Hesi Case study Gerontology: Age-Related Risks
Carl Rogers, a 67-year-old African American male with a history of type 2 diabetes mellitus, visited his
healthcare provider due to a nonhealing ulcer on his right heel. Despite attempting home remedies for
several weeks, the ulcer did not improve, prompting him to seek medical attention. Vital signs were
assessed, and a physical examination was conducted during his clinic visit. Based on the diagnosis, the
healthcare provider recommended immediate admission to the medical-surgical unit for treatment of
the heel ulcer.
Mr. Rogers was diagnosed with type 2 diabetes mellitus last year and manages his condition with three
daily insulin injections. While he admits his eating habits are not ideal, he is diligent about his insulin
regimen. Living alone, he prefers not to eat alone. The stage II nonhealing ulcer on his right heel may
potentially necessitate amputation.
Effective wound healing requires additional protein intake to replenish losses and support tissue repair.
Older adults with type 2 diabetes often experience delayed wound healing. Hypoglycemia remains a
critical concern due to the risk it poses to Mr. Rogers' health. Managing hydration is also crucial,
especially given the potential for dehydration exacerbated by poor nutrition.
Ensuring adequate nutrition is essential as lack of appetite and reluctance to eat alone can lead to
malnutrition in older adults. Many health issues in this age group stem from factors such as poor dietary
habits and social isolation.
The nurse conducted a focused assessment, checked Mr. Rogers' blood glucose levels using a
glucometer, and administered his prescribed insulin dose during the morning medication rounds.
Which information about the client is of most concern to the nurse?
c
Blood glucose rises from 120 mg/dL to 125 mg/dL in 8 hours.
Washes hands with soap and water and allows alcohol swab wipe to dry before performing chemstick.
Reports a new onset of blurry vision.
,Depends on handwritten notes to recall his last blood glucose reading. ✔️Reports a new onset of blurry
vision.
Blurry vision can indicate cataracts, glaucoma, optic nerve damage or diabetic retinopathy.
The nurse reports Mr. Rogers' blurry vision to his HCP, who then evaluates and treats Mr. Rogers for
worsening diabetic retinopathy.
Select all that apply
Which other symptoms should the nurse expect to find in a client with a diagnosis of diabetic
retinopathy?
Reports of floaters.
Loss of vision.
Jaundice of the sclera.
Difficulty with color perception.
Pupil fixation. ✔️Reports of floaters.
Small micro aneurysms protrude from the vessel walls, causing the client to see red and black spots or
lines described as floaters
Loss of vision.
Micro aneurysms and edema can lead to increased intraocular pressure, retinal detachment and
glaucoma, which can all cause loss of vision.
, Difficulty with color perception.
Macular edema associated with diabetic retinopathy can cause impaired hue discrimination resulting in
impaired color perception.
During Mr. Rogers' hospital stay, the HCP prescribes an insulin pen to replace Mr. Rogers' insulin
syringes and insulin vials. Mr. Rogers is taught by the nurse to dial the pen to the prescribed amount and
to use a magnifying glass to ensure that the amount of insulin is correct with each injection. The nurse
ensures that the two insulin pens are clearly marked as glargine (Lantus) or lispro (Humalog) so Mr.
Rogers can identify them easily.
The nurse understands that which information is correct regarding the prescribed insulin?
Glargine (Lantus) is rapid-acting insulin typically administered 15 minutes before meals.
Lispro (Humalog) is intermediate-acting insulin that peaks in 4 to 10 hours.
Glargine (Lantus) does not have a peak interval.
Lispro (Humalog) is typically given at bedtime on an empty stomach. ✔️Glargine (Lantus) does not have
a peak interval.
Glargine (Lantus), long-acting insulin, has an onset of 1 to 2 hours, has no pronounced peak, and has a
duration of 24+ hours.
The nurse making rounds finds Mr. Rogers unresponsive. His vital signs are BP 92/60 mmHg, apical pulse
135 beats/min, T 100.4° F (38.0° C). His chemstick reading is high.
What conditions, other than hyperglycemia, might Mr. Rogers have?
Carl Rogers, a 67-year-old African American male with a history of type 2 diabetes mellitus, visited his
healthcare provider due to a nonhealing ulcer on his right heel. Despite attempting home remedies for
several weeks, the ulcer did not improve, prompting him to seek medical attention. Vital signs were
assessed, and a physical examination was conducted during his clinic visit. Based on the diagnosis, the
healthcare provider recommended immediate admission to the medical-surgical unit for treatment of
the heel ulcer.
Mr. Rogers was diagnosed with type 2 diabetes mellitus last year and manages his condition with three
daily insulin injections. While he admits his eating habits are not ideal, he is diligent about his insulin
regimen. Living alone, he prefers not to eat alone. The stage II nonhealing ulcer on his right heel may
potentially necessitate amputation.
Effective wound healing requires additional protein intake to replenish losses and support tissue repair.
Older adults with type 2 diabetes often experience delayed wound healing. Hypoglycemia remains a
critical concern due to the risk it poses to Mr. Rogers' health. Managing hydration is also crucial,
especially given the potential for dehydration exacerbated by poor nutrition.
Ensuring adequate nutrition is essential as lack of appetite and reluctance to eat alone can lead to
malnutrition in older adults. Many health issues in this age group stem from factors such as poor dietary
habits and social isolation.
The nurse conducted a focused assessment, checked Mr. Rogers' blood glucose levels using a
glucometer, and administered his prescribed insulin dose during the morning medication rounds.
Which information about the client is of most concern to the nurse?
c
Blood glucose rises from 120 mg/dL to 125 mg/dL in 8 hours.
Washes hands with soap and water and allows alcohol swab wipe to dry before performing chemstick.
Reports a new onset of blurry vision.
,Depends on handwritten notes to recall his last blood glucose reading. ✔️Reports a new onset of blurry
vision.
Blurry vision can indicate cataracts, glaucoma, optic nerve damage or diabetic retinopathy.
The nurse reports Mr. Rogers' blurry vision to his HCP, who then evaluates and treats Mr. Rogers for
worsening diabetic retinopathy.
Select all that apply
Which other symptoms should the nurse expect to find in a client with a diagnosis of diabetic
retinopathy?
Reports of floaters.
Loss of vision.
Jaundice of the sclera.
Difficulty with color perception.
Pupil fixation. ✔️Reports of floaters.
Small micro aneurysms protrude from the vessel walls, causing the client to see red and black spots or
lines described as floaters
Loss of vision.
Micro aneurysms and edema can lead to increased intraocular pressure, retinal detachment and
glaucoma, which can all cause loss of vision.
, Difficulty with color perception.
Macular edema associated with diabetic retinopathy can cause impaired hue discrimination resulting in
impaired color perception.
During Mr. Rogers' hospital stay, the HCP prescribes an insulin pen to replace Mr. Rogers' insulin
syringes and insulin vials. Mr. Rogers is taught by the nurse to dial the pen to the prescribed amount and
to use a magnifying glass to ensure that the amount of insulin is correct with each injection. The nurse
ensures that the two insulin pens are clearly marked as glargine (Lantus) or lispro (Humalog) so Mr.
Rogers can identify them easily.
The nurse understands that which information is correct regarding the prescribed insulin?
Glargine (Lantus) is rapid-acting insulin typically administered 15 minutes before meals.
Lispro (Humalog) is intermediate-acting insulin that peaks in 4 to 10 hours.
Glargine (Lantus) does not have a peak interval.
Lispro (Humalog) is typically given at bedtime on an empty stomach. ✔️Glargine (Lantus) does not have
a peak interval.
Glargine (Lantus), long-acting insulin, has an onset of 1 to 2 hours, has no pronounced peak, and has a
duration of 24+ hours.
The nurse making rounds finds Mr. Rogers unresponsive. His vital signs are BP 92/60 mmHg, apical pulse
135 beats/min, T 100.4° F (38.0° C). His chemstick reading is high.
What conditions, other than hyperglycemia, might Mr. Rogers have?
