Lack of Proper Diagnosis and Proper Treatment - Essay Example

Diabetes A Case Study Order No: 154295 Deadline 10/3/2007 No. of pages – 10 6530 In ancient times, many of the diseases were incurable and diabetes was one of them. Scores of people had lost their lives for sheer lack of proper diagnosis and proper treatment. But now in these modern times, with the advancement of Medical science and state-of-the-art technology, diabetes is no longer considered life threatening. In fact, modern medicine, the expertise of specialists with improved amenities has contributed in making diabetes a less dreaded disease. But all said and done, diabetes, unlike some of the other diseases cannot be cured in a day. Special care and the right medication will improve the health of the patient over a period of time. A Case Study The following is a case study of Cherry Honeywell, a fourteen year old girl who was brought to the hospital by her mother following heavy bouts of vomiting. Her mother seemed particularly agitated and anxious because Cherry had “passed out” during her last episode of vomiting. She complained of severe abdominal pain and feeling hot. She seemed drowsy and lethargic as she was taken into the Emergency department. Initial Assessment: The nurse on duty made an initial assessment of Cherry in order that she could take better care of her. She found that Cherry had an acetone smell to her breath and inquired if she had taken any drugs or alcohol the previous day, but Cherry denied taking any such thing. She also found that Cherry complained of having pain in all quadrants of her abdomen. The following tests were carried out by the nurse on duty- Tests carried out: Pulse rate was 120 beats per/min BP was recorded at 100/60 Temperature was 35.8 degrees Celsius Respiration was 32 breaths per minute and air entry into her lungs were equal and so concluded that Cherry’s lungs were clear. Height was found to be 172cms Weight was found to be 46kgs Urine was pale in color and tested positive for acetone and sugar. Blood sugar level showed 44 mmol/L When the nurse inquired about her weight the mother told the nurse that Cherry had been gradually losing weight and she thought that it was due to adolescence or just “puppy fat” Collaborated Treatment: A Medical Officer requested the nurse on duty to carry out blood tests. Blood was taken for testing at 0200 hours. Cherry was disoriented and upset and vomited 30mls of clear liquid at 0205 hours. The blood was sent to the lab and tested thoroughly and at 0330 hours the following results were brought in- Results of the Initial Tests: Taking into consideration the blood results and reviewing the client history, the physician as well as the nurse concluded that Cherry Honeywell had “Diabetic ketoacidosis”. Cherry’s mother was visibly shocked and could not believe that her daughter was a diabetic. Urine Tests: The reason for concluding that Cherry had a condition called “Diabetic Ketoacidosis” was because the nurse found the urine containing “ketones”. The nurse was very vigilant in informing the doctor of Cherry’s condition because such a condition if left untreated immediately could lead to coma and death. Supporting Literature: Diabetes is a disease a person gets when his or her body is not in a position to produce enough insulin to convert sugar, starch and other food to energy needed for daily life. It is still a mystery as to the actual cause of diabetes, but the Medical Fraternity believe that environmental factors and genetics like obesity and lack of exercise play major roles. In fact most people are not even aware that they have diabetes. Doctors recommend a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT) in order to determine if a person is suffering from diabetes. Fasting Plasma Glucose Test (FPG) – In this test, if the fasting blood glucose level falls between 100 and 125 mg/dl it signifies pre-diabetes. If the glucose level is higher than 126 mg/dl then the person has diabetes. Oral Glucose Tolerance Test (OGTT)- In this test a person’s blood glucose level is checked after a fast and two hours after drinking a glucose rich beverage. If the blood glucose level is between 140 and 199 mg/dl then the person has pre-diabetes. If the blood sugar level is above 200 mg/dl then the person is suffering from diabetes. (American Diabetes Association. Cure, Care, Commitment) see http://www.diabetes.org/about-diabetes.jsp Preparation of the patient for an IV Cannula : To prepare the patient for an IV Cannula, the nurse rubs Emla cream on Cherry’s hands. The IV Therapy commenced by giving her 1000ml of Normal Saline at 0345 hours to be run over for 8 hours. This was given via an infusion pump. At 0400 hours the nurse gave Cherry another 30 units of Actrapid insulin in 30ml of Normal Saline Water which had to be run at 2 units per hour. The nurse took regular blood sugar readings and urine tests for the patient to check the glucose level and the presence of ketones. She also regularly checked the fluid input and out put of the patient. The consolidated results were as follows- Time (h) 0600 hours Reference Range Na 138 (132–144) mmol/L K 2.9 (3.5–5.0) mmol/L Cl 110 (98–109) mmol/L HCO3 10 (23–33) mmol/L Creat 0.27 (0.06–0.12) mmol/L AGap 26 (4–17) mmol/L Glu 36.0 (3.5–6.4) mmol/L PO4 3.5 (0.65–1.25) mmol/L Preparation and application: Before administering an insulin injection to Cherry, the nurse carried out the necessary instructions of the doctor. She washed and dried the area to be treated and then gently applied Emla cream to the spot where the injection was going to given. She instructed Cherry not to rub her eyes or mouth with the cream as it is harmful. Literature: Emla cream is