Organize an interdisciplinary plan of care for your client and the delivery of safe and effective care including interventions with rationals, short term and long term goals, and desired patient outcomes.

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The Interdisciplinary Care Plan

Client: Mr. Smith

Diagnosis of Hypertension Type 2 and Diabetes Mellitus

Interventions:

1. Monitor vital signs daily and adjust medications as needed to maintain target blood pressure – Rationale: To ensure that BP is being adequately managed in order to prevent potential complications such as stroke or heart attack.

2. Begin insulin therapy as prescribed by physician – Rationale: To better control glucose levels in order to reduce risk of diabetic complications.

3. Provide patient with dietary education on portion size and food choices – Rationale: To promote healthy eating habits which can help improve glycemic control while also reducing caloric intake, thereby aiding in weight loss if necessary.

4. Refer patient for physical activity counseling/exercise program – Rationale: To encourage lifestyle modifications that can lead to improved cardiovascular health, increased energy levels, decreased stress levels, and other general health benefits.

Short-Term Goals & Desired Outcomes (In 6 Weeks):

1. Achieve your target blood pressure goal through effective medication management.

2. Through dietary modification and an exercise program, improve the overall control of glycemic levels by 10%.