Get to Know the Patient: Eugene Shaw Eugene Shaw, 87-years-old, is a retired illustrator and former Marine who served in

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Get to Know the Patient: Eugene Shaw Eugene Shaw, 87-years-old,is a retired illustrator and former Marine who served in the KoreanWar. He and Nancy, his wife of 59 years, live in the city. Gene hashad cold sensitization and nocturnal pain in his lower limbs andhands since trench foot, acquired in Korea, required amputation ofseveral toes. He has hypertension, osteoarthritis, and Type 2Diabetes. He is overweight, and he smokes and drinks. Chronic legpain and ulcerations brought Eugene to the hospital where he hadthe following to say to the intake nurse... My name’s Eugene Shawbut everybody calls me Gene. I was born on May 21 in Cleveland,Ohio. I am 82-years old and live with my wife Nancy. We have a son,Robert Shaw who is 57. He lives about 500 miles away with his wifeand they come to visit us fairly often. He went to college and gotsome fancy job selling chemicals. We have no family living close byexcept for my cousin Arthur and his family. We see them sometimesbut Nancy doesn’t seem to be too social these days so I don’t pushher too much. I try to get out with my buddy Jim. We servedtogether in the Korean War but Nancy yells that we drink too muchwhen we are together and it gets my sugar high. Who cares at myage? I’m not going to be around forever. I like my beer and alittle nip of whiskey at night to help me sleep. I am a Veteran. Iproudly enlisted and served for 2 years in the Marines. I was aprivate in the Medina County Marine Corps League Detachment 569,Medina VFW Post 5137. A great group of guys and we lost quite afew. I didn’t know what I was getting myself into when I signed up.It was so cold that first winter. Korea was a land of weatherextremes-- all bad. It went from 30 below zero in the winter toover 100 degrees in the summer. During the cold winter months, wewore longjohns, utility trousers, waterproof cold weather trousers,utility jacket, sweater, a parka and thermo boots. The enemy woreheavy quilted coats and pants and, for the most part, sneaker-likeshoes. From what I understand, they weren't very warm. In betweensummer and winter was the monsoon season that turned the countryinto a flooded swamp. Aside from the war, the bad weather was amorale factor more than anything. The cold and heat were unbearableand during monsoon season, no one was ever dry. That’s where mytroubles started with my feet. Wow wee, my darn feet were alwayswet, stinking wet in the summer and cold and frozen in the winter.Those boots didn’t protect at all; in fact I think that they madethings worse because they leaked so much. Probably can’t blameanyone but the soggy wet soil. You ever hear of trench-foot? I hadit and still got some of it. That’s what I got to take home with mefrom Korea but it’s better than the alternative. Yeah that is waror a least it was in my time. I bet they have made some progress ingetting those troops better equipment than in my day. I came homefrom the Marines and I had a hard time walking. I went to the VAand they told me – “Boy, it’s off with those toes,” and off theywent. You didn’t ask questions in those times. They took three offmy right foot and left the others. Sometime after one just gotblack and fell off. My poor Nancy she washed my feet and tried tokeep them circulating but it was too late. I go to the doctorsporadically, never can remember those dates. I’ve had severalvisits the last year or so. I keep getting sores on my right lowerleg that don’t go away. My heel had a big ulcer not too long agoand I needed a lot of antibiotics to get that one to go away. Nowlook, it’s back again and it looks so blue. My foot is always socold. I came here today because my leg is really bothering me forabout a week. I was getting into my car and I hit my foot on thecar door. Since then I started to have these pains and my heel isgetting bad again. My right calf has some awful pains and burningdown the sides. I couldn’t hardly sleep at all last night cause ofthe pain and it got worse during the day. Nancy has been nagging meto have my leg checked out all week. She really got worried todaywhen she saw how bad the pain was and the color of my leg and foot.She insisted that I come here to see what’s up, so here I am.Gene's Femoral-Popliteal Bypass Surgery Mr. Shaw came to the ERwith complaints of pain and a burning sensation in his right leg.He had some small ulcerations of the skin, especially on the heel,with bluish discoloration of his right foot and some ankle edema.After Gene was admitted to the medical-surgical unit for a surgicalevaluation, an angiogram revealed a clot in the popliteal artery,below the right knee. He was scheduled for a femoral-poplitealbypass surgery the next morning (Day 2). Gene is on his secondpostoperative day (Day 4) and his vital signs are stable. Theincision is healing well and his neurovascular checks are greatlyimproved. As his nurse, you need to encourage Gene to ambulate andassess how he will be able to manage in his home after discharge.Post-Operative Situation Gene is alert and orientated to person,place, and time. His vital signs have been stable with atemperature of 98.6 F (37 C), BP 128/70, heart rate 88,respirations 16, SpO2 96% on room air. Mr. Shaw’s blood glucose was115 mg/dL at 0630. His neurovascular checks have greatly improved.There is some swelling in his leg. He has been eating well andvoiding. He had a bowel movement this morning. He continues tocomplain of some pain but says it is not as bad as before surgeryand he no longer has the aching and burning in his leg. His lastdose of hydrocodone bitartrate 5 mg/acetaminophen 500 mg was at1300. The incision site is healing well. Gene has had somedifficulty ambulating and needs a lot of assistance. Gene may bedischarged in two days and we need to develop a teaching plan forMr. Shaw, his wife, and other members of his support system to helphim manage at home. This plan must consider Mr. Shaw's specificchallenges which per his admission include: • Not sticking to hisdiet • Type 2 diabetes • Sneaking a few cigarettes when out withfriends at the local bar • Nocturnal pain in his lower limbs andhands On the positive side, Gene does insist he takes hismedications regularly which include the cholesterol medicationSimvastatin. You will need to employ evidence-based strategies toguide your plan and address at least three teaching areas that area priority for Mr. Shaw and his health status. You will be creatinga short slide presentation as well as a one-page handout that Geneand his wife can take home and refer to.(see the M2 Eugene Shawteaching plan assignment for specific details). Before you do that,be sure to review the additional information below. Read PromotingHealth for Adults This CDC web page provides some valuablereminders as you begin to think about your education plan for Mr.Shaw and his wife. Post-Operative Medical OrdersAllergies/Sensitivities: None known Date/Time: Day of surgery, 1100Condition of patient: good DIET: resume 1800 ADA diet as toleratedFLUIDS: discontinue IV fluids as soon as able to tolerate oralfluids VITAL SIGNS: every 4h. If temperature > 101 F (38.33 C)notify resident ACTIVITY: a. Up in chair with leg elevated b.Ambulate with assistance NEUROVASCULAR CHECKS: every 2 hours forfirst 24 hours, then every shift LABS: CBC, Basic Metabolic PanelCall abnormal results to orthopedic resident or attending surgeonMEDICATIONS: a. Hydrocodone bitartrate 5 mg/acetaminophen 500 mgevery2h PRN for pain b. Furosemide 10 mg daily c. Clopidogrel 75 mhPO daily d. Docusate sodium 100 mg PO daily, may repeat X1 PRN forconstipation e. Ferrous Sulfate 325 mg PO daily f. Simvastatin 20mg PO daily g. Lisinopril 5 mg PO daily h. Glipizide 30mg 1 tab POtwice a day i. Enoxaparin sodium 30 mg subcutaneous every 12 hoursj. Sulfamethoxazole 800mg/ trimethoprim 160 mg one tab twice a dayk. Penicillin VK 500 mg PO every 6 hours CHECK THE BLOOD SUGAR(BS): before every meal & before bedtime with regular insulincoverage as follows: • 0-150: no insulin • 150-199: 2 units •200-249: 4 units • 250-299: 7 units • 300-349: 10 units • Over 350:12 units and notify MD Robert Moses M.D. Lab ResultsGlycohemoglobin Result Reference Range A1c 6.6% 4-6% BasicMetabolic Panel Result Reference Range Sodium 141 135-145 mmol/LPotassium 4.1 3.5-5 mmol/L Carbon dioxide 40 35-45 mm hg Calcium 22-2.6 mmol/L Chloride 103 95-105 mEq/L Glucose 120 65-110 mg/dL Bun1.9 1.2-3 mmol/L Creatinine 1.0 0.8-1.3 mg/dL MedicalReconciliation Form Medication Name Dose Route Frequency ReasonLast Dose Continue/DC Docusate sodium 100 mg PO Daily today AM C DCClopidogrel 75 mg PO Daily today AM C DC Ferrous Sulfate 325 mg PODaily today AM C DC Simvastatin 20 mg PO Daily today AM C DCLisinopril 5 mg PO Daily today AM C DC Glipizide 30mg PO Twicedaily today AM C DC Furosemide 10 mg PO Daily today AM C DC
Create an Outline with teaching topics and/or sub-topics, andrationales that you will use to educate Mr. Shaw and his wifeNancy.