a local anesthetic cream used on a patient to block nerves from transmitting painful impulses to the brain. It numbs the skin to pain from injections and other medical procedures. (See Database Edition 06.4.1.002) Insulin: A person suffering from “Diabetes Mellitus” needs insulin. Diabetes Mellitus is a condition where the pancreas is not capable of producing enough Insulin to control the blood sugar (glucose) levels in the body. Therefore extra insulin is needed by a patient to control his blood sugar levels. Injections of Human Insulin are administered to a patient to bring down his blood sugar levels. The following are some of the Human Insulin’s that could be used for a patient- Actrapid: It is Neutral Insulin Injection 100 IU m/L. It contains glycerol, metcresol, zinc chloride and water. Hydrochloric acid and sodium hydroxide are used to adjust the pH. It is a neutral solution of Human Insulin (rys- is an abbreviation used to indicate the method of genetic engineering used in the preparation of insulin) which appears clear and colorless. Protaphane: It is an isophane human injection. It is a neutral suspension of isophane human insulin. When shaken it appears cloudy. Mixtard: It is a Biphasic Isophane Insulin injection. It is a pre mixed neutral suspension of 30% neutral insulin and 70% isophane insulin injection. When shaken it appears cloudy. (See novo Nordisk.com.au/media/CMI/Inshvialcmi7.) Actrapid is used by doctors in an emergency situation to treat people with diabetes. Nurses’ Duty: Since the doctor ordered the use of Actrapid for Cherry, the nurse instructed her to have a meal or a snack filled with carbohydrates half an hour before she can inject her with insulin. The insulin contained in Actrapid 10mL vial can be given intravenously. The nurse drew a volume of air into the vial, equal to the amount of insulin to be taken. She then pierced the vial with the needle and exerted the air into the vial. She turned the vial and the syringe upside down and began to withdraw the insulin. She then inserted the needle into Cherry’s arm and injected the insulin and discarded the needle into a bin. Symptoms of High Blood Sugar Levels: Loss of appetite Thirst Nausea and vomiting Increased urination Drowsiness (fatigue)S Flushed dry skin and dry mouth Acetone breath. The nurse was very alert to understand that her patient Cherry had most of these symptoms and therefore needed utmost care. Children and adults who develop DKA should be admitted to those centers with experience of such treatment, where neurological status, vital signs and other Laboratory results can be monitored and evaluated frequently, so that the patient would recoup considerably well. Careful and critical monitoring should be done in order to keep complications under control. (See diabetesguidelines.com/health/dwk/pro/guidelines/ispad/05.asp) “Managing Diabetes is a matter of juggling three things: insulin, food and exercise. All three things have a major effect on Diabetes control.” (See American Diabetes Association for parents and kids.) High Dependency Unit: The nurse transferred Cherry to the High Dependency Unit because she thought she needed close monitoring due to her altered conscious state. She was taken in at 0715 hours for observation and continuation of her treatment. Literature: A High Dependency Unit offers care between the acute ward and full Intensive care. It provides support and monitoring for patients who are at risk of developing organ failure. It also undertakes short term resuscitative measures and ventilator support to patients before taking them to an ICU. The High Dependency Unit does not need a full time resident doctor. It can function with a nurse/patient ratio of 1:2. (Adult Intensive Care Services in Northern Ireland –pg 10) Nurses’ advice to Cherry’s mother: The nurse understands how Cherry’s mother feels, because at the bottom of it all no one likes diabetes- leave alone seeing your child with it. She gently tells her mother that with a lot of love and care Cherry would get well soon. She asks her to see that Cherry gets the right diet with a lot of exercise and the right amount of insulin from time to time. She also advises Cherry’s mother to be tolerant and kind because Cherry would throw a few tantrums because of her condition. She also asks her to help Cherry find friends having the same problem so that she could discuss her condition from time to time. Nurse’s advice to Cherry: The nurse very gently informs Cherry that this disease- diabetes is going to stay with her for a lifetime and there is no escape- so it is better if she accepts this fact here and now. She tells Cherry that she has the support of a wonderful family and she should confide in them always. She should answer any questions her parents ask her because it is for her own good. If at any time she feels sick or down she should immediately inform her parents. She also advises her to eat the right foods and do plenty of exercise so that she could feel better. She advised her to regularly take her insulin and find other friends who may have the same problem so that she could exchange ideas on how she feels with them. (ADA Wisdom Youth Zone TM Website for kids and teens with diabetes.) Nurses Log Book: The nurse’s duty ended after 8 hours of looking after the patient Cherry who was admitted for “Diabetic ketoacidosis”. She had taken great care to see that she had jotted down all the details regarding Cherry- like blood sugar levels, urine tests, BP, Temperature, Pulse, ECG etc. and handed this over carefully to the next nurse on duty. References: ADA Wisdom Youth Zone TM Website just for kids and teens with diabetes. www.crestni.org.uk/publications/adult_