The patient, Juan Carlos, has just returned after surgical debridement of a diabetic foot ulcer on his right great toe. The procedure was done under local anesthesia, and I would like to give you a report on him before I hand him over to you.
Mr. Carlos is a 52-year-old Hispanic male with a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia who presented in the emergency department last night complaining of pain in a wound on his right great toe. He states he dropped a large rock on his toe several weeks ago and sustained an open wound. The pain had been increasing over the last days, and he was unable to get the pain under control. He was then admitted for surgical debridement of what showed to be a diabetic ulcer and to receive antibiotic treatment.
This morning at 0730 Mr. Carlos’s blood sugar was 225 and he received 4 units of insulin aspart, a sliding scale insulin, along with his regular medications before the surgery. It is all in the MAR. He also received his antibiotic treatment this morning as prescribed. The surgery was performed under local anesthesia. He was given one tablet of oxycodone 5 mg/acetaminophen 325 mg for his pain after surgery. He now reports his pain to be 3 out of 10. He has a dressing on the toe and a right forearm IV that is saline locked. The dressing on his toe is dry and intact. He seems to be doing well, and his wife has just been here to see him.
He is due for a check of blood sugar level and vital signs. The provider has just updated the orders, so please take a look at the patient chart to see all details.” 364



Describe at least three challenges nurses face today in care delivery. These can be ethical, legal, financial, or social. Provide at least one way to successfully overcome each challenge.
In the Institute of Medicine’s 2010 Future of Nursing report, the committee developed four key messages. Choose one message, explain the message in detail, and why it is important to the nursing profession.
Explain each of the Institute of Medicine’s five core competencies and describe ways in which nursing practice can meet each of these. Identify at least one obstacle for each and explain in detail how it can be overcome.