NR 325 Pre-Simulation – Carl Rogers

NR 325 Pre-Simulation – Carl Rogers

Student Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

Scenario Overview

Carl Rogers is a 67-year-old African American male with a long-standing history of type II diabetes mellitus, spanning approximately 20 years. On a Tuesday afternoon at 1530, he was admitted directly to the medical-surgical unit following a referral from his primary physician. At the time of admission, the patient presented with a stage II non-healing ulcer on his right heel. Initial admission protocols, including paperwork and administration of pain medication, were completed. However, physician’s orders such as insulin administration and wound dressing changes had not yet been implemented. This case scenario begins at 1700 on the same day, highlighting the need for timely interventions and patient-centered care.

Comparison of Long- and Short-Acting Insulin

Insulin therapy plays a central role in managing both type 1 and type 2 diabetes mellitus. Different insulin types serve distinct purposes in glycemic control.

Long-Acting Insulin

Long-acting insulin is primarily used to provide a steady baseline of insulin coverage. It is effective in regulating blood glucose levels between meals and overnight, reducing fluctuations in blood sugar. The onset of action generally ranges from 0.8 to 4 hours. Unlike rapid- or short-acting insulins, long-acting formulations have no pronounced peak, minimizing the risk of hypoglycemia caused by sudden insulin surges. Their therapeutic effect can last between 16 to 24 hours, providing once-daily dosing convenience for most patients. Commonly prescribed examples include glargine (Lantus), detemir (Levemir), and degludec (Tresiba).

Short-Acting Insulin

Short-acting insulin, often referred to as mealtime or bolus insulin, supports glycemic control during food intake. Its onset is approximately 30 minutes to 1 hour, with a peak effect occurring within 2 to 5 hours, and a total duration of 5 to 8 hours. It is typically administered 30 to 45 minutes prior to meals to align with carbohydrate absorption. While effective in postprandial glucose regulation, this insulin type carries a higher risk of hypoglycemia due to its distinct peak and extended action time.

Table 1: Comparison of Long- and Short-Acting Insulin

Insulin Type	Onset	Peak	Duration
Long-Acting Insulin	0.8 – 4 hours	No significant peak	16 – 24 hours
Short-Acting Insulin	30 min – 1 hour	2 – 5 hours	5 – 8 hours

NR 325 Pre-Simulation – Carl Rogers

Dietary Education for Type II Diabetes Mellitus

For individuals with type II diabetes mellitus, structured dietary education is a cornerstone of disease management. A balanced diet promotes weight control, blood sugar stability, and overall health. Patients who are overweight or obese are often advised to implement weight reduction strategies to improve insulin sensitivity.

Carbohydrate consumption should be tailored to individual energy requirements and emphasize nutrient-dense, high-fiber sources, such as whole grains, fruits, and vegetables. Daily fiber intake should range from 25 to 30 grams to improve satiety, digestive health, and glycemic control. Fat intake, particularly saturated and trans fats, should be minimized, while cholesterol intake should not exceed 200 mg daily. Protein requirements vary per patient, but very high-protein diets are generally discouraged, especially in those with renal complications. Collaborating with a registered dietitian can enhance adherence to nutritional guidelines, ensuring meal planning aligns with personal goals and medical needs.

Table 2: Dietary Recommendations for Type II Diabetes

Nutrient Category	Recommendation
Carbohydrates	Individualized intake; prioritize fiber-rich sources
Fiber	25 – 30 g/day
Fats	Minimize trans-fat; limit cholesterol to < 200 mg/day
Protein	Individualized intake; avoid excess in renal disease

Wound Care Best Practices for Diabetic Foot Ulcers

Patients with diabetes mellitus are at an increased risk for developing foot ulcers due to neuropathy, poor circulation, and delayed wound healing. Proper wound care is essential to minimize infection risks, promote tissue regeneration, and avoid severe complications such as necrosis or amputation.

Initial Assessment

Upon identifying a wound, clinicians should thoroughly document its size, depth, and characteristics. Establishing a baseline helps monitor healing progress over time.

Dressing Management

Dressings should be changed according to provider instructions or based on drainage levels. Maintaining a moist wound environment while preventing excessive saturation supports faster recovery.

Infection Prevention and Protective Measures

Infection control practices—such as thorough handwashing, use of gloves, and sterile dressing techniques—are essential. Medicated dressings may be applied to create a protective barrier and promote tissue repair.

Debridement

In some cases, debridement may be necessary to remove necrotic or infected tissue. This process facilitates the growth of healthy granulation tissue and enhances the wound-healing trajectory.

Table 3: Wound Care Best Practices

Step	Description
Initial Assessment	Record wound dimensions and characteristics as a baseline
Dressing Change	Replace dressings per provider’s order or when saturation is observed
Protective Measures	Wash hands, wear gloves, and use sterile/medicated dressings as needed
Debridement	Remove necrotic tissue to promote healthy tissue growth

References

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. M. (2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (10th ed.). Elsevier.

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2017). Davis’s Drug Guide for Nurses (15th ed.). F.A. Davis.