiratory benefits that occur when activity is done in shorter sessions, (approximately 10 minutes) accumulated throughout the day than in activity sessions of prolonged sessions (greater than 30 minutes) (Franz, 2001). This is an important factor to emphasize with patients who dont think they have the time and energy for exercise.
products, fish, lean meats, and poultry (Franz, 2001). The exchange diet of the ADA includes protein, bread, fruit, milk, and low and intermediate carbohydrate vegetables (Ferri, 1999). The food/meal plan is based on the individuals appetite, preferred foods, and usual schedule of food intake and activities, and cultural preferences. Determination of caloric needs varies considerably among individuals, and is based on present weight and current level of energy. Required calories are about 40 kcal/kg or 20 kcal/lb per day for adults with normal activity patterns (Davis, 2001). Emphasis should also be placed on maintaining a consistent day-to-day carbohydrate intake at meals and snacks. It is the carbohydrates that have the greatest impact on glycemia. A number of factors influence glycemic responses to foods, including the amount of carbohydrate, nature of the monosaccharide components, nature of the starch, cooking and food processing, and other food components (Franz, 2001, p.13). Maintaining a food diary can help identify areas of weaknesses and how to prepare better menu plans. Recommendations for fiber intake are the same for patients with diabetes as for the general population. It is recommended that they increase the amount of fiber to approximately 50 grams per day in their diet. Insoluble and soluble globular fiber delay glucose absorption and attenuate the postprandial serum glucose peak, they also help to lower the elevated triglyceride levels often present in uncontrolled diabetes (Ferri, 1999). The discussion of diet management should also include a discussion of alcohol intake. Precautions regarding the use of alcohol that apply to the general public also apply to people with diabetes. Abstaining from alcohol should be advised for people with a history of alcohol abuse, during pregnancy, and for people with other medical conditions such as pancreatitis, advanced neuropathy, and elevated triglycerides. The effects of alcohol on blood glucose levels is dependent on the amount of alcohol ingested as well as the relationship to food intake. Because alcohol cannot be used as a source of glucose, hypoglycemia can result when alcohol is ingested without food. The hypoglycemia can persist from eight to twelve hours after the last drink of alcohol. When alcohol is ingested in moderation and with food, blood glucose levels are not affected by the ingestion of moderate amounts of alcohol. If the patient plans to consume alcoholic beverages they are to be included in the meal plan. The patient should be reminded that no food should be omitted because of the possibility of alcohol induced hypoglycemia (Franz, 2001).
hydration because of the risk of dehydration from decreased fluid intake, polyuria, vomiting, diarrhea, and evaporative losses from fever. Patient should be instructed to drink at least eight ounces of calorie free liquids every hour while they are awake. The beverages should be caffeine-free, since caffeine acts as a diuretic and can actually increase the chances of hypovolemia. If the patient is unable to tolerate fluids by mouth, antiemetic suppositories or intravenous fluids may be required. Vomiting that is persistent and intractable may require emergency room care. The patient should be encouraged to perform blood glucose monitoring more frequently while he/she is ill and to initiate urine ketone monitoring with urine dipsticks, during the illness (Franz, 2001). The patient should be instructed to continue taking his/her insulin and/or oral antidiabetic agents while ill and even when unable to eat. The omission of insulin is a common cause of ketosis and can result in a serious condition called diabetic ketoacidosis. The patient should be given a list of foods that contain fast acting carbohydrates that they can consume when they experience signs and symptoms of hypoglycemia. Patients should be encouraged to seek regular ophthalmologic examinations to detect for diabetic retinopathy. Regular dental examinations should also be encouraged to evaluate to potential areas that can become infected and possible oral lesions.
plan would include an evaluation tool in which the patients could complete anonymously at the end of the program.
References
Buttaro, T.M., Trybulski, J., Bailey, P.P., Sandberg-Cook, J. (1999). Primary Care: A Collaborative Practice. Philadelphia, PA: Mosby, Inc. Davis, A. (2001). Adult Nurse Practitioner: Certification Review. Philadelphia, PA; Mosby, Inc. Ferri, F. (1999). Clinical Advisor: Instant Diagnosis and Treatment. Philadelphia, PA: Mosby, Inc. Franz, M. (Ed.) (2001). Diabetes Management Therapies: A Core Curriculum for Diabetes Education. 4th Edition. Chicago, IL: American Association of Diabetes Educators. Herfindal, E. and Gourley D. (2000). Textbook of Therapeutics: Drug and Disease Management. Seventh Edition. Philadelphia, PA: Lippincott Williams and Wilkins. McGovern, K., Devlin, M., Lange, E., and Mann, N. (Eds.) (2002). Disease Management for Nurse Practitioners. Springhouse, PA: Springhouse Corporation.
Diabetes Exercise and Sports Association (DESA) http://www.diabetes-exercise.org Endocrine Society http://www.endo-society.org National Diabetes Information Clearinghouse http://www.niddk.nih.gov National Kidney Foundation, Inc. (NKF) http://www.kidney.org NovoNordisk Pharmaceuticals, Inc http://www.novo-nordisk.com Roche Pharmaceuticals http://www.rocheusa.com
Evaluation Tool
Please evaluate each session that you attended. Make any comments that you would like to add. Circle your response.
Day 1
The content was easy to understand My expectations for attending the class were met
Day 2
The content was easy to understand My expectations for attending the class were met
Day 3
The content was easy to understand My expectations for attending the class were met
Day 4
Complications from Diabetes (1 hour) Skin and Foot Care (0.5 hour) Exercise and Diabetes (1.5 hour) Agree Agree Neutral Neutral Disagree Disagree
The content was easy to understand My expectations for attending the class were met
Day 5
The content was easy to understand My expectations for attending the class were met
Day 6
Questions and Answers (1 hour) Review of any concepts requested by patients (1 hour)
Agree Agree Neutral Neutral Disagree Disagree
class were met Make any additional comments that you would like to add. Would you recommend this program to a friend or relative? Are there topics that you would like to see added to the program? Agree Agree Neutral Neutral Disagree Disagree
If you agree that there are topics you would like to see added. Please list these topics.