Diabetes Case Study; Help!

[eightzmusic]

Hello and thank you for taking the time to read my question. I am in my 2nd semester and need a little guidance. I really appreciate your help!

I have a case study on a patient with diabetes.

She is a 45 yoa female with Type II DM. She injured her toe while walking out to her car over a month ago. The wound got worse, turning dark in color and with her losing sensation in the toe. She has a history of PVD and DM, so decision was made to amputate the toe. Before being hospitalized, she was taking an oral hypoglycemic for control of her DM. While in the hospital she is placed on a sliding scale of regular insulin AC and HS based on accu check results. Two days after surgery, she goes to an extended care facility.

Drugs ordered: Glucophage 500mg PO BID

Humulin R SC 30 min AC and HS sliding scale base.

Fasting blood glucose levels BID

Vitals qd

2000 calorie diet

Shift change at 11pm, report says her blood sugar was 165 and received 2 units of insulin. The night before she didn't sleep well and is now wondering hall. Based on events above my first action would be...?

I was thinking the first thing I should is assess her for pain, which may be keeping her from sleeping.

Then if need be, call doctor for Rx for sleep aid?

I would maybe make my additional diagnosis of sleep pattern disturbance?

And to determine her night awakenings, I would check her ABG labs to see if she is not getting adequate O2; sleep apnea.

I would appreciate any advise!!! THANK YOU!!

[Daytonite, BSN, RN]

i get the impression that this is a simulation case study because of the question: "based on events above my first action would be...?" when those kinds of questions are asked there is only one way to answer them and that is to place the entire set of facts you are given into the steps of the nursing process, apply maslow's hierarchy of needs and see what shakes out.

step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology - get the events in order of their occurrence. also look up the complications of the dm, pvd, medications and general anesthesia

• type ii dm
  
• history of pvd
  
• injured her toe over a month ago
  
• the toes turned dark and lost sensation
  
• they amputated the toe (general anesthetic?)
  
• night before she didn't sleep well and is now wondering hall
  
• medications:
  • oral hypoglycemic
    • glucophage 500mg po bid

    [*]sliding scale insulin coverage based on accu check results

    • humulin r sc 30 min ac and hs sliding scale base - check the signs and symptoms of hypo- and hyperglycemia

  [*]other treatment orders

  • fasting blood glucose levels bid
    
  • 2000 calorie diet

maslow's hierarchy of needs (the physiological portion):

1. physiological needs (in the following order)
   • the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxgenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
     
   • the need for food and water
     
   • the need to eliminate and dispose of bodily wastes
     
   • the need to control body temperature
     
   • the need to move
     
   • the need for rest
     
   • the need for comfort

i might want to check her orientation to person, place and time first. however, i have a feeling that the answer is more like check her blood sugar first to make sure she isn't hypoglycemic (the need for food). restlessness is a symptom of hypoglycemia. if her blood sugar is ok, then i would assess her for sleep problems and work may way into a pain assessment (the need for rest and comfort). i would consider calling the doctor for a sedative or pain medication depending on what i learned from my assessment.

[eightzmusic]

Thank you very much for your help!! I didn't think someone would respond so quickly, too!