Case Study #4: Diabetes Diagnosis and Management

QUESTION

Case Study #4 A 41-year-old presents to the primary care provider reporting a gradual onset of flu-like symptoms, increased thirst, and increased urination. Physical assessment reveals a blood glucose level of 812 mg/dl. Urinalysis reveals negative ketones. The patient denies taking any medications or having any chronic health problems. The patient is admitted to the hospital for additional evaluation and treatment. 1. What diagnosis do you anticipate this patient will have? 2. What type of diabetes would you anticipate this patient to have? 3. Explain the pathophysiology of the patient’s current condition. 4. What other laboratory results would you anticipate the patient to have? 5. What other physical assessment findings would you anticipate? 6. What is the first intervention that should be provided? 7. Explain the drug therapy you would anticipate administering to this patient. 8. What is a major complication this patient may experience? How can this be prevented? 9. What electrolyte abnormality should you anticipate? 10. What should you plan to teach this patient upon hospital discharge? 1 1. List two NANDA diagnoses for this patient. Case Study: #5 The nurse enters Room 312 at 9 AM and finds the patient disoriented with cold and clammy skin. The patient reports feeling "shaky". The nurse checks the report sheet and sees that the patient is a Type 1 diabetic and was admitted for pneumonia. The patient’s blood sugar level at 7am was 78 mg/dl. The patient received Lispro insulin 18 units at 7 AM. There is a breakfast at the bedside, which is uneaten. 1. What patient information should the nurse obtain next? 2. What action should the nurse take NEXT based on the assessment findings? 3. What factors might put the patient at risk for hypoglycemia? 4. What other signs or symptoms should you assess for? 5. How can hypoglycemia be prevented? 6. The patient’s family arrives and asks you to explain how an insulin pump works. What should you tell them? Include all nursing care. 7. What should you plan to teach this patient upon hospital discharge? 8. List two NANDA diagnoses for this patient

ANSWER

Case Study #4: Diabetes Diagnosis and Management

Anticipated Diagnosis
Diabetic ketoacidosis (DKA)

Type of Diabetes
Type 1 diabetes

Pathophysiology Explanation
In type 1 diabetes, the body’s immune system attacks and destroys insulin-producing beta cells in the pancreas. This results in a lack of insulin, leading to hyperglycemia. The absence of insulin prevents glucose uptake by cells, causing cells to use fats for energy, leading to ketone formation. High levels of glucose and ketones in the bloodstream cause osmotic diuresis, leading to increased thirst, urination, and dehydration.

Anticipated Laboratory Results
Elevated blood glucose levels
Elevated serum ketones
Metabolic acidosis (low bicarbonate levels)
Electrolyte imbalances (e.g., decreased potassium, sodium)

Anticipated Physical Assessment Findings
Rapid and deep respirations (Kussmaul breathing)
Dehydration signs (dry mucous membranes, sunken eyes)
Fruity breath odor (acetone)
Confusion or altered mental status
Hypotension

First Intervention
Administer intravenous fluids, specifically normal saline, to correct dehydration and improve hemodynamic stability.

Drug Therapy
Administer regular insulin intravenously to lower blood glucose levels and halt ketone production.

Major Complication and Prevention
A major complication is cerebral edema due to rapid glucose and electrolyte shifts during treatment. Prevent this by avoiding overly aggressive fluid resuscitation.

Anticipated Electrolyte Abnormality
Hypokalemia (low potassium) due to insulin therapy’s intracellular shift of potassium.

Patient Education Upon Discharge
Insulin administration and blood glucose monitoring
Signs of hyperglycemia, hypoglycemia, and DKA
Importance of medication adherence and regular follow-up

NANDA Diagnoses
Risk for Fluid Volume Deficit related to osmotic diuresis
Risk for Impaired Skin Integrity related to poor wound healing

Case Study #5: Hypoglycemia Management

Patient Information to Obtain
Time of last insulin administration, Lispro insulin onset and peak time, recent blood glucose levels, patient’s usual insulin regimen, any recent changes in diet or activity level.

Nurse’s Next Action
Check the patient’s blood glucose level to confirm hypoglycemia.

Risk Factors for Hypoglycemia
Recent insulin administration
Uneaten meal
Increased physical activity

Additional Signs/Symptoms to Assess
Shakiness
Rapid heartbeat
Confusion
Pallor
Sweating

Hypoglycemia Prevention
Consistent carbohydrate intake, regular blood glucose monitoring, adjusting insulin doses based on activity and food intake.

Explaining Insulin Pump to Family
Explain that an insulin pump delivers a continuous supply of insulin to maintain blood glucose levels and that the patient can also administer bolus doses before meals.

Patient Discharge Teaching
Insulin pump use and maintenance
Hypoglycemia prevention and management
Meal planning and carbohydrate counting

NANDA Diagnoses
Risk for Unstable Blood Glucose Level related to insulin therapy
Risk for Injury related to hypoglycemia and altered mental status