help please - with diabetic patient case study

[Oz_guy_student]

hi all,

i am new to this forum and am wondering if you could help me.

i have a case study which i need help with in terms of prioritising nursing interventions. i am writing from australia, so terminology below may not be universal. i have tried to convert some of the observations. (ie: temperature from celcius to farenheit)

pt is male, early 40's, who is admitted onto ward from emergency department, having been referred by his local doctor. he has a week long history of fatigue, headache, poor appetite, thirst and frequency.

his weight is 198.5 pounds and his height is 5 feet, 4 inches. admission observations are:

ƒ temp: 100.7 degrees farenheit

hr: 128 bpm

ƒ rr: 24

ƒ bp: 160/95

ƒ oxygen saturations (sao2) 95% ra

ƒ a urine analysis (ua) was undertaken and shows a large amounts of glucose a trace of albumin, no ketones and a specific gravity (sg) of 1.016.

the medical officer (mo) reviews patient and inserts an intravenous cannula, orders oxygen at 6litres/minute via a hudson mask, blood to be taken for analysis including, blood cultures, bsl, fbc, euc, lft and requests that a mid stream urine (msu) and an electrocardiograph (ecg) be undertaken.

patients blood sugar levels is 15.2 mmol/l, so the doctor orders actrapid 4units, stat.

he has a provisional diagnosis of type 2 diabetes mellitus.

identify at 4 high priority nursing interventions relevant to pt's needs and the rationale for these as you assess him. your answer should demonstrate an understanding of the pathophysiology related to pt's symptoms and the treatment ordered by the medical officer (i.e. urine analysis and culture, blood analysis and ecg).

can anyone help?

thanks

oz guy

[DolceVita, ADN, BSN, RN]

Welcome to allnurses.

As you are new to this site you should know it really is bad form to post a homework assignment having not shown any effort to answer it yourself. What is good form is to make a real effort to do it yourself. Post what you got and ask someone to review it.

Sorry if this is snippy but it really rubs my rhubarb when people work so hard to finish assignments and others post case studies, say they don't get it...and get them answered on allnurses. It is no better than copying someone else's work.

I feel like a broken record.

[Oz_guy_student]

thanks for your feedback.

My intention was never to just get the answers from others (and not do my homework) but get a gauge of whether I was on the right track. In light of that, yes, i should know for next time to write down my answers and get feedback.

Apologies for not following the etiquette.

My priorities would be:

1. Administer oxygen therapy due to compromised respiration efforts

2. Administer atrapid insulin and monitor BSL levels as current reading is high

3. Do ECG and determine any cardio alterations, as those with diabetes are at risk of cardiovascular disease

4. Review UA and blood results to decipher any other factors causing febrile status, hypertension etc.

5. Patient education

I am not sure whether putting oxygen therapy over administering Atrapid is correct but i figured within the ABC' framework that dealing with compromised breathing is more critical?

any feedback would be valuable.

Thanks

Oz guy

[llg, PhD, RN]

I'm not an expert in nursing care of adults and I am not in Australia ... but your reasoning and priory list seem right to me. Get the oxygen on first (as in ABC framework) and then do the rest.

You might also want to include that you would do a little patient education as you went, explaining things to the patient as you did things. The major diabetic teaching would come a little later, but you would explain things you were doing from the very beginning.

I hope someone with more expertise on this type of scenario comes along to give you more help soon. Good luck!

... and welcome to allnurses. :)

[Aeterna, BSN, RN]

Between applying oxygen and administering insulin, yes, maintaining sufficient oxygenation is top priority. You can't live if you can't breathe And a CBS of 15.2 is high but not life threatening.

So, yes, if it were me, I'd do the O2 first and then the insulin. I would then reassess the glucose levels in an hour (this would just be me personally, though) and, of course, monitor for any signs of hypoglycemia.

And this scenario kind of sucks because it doesn't tell you a whole lot about the patient's history. Does he have any history of hypertension or any other heart disease? (i.e. is he on any meds at home for this?) Any cardiac history, respiratory history, other endrocrine history, etc? Does he smoke and/or drink alcohol? What does his physical assessment reveal? (i.e. adventitious sounds in the chest, diaphoresis, distress, pain, level of consciousness and orientation) I hate it when they don't tell you this stuff xD

After that, things get fuzzier. I mean, in the real world, a lot would depend on what I'm seeing and what the lab results come back as. Also, lab results may come back quickly and sometimes they are delayed, depending on the lab's situation. Even if you got the results and got some abnormal values, you can't actually do anything about them until you get an MD order.

But, in terms of priority, the labs are probably third most important because it would direct a lot of the care plan. Then comes patient education. However, it may not occur in that order time-wise - might as well do a bit of patient education while you're administering insulin and waiting for the lab results, no?

[Oz_guy_student]

Thank you PP for your advice.

llg - thank you re: patient education as I go through the interventions. I glad I am on the right track as I definitely put that into consideration.

Aeterna - thank you for your words. yes, unfortunately with assignments like this, information is partial and you have to 2nd guess a lot of things. thank you for your wisdom, atleast i don't feel so dumb as I was doubting my priorities!

Much appreciated that you both took the time to respond so kindly to my dumb questions.

Cheers