Jenny O'Connell, APN, Case Study

Mr. Juan Duran is a 60-year-old patient who has been coming to the diabetes clinic at the VA for a few months. One day, the clinic director, Jim Carlson, finds him wandering the hallway, appearing somewhat dazed, with a bag of supplies for blood glucose testing and insulin administration. Mr. Duran tells him that he has been instructed to start insulin for his diabetes but doesn’t know how. He doesn’t recall receiving any appointment or instructions. Mr. Carlson finds the advanced practice nurse and diabetes educator, Jenny O’Connell, and asks her to fit Mr. Duran in for an unscheduled appointment.

Jenny O’Connell starts the appointment with a thorough assessment of Mr. Duran. In addition to the physical assessment, she covers psycho-social-spiritual issues. She discovers that Mr. Duran has had diabetes for about 10 years, and, recently, his blood glucose levels and HgbA1c cannot be controlled with oral medications and exercise. The physician wants to start him on insulin. Here are notes that she took from her assessment:

• Sixty-year-old Mexican-American patient. He is exceedingly polite and respectful of health care personnel (and does not like to interrupt or ask too many questions). He has been in the United States more than 50 years; he is a Navy veteran.
• Married; lives with wife in a comfortable apartment in Chula Vista, California.
• Mr. Duran speaks fluent English, but his wife’s English is limited. They speak Spanish at home.
• Because Mr. Duran has limited vision, his wife has to administer the insulin.
• Had one (single) daughter, who was found murdered in the apartment parking lot less than 2 weeks ago, leaving Mr. and Mrs. Duran to care for her child.
• Mr. Duran seems befuddled by the insulin and syringes and is stoic when he talks about the loss of his daughter.