Opposites responses to instructs

I observed two instructs on Friday. (There still haven't been too many referrals for education for cardiac and DM pts since I started my cardio/DM rotation. I'll be doing more on my own next week, I suppose...)

Anyway, I think I could have handled the first one on my own because the pt was clearly pretty well educated and very interested in the material. The pt just had a CABG, but he and his wife reported eating pretty well for the past several years (the pt said he craves fruit)...although they knew they were eating more fat than they should because the wife cooks for their child who has CF. Can you imagine trying to cook dinner for a cardiac pt and a child with CF! They were really receptive to all of our educational materials and suggestions, though, saying that they wanted to be doing everything possible. The pt was hilarious - he asked both of us what we did personally to stay so healthy. My preceptor said that this was a rare occasion when she went into MyPyramid, whole grains, reducing processed foods, etc. We stressed that there is no magic bullet, which I think kind of disappointed the pt. Oh, and they also asked us about energy drinks - just out of curiosity. I guess you have to be ready for anything.

The second instruct was so different. The pt was 59 yo but looked 70. She had been diagnosed with T2DM almost 20 years ago, but her records said she was non-compliant, so the CDE ordered the instruct for a refresher. We went in expecting to just go over a sample meal plan and reinforce what she's probably head dozens of time. Oh no. The first question out of her mouth after my preceptor started talking was, "What is a carbohydrate?" And this after the CDE spent time with her earlier that day! Clearly she hasn't been absorbing any of the info. We spent a lot of time giving examples of CHO foods and trying to identify those that she ate. We created a meal plan with foods that she eats along with some new foods that she seemed receptive to eating more regularly. (She reportedly never ate a fruit or vegetable, but she thought she could try an apple or fruit cocktail.) I don't know if any of this will make a difference after 20 years, but we did our best. I wonder if there's any info out there about the effectiveness of inpatient instruction and tips to get through to people...

And an update on the scleroderma case: she was discharged yesterday since there's nothing more the hospital could do after her respiratory distress (caused by an endoscopy) subsided. We sent her home with a 5 day supply of high-calorie Mighty Shakes to help get her wt up (current BMI: 15) since she can't eat solid foods anymore. Her husband said he would drive back to Rex to purchase more when they ran out - even though they live over an hour away. (The only other way to get them is mail-order, and it's super expensive since they're shipped frozen.) He said that he would gladly drive to Oregon and back to get whatever his wife needed. I would certainly never want to be dying of scleroderma, but if it happens, I hope I have such a supportive and loving husband.