Patient A.B. a 69-year-old White mail visited his local clinic

 Patient A.B. a 69-year-old White mail visited his local clinic for a checkup as lately he was feeling lethargic and has gained 22 lbs in the past year. He also has episodes of nocturia. He has being diagnosed with Type 2 diabetes for 5 years. However, he was diagnosed with Borderline diabetes since 1997, but never took it seriously and made no lifestyle changes. He has symptoms of hyperglycemia for the past 2 years. He does not check his glucose daily. He has never had a foot examination.

AB carbohydrate intake daily most times consists of eating at least three slices of bread with each meal and eating pasta meals at least 3 times a week. He likes his wife to cook Italian meals no less than 3-4 times a week. He drinks a glass of red wine with dinner every day. He stopped smoking 10 years ago. He exercises on occasion, maybe once or twice a month.

A.B. takes Atorvastatin 10mg daily. Glyburide 2.5mg daily. However, he reports he stopped taking the Glyburide about 6 months ago as it was making him feel dizzy whenever he took it. He has not notified his PCP about not taking the Glyburide.

Physical Examination

Constitutional: Alert and oriented to person, place, time and situation. He is well groomed.  He is 5 feet 2 inches and weighs 178 pounds.

Eyes: Pupils round, reactive to light. EOM intact. Fundi clear.

Hearing: No deficit noted

Mouth: Mucosa moist. Upper and lower dentures.

Heart: Rate and rhythm regular. No murmur.

Lungs: Clear to auscultation

Neurological assessment: Diminished vibrating sense to the forefoot, absent ankle reflexes. Monofilament felt only above the ankle.

Vascular: No carotid bruits. Femoral, popliteal and dorsalis pedalis pulses 2+ bilaterally.

His Immunization is updated. He has erectile dysfunction and takes Sildenafil.

Vital signs: BP= 150/87, P= 88, RR= 20, T= 97.8, Oxygen Sat= 98%

Laboratory Results:

Glucose (fasting) = 178mg/dl

Creatinine = 1.0mg/dl

Blood Urea Nitrogen = 18mg/dl

Sodium = 141 mg/dl

Potassium = 4.3 mg/dl

Total Cholesterol = 162 mg/dl

HDL Chol = 43mg/dl

LDL Chol = 84 mg/dl

Triglycerides = 177 mg/dl

AST = 14 IU/L

ALT = 19 IU/L

Alkaline Phosphatase = 56 IU/L

A1C = 8.1%

a) Nursing Plan for A.B.

b) No less than three nursing diagnoses

c) Fully developed care plan

d) What is the priority nursing education this patient needs with rationale?

e) Nursing interventions

Remember no less than 2 references.