Chronic Diabetic
PNCI® - Learner
Brian Zimmerman
Age: 63
Weight: 70 kg
Location: Homeless Shelter Clinic
Background
Patient History
Past Medical History: Diabetic ketoacidosis that has recently been resolved. Diagnosed with Type 1
diabetes at the age of 15
Allergies: No known drug allergies
Medications: Insulin glargine 20 units at bedtime, Humulin R insulin per sliding scale before meals and
at bedtime, Captopril 20mg twice a day
Code Status: Full code
Social/Family History: Married at age 23. His wife helped him with a proper diet, exercise and blood
glucose level monitoring. At age 52, his company was downsized, and he lost his job. Two years later,
his wife died of ovarian cancer. He became depressed and lost his home and the will to effectively
manage his diabetes. He has lived on the streets for the past four years. He visits a homeless shelter that
has a clinic where the community health nurse attempts to monitor and manage his diabetes. He often
misses his clinic visits
Handoff Report
Situation:
The patient is a 63-year-old male diagnosed with Type 1 diabetes since the age of 15. Recently he
was found on the streets in a semi-conscious state in diabetic ketoacidosis with a blood glucose of
510. He was transported to the hospital via EMS and was treated in the Emergency Department (ED),
then admitted to the Medical Unit for further stabilization and treatment. He has progressed well
and stabilized following the healthcare provider’s orders. He is currently being seen for a follow-up
appointment in the homeless shelter clinic.
Background:
He has lived on the street for the last four years and visits a homeless shelter that has a clinic where the
CHN assists with providing insulin supplies and food. He married at age 23. His wife helped him with
a proper diet, exercise and blood glucose level monitoring. At age 52, his company was downsized,
and he lost his job. Two years later, his wife died of ovarian cancer. He became depressed and lost his
home and then the will to effectively manage his diabetes. His only support comes from the CHN at the
homeless shelter clinic. She reports that he frequently misses his visits. He has no known drug allergies.
Program for Nursing Curriculum Integration (PNCI®) 1
© 2012 CAE Healthcare, Sarasota, FL v.5
, Chronic Diabetic
PNCI® - Learner
Handoff Report Continued
Assessment upon Discharge:
Vital Signs: HR 86, BP 110/70, RR 20, SpO2 98% on room air, Temperature 37C
General Appearance: Clothing is old, worn and does not fit well. Appears older than stated age
Cardiovascular: Sinus
Respiratory: Breath sounds clear
GI: Normal bowel sounds. States has been eating 100% of meals using carbohydrate counting
GU: Voids
Extremities: Full range of motion in all four extremities
Skin: Pink, warm and with adequate turgor. Mucous membranes moist
Neurological: Alert and oriented to person, place and time. Pupils equal, round and reactive to light
and accommodation. No neurological deficits
Labs: Blood glucose 144
Fall Risk: Low-risk for falls
Pain: Denies pain
Recommendations:
Monitor adherence to diabetic program
Orders
Initial Healthcare Provider’s Orders:
Discharge to homeless shelter clinic
Community health nurse to assess and monitor 3 times a week for one week, then once a week for 4
weeks, then every 2 weeks
Monitor adherence to diabetic program
Resume activities of daily living
Vital signs every visit
1800 calorie American Dietetic Association (ADA) diet
Home medications:
Capillary blood glucose AC and HS and follow sliding scale protocol with Humulin R insulin:
0-150 no coverage
151-200 2 units SUBCUT
201-250 4 units SUBCUT
251-300 6 units SUBCUT
Call healthcare provider for blood glucose greater than 300 or less than 50
Insulin glargine 20 units subcutaneous at bedtime
Captopril 25 mg 1 tab PO two times per day
Review diabetic education
Refer to other agencies as appropriate
Program for Nursing Curriculum Integration (PNCI®) 2
© 2012 CAE Healthcare, Sarasota, FL v.5
PNCI® - Learner
Brian Zimmerman
Age: 63
Weight: 70 kg
Location: Homeless Shelter Clinic
Background
Patient History
Past Medical History: Diabetic ketoacidosis that has recently been resolved. Diagnosed with Type 1
diabetes at the age of 15
Allergies: No known drug allergies
Medications: Insulin glargine 20 units at bedtime, Humulin R insulin per sliding scale before meals and
at bedtime, Captopril 20mg twice a day
Code Status: Full code
Social/Family History: Married at age 23. His wife helped him with a proper diet, exercise and blood
glucose level monitoring. At age 52, his company was downsized, and he lost his job. Two years later,
his wife died of ovarian cancer. He became depressed and lost his home and the will to effectively
manage his diabetes. He has lived on the streets for the past four years. He visits a homeless shelter that
has a clinic where the community health nurse attempts to monitor and manage his diabetes. He often
misses his clinic visits
Handoff Report
Situation:
The patient is a 63-year-old male diagnosed with Type 1 diabetes since the age of 15. Recently he
was found on the streets in a semi-conscious state in diabetic ketoacidosis with a blood glucose of
510. He was transported to the hospital via EMS and was treated in the Emergency Department (ED),
then admitted to the Medical Unit for further stabilization and treatment. He has progressed well
and stabilized following the healthcare provider’s orders. He is currently being seen for a follow-up
appointment in the homeless shelter clinic.
Background:
He has lived on the street for the last four years and visits a homeless shelter that has a clinic where the
CHN assists with providing insulin supplies and food. He married at age 23. His wife helped him with
a proper diet, exercise and blood glucose level monitoring. At age 52, his company was downsized,
and he lost his job. Two years later, his wife died of ovarian cancer. He became depressed and lost his
home and then the will to effectively manage his diabetes. His only support comes from the CHN at the
homeless shelter clinic. She reports that he frequently misses his visits. He has no known drug allergies.
Program for Nursing Curriculum Integration (PNCI®) 1
© 2012 CAE Healthcare, Sarasota, FL v.5
, Chronic Diabetic
PNCI® - Learner
Handoff Report Continued
Assessment upon Discharge:
Vital Signs: HR 86, BP 110/70, RR 20, SpO2 98% on room air, Temperature 37C
General Appearance: Clothing is old, worn and does not fit well. Appears older than stated age
Cardiovascular: Sinus
Respiratory: Breath sounds clear
GI: Normal bowel sounds. States has been eating 100% of meals using carbohydrate counting
GU: Voids
Extremities: Full range of motion in all four extremities
Skin: Pink, warm and with adequate turgor. Mucous membranes moist
Neurological: Alert and oriented to person, place and time. Pupils equal, round and reactive to light
and accommodation. No neurological deficits
Labs: Blood glucose 144
Fall Risk: Low-risk for falls
Pain: Denies pain
Recommendations:
Monitor adherence to diabetic program
Orders
Initial Healthcare Provider’s Orders:
Discharge to homeless shelter clinic
Community health nurse to assess and monitor 3 times a week for one week, then once a week for 4
weeks, then every 2 weeks
Monitor adherence to diabetic program
Resume activities of daily living
Vital signs every visit
1800 calorie American Dietetic Association (ADA) diet
Home medications:
Capillary blood glucose AC and HS and follow sliding scale protocol with Humulin R insulin:
0-150 no coverage
151-200 2 units SUBCUT
201-250 4 units SUBCUT
251-300 6 units SUBCUT
Call healthcare provider for blood glucose greater than 300 or less than 50
Insulin glargine 20 units subcutaneous at bedtime
Captopril 25 mg 1 tab PO two times per day
Review diabetic education
Refer to other agencies as appropriate
Program for Nursing Curriculum Integration (PNCI®) 2
© 2012 CAE Healthcare, Sarasota, FL v.5
