Your pt arrives late for his appt. You notice that his A1c is higher and that his adherence to self care skills (specifically monitoring, exercise, and taking meds) has decreased since his last visit 6 months ago. When you ask, "Over the last month or so, have you lost interest in doing things that usually bring you pleasure?" He replies, "Yes, I have to admit that I have," What implication does this have and what should your response be?
A. His answer suggests that the pt is in a "slump" (or "burnout"), which many people with diabetes experiencE. Assure him it is normal and encourage him to think back to how he felt when he was faithfully performing self care behaviors
B. His answer is expected, for when a person neglects self care behaviors, it negatively affects glucose levels, which then decreases one's ability to participate in pleasurable activities
C. The pt's answers suggest that he may be experiencing diabetes related anxiety. Stress, the body's response to the anxiety, is manifested in his increased A1c and neglect of self care behaviors. Discuss ways to reduce anxiety and stress, such as medication or breathing exercises
D. His response is a strong indicator for depression. Encourage the pt to meet with a mental health professional; then make the referral and offer to help schedule the appt. F/u with the pt by phone to ensure that he attended the appt. and schedule a f/u visit for diabetes care in one month