Needing assistance with a part question for case study

lil' girl, LPN · Apr 2, 2005

Don't forget diet!

mendu · Apr 2, 2005

My case study is about caring for a 15 year old boy, who has been diagnosed with insulin dependent diabetes 6 months ago. The patient has irratic blood sugar levels over the past two weeks
Question is: Identify and discuss the acute and ongoing assessment you would see as important for your patient.
My idea to this question and hoping that it is a yay. That when I come to start my shift and look after the teenager. I would want to check his BSL's and do a Urinalysis. Would this be the case?
Look forward to your help
kind regards
:thankya:

i would add diet, exercises, medication teaching. glucose monitoring teaching: when, how often, how to use monitor. how to make insulin injection self, what is the best formula for pt to use. maybe involve social worker to help your pt's family to choose the best equipment his insurance would pay. it is expensive and he is very young. it is life lasting regiment and your pt need to understand this and comply with it. hope it helps. good luck with your assignment. :)

suzanne4, RN · Apr 2, 2005

Forget about the urinalysis. It is no longer tested for sugar levels.......at least in the more critical situations, and especially at any hospital. All testing is done on blood for glucose levels.

The urinalysis would only tell you if he is spilling "sugar" in his urine. Quite non-specific nowadays.

AussieKylie · Apr 4, 2005

Thank you everyone for your help. Truly appreciate it.

:thankya: :yeah:

hmcna · Apr 4, 2005

I agree, to not do the UA.....

do a fingerstick.... review the labs... and any orders for coverage.

One thing, with a teen, is i'd ask them to tell you what they'd been eating, and or have them keep a log, since teens tend to be impulsive esp around food.

I'd also do a quick assessment of where he's at with patient teaching, and with skills, and emotional compliance.

talaxandra · Apr 6, 2005

Also suggest an HbA1C, to see what his long-term control has been.

It's not uncommon for people with chronic illnesses to become less compliant in adolescence - six months in, he may now be becoming more willing to see how far he can push the disease. You could also include something about a diabetes teen support group, either one in the area or online.

FuturenurseCA&O · Apr 7, 2005

In regard to ongoing assessment, check each time you go into the room for alert and oriented...you can do this by talking to him, and making sure his answers to you make sense.

When you are sick with diabetes your blood sugar goes whacko. Basically the body breaks down glycogen and to have available for the body under stressfull conditions (sickness). So their blood sugar levels take large swings up and down. So you want to watch for outward signs of hypo & hyperglycemia in addition to the glucometer.

Hope this helps...

~D

Nrs_angie, BSN, RN · Apr 9, 2005

My case study is about caring for a 15 year old boy, who has been diagnosed with insulin dependent diabetes 6 months ago. The patient has irratic blood sugar levels over the past two weeks
Question is: Identify and discuss the acute and ongoing assessment you would see as important for your patient.
My idea to this question and hoping that it is a yay. That when I come to start my shift and look after the teenager. I would want to check his BSL's and do a Urinalysis. Would this be the case?
Look forward to your help
kind regards
:thankya:

When you check the labs, check the HbA1c to see how his blood sugar has been over the last 3 months. Perhaps lately it has been fluctuating due to the stress of being sick if thats why he's in the hospital or maybe he's not been following diet. So in your ongoing assessment, you should assess his understanding of controlling his diet, what he does when he is hypoglycemic, and what times of day is he peaking or bottoming out... ect. If he he getting nighttime hypoglycemia... put in teaching about a fast carb, slow carb, and a protein.

AussieKylie · Apr 13, 2005

Hi, I feel pretty silly for questioning this :idea: , but I need to be sure.

I am wondering if erratic blood sugars are fluctuating through a hyper and hypo sugar levels?

I say yes but to be sure is to be sure :wink2:

regards

Nrs_angie, BSN, RN · Apr 20, 2005

Hi, I feel pretty silly for questioning this , but I need to be sure.
I am wondering if erratic blood sugars are fluctuating through a hyper and hypo sugar levels?
I say yes but to be sure is to be sure :wink2:
regards

Hello,

I am not sure what you are trying to ask. You want to know if his blood sugar is fluctuating because of hyperglycemia and hypoglycemia episodes??

Well... How has his blood sugar been running? you say "irratic" do you mean he's been both hyper and hypo? Or has he mostly been running high? or mostly low? Can you be more specific?

What has he been taking? Insulin? and what kind? Depending on what insulin he takes and when his meal times are... maybe for example... if he takes a rapid acting insulin like Lispro and he does not eat immediately after that... he is bottoming out. ( hypoglycemic )

Does he do any strenuous exercise? Since he is 15 maybe he is in highschool football or weight lifting and it would cause him to have hypo.

Many things can be causing this... Has the blood sugar been erratic before he came to the hospital ? or only since he's been in the hospital?