A Diabetic Patient - Case Study Example

Running Header: A DIABETIC PATIENT A DIABETIC PATIENT LA TROBE ACUTE CARE B- NSG2ACB Running Header: A DIABETIC PATIENT LAST NAME 2 INTRODUCTION Douglas Adams has just been admitted to the hospital ward after a friend found him in a confused state. He is to have an assessment done to discover what is going on with him physiologically. The ambulance did minimal assessment and he will receive a more focused assessment once admitted. Running Header: A DIABETIC PATIENT LAST NAME 3 SECTION 1 51 year old male patient presented to emergency room after friend found him alone in his home in a confused state. Glasgow coma scale was 14/15 and he was admitted for further observation and tests. His Glasgow coma scale remains at 14/15. Vital signs are HR 82/ BP 110/87, respirations 18, temperature 36.8. The patient is scheduled for a CT scan. He is having his blood sugar taken QID and neurological assessments QID. Patient admits to one pack per day smoking history, denies any alcohol consumption, weight is 70 kg., height is 190 cm. He has a history of Type 1 Diabetes and hypertension He takes Humalog 25, 26 units each morning and 16 units in the evening for his Diabetes. He also takes Perindopril, 4 mgs. each morning. Also he takes aspirin, 100 mg. daily. He denies all allergies except penicillin. He lives in a single bed unit by himself. His blood sugar before breakfast was 5.2 and his morning Humalog 25, 26 units was administered. He was also given his Perinodopril, 4 mg. The patient asks a nurse when he is going for his test. He appears slightly sweaty and it is noticed he has a slight hand tremor. His breakfast tray is only half eaten though he denies hunger. He appears pale and has slightly slurred speech. He is not oriented to place. HR 88 bpm, BP 105/80, respirations 18, and temperature 36.5. Running Header: A DIABETIC PATIENT LAST NAME 4. Hypothesis 1: His blood sugar was slightly elevated before breakfast and now he is showing symptoms of hypoglycemia. Hypoglycemia can affect mental functioning and common manifestations of it are confusion, diaphoresis and tremors. Weakness and visual disturbances are common as well. Hypothesis 2: It is possible his antihypertensive is lowering his blood pressure to much, causing him confusion. It is also possible it is interacting with his Humalog in some way. Hypothesis 3: He may also be suffering from hypoglycemic unawareness. Antihypertensive agents in general can impair insulin action. Hypothesis 4: He may have a viral illness or infection that is interfering with his metabolic system. Running Header: A DIABETIC PATIENT LAST NAME5 SECTION 2 1. Hypoglycemia occurs when there is too much insulin in the body in proportion to glucose in the blood. This will cause a drop in blood glucose to less the 3.9 mmol/L. The brain requires a constant supply of glucose to function properly so it is more likely you will see neurological changes when a person is suffering from hypoglycemia. 2. The patient should be questioned on how long he has been on his antihypertensive. Perindopril has no known side effects with Humalog and it is not a b-adrenergic blocker. The patient’s blood pressure should be checked before he takes his medications in the morning and throughout the day. His salt intake should be questioned and labs drawn for his fluid and electrolytes. 3. In hypoglycemic unawareness a patient is unable to detect the warning signs and symptoms of hypoglycemia due to any number of factors. Elderly patients with hypoglycemic unawareness should not try to control their blood sugar levels too tightly. Hypoglycemic symptoms may start to appear as the patients’ blood sugar level drops very quickly causing a sudden metabolic shift which will mimic hypoglycemia even though the blood glucose readings may appear normal or slightly high. 4. The patient may be suffering from an infection which would cause physiologic impairment and worsen his known health problems. Running Header: A DIABETIC PATIENT LAST NAME6 FURTHER ASSESSMENT The patient will need a nutritional assessment to determine diet at home. Small amounts of carbohydrates should be administered throughout the day to avoid a sudden metabolic shift of insulin and glucose. Sweet foods that also contain fat should be avoided because they will slow the absorption of sugar. Overtreatment should be avoided so that a rapid transition to hyperglycemia is not experienced. An appropriate amount would be 10-15 grams of a simple fast acting carbohydrate such as 4-8 oz of fruit juice between meals to keep glucose levels stable. Once the patient is stable further assessment should be made. The patient should be questioned regarding the following assessments that will help lead to an appropriate nursing care plan. Is the patient eating properly, at the same times each day and an adequate amount? What types of food is the patient eating? Eating appropriate carbohydrates and following a nutritional diet is important for the diabetic patient. Who prepares the patient’s food? The patient is also on an antihypertensive and should avoid foods high in sodium as well. What is the patient’s activity level? Too much activity without compensation will also cause hypoglycemia problems as the activity burns carbohydrates in the body as well. Is the patient taking his Humalog at the proper times? The patient lives alone, does he have reminders? Running Header: A DIABETIC PATIENT LAST NAME7 Does the Patient understand the signs and symptoms of hypoglycemia and take preventative measures at once? Does the patient check blood glucose QID as ordered? Does the patient wear a medic alert bracelet that states he has diabetes type 1? If he were to become confused or symptomatic in public he would be treated quicker. Question the patient on his liquid intake and monitor his urinary output. Is the patient’s food intake at an appropriate time to match the peek effects of the humalog? Has the patient attempted the Dusseldorf model of adjusting his own medication to suit his lifestyle? (Kamps, E. 2006, October/November). Has the patient recently had a weight gain or loss? This could suggest an insulinoma which is a tumor in the pancreas. Running Header: A DIABETIC PATIENT LAST NAME8 PHYSICAL ASSESSMENT Determine the patients Glasgow Coma Scale. A comprehensive metabolic profile, complete blood count, liver function tests, pre-albumin/albumin, serum insulin, serum cortisol, C-peptide, and thyroid panels should be obtained. Urine output and fluid intake should be monitored The Dr. may order a chest x ray. Urine should be obtained for a culture and sensitivity, to rule out infection. Skin turgor, color and general appearance should be noted. Pupils should be assessed, are they equal and reactive? Breath sounds should be clear, with no rails, rasping or crackles. Does the patient present with any edema? Bowel sounds should be normal and active and abdomen should be soft and non tender. CONCLUSION The patient’s blood work, labs, and physical assessment combined will ultimately guide his treatment plan. Education and reeducation will be a part of the nursing care plan so that the patient is knowledgeable about his conditions. The CT scan may uncover a tumor that needs further investigation. Running Header: A DIABETIC PATIENT LAST NAME 9 References Cryer PE, Davis SN, & Shamoon H. (2003, June 26). Hypoglycemia in diabetes. Hypoglycemia in diabetes. Retrieved August 24, 2010, from http://www.ncbi.nlm.nih.gov/pubmed/12766131 Kamps, E. (2006, October/November). Journal of Diabetes Nursing. Journal of Diabetes Nursing - Antidiabetic agents, Blood glucose monitoring, Cardiovascular risk management, Complications and comorbidities, CSII/pump therapy, Diet and exercise, Education, Enabling empowerment, Insulin initiation/therapy, New advances in diabetes management, Service delivery. Retrieved August 24, 2010, from http://www.thejournalofdiabetesnursing.co.uk/article-paginated-page.php?channelid=173&contentid=2414&issueid=112&page=1 National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. (2008, October). Hypoglycemia. National Diabetes Information Clearinghouse. Retrieved August 24, 2010, from http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/ Read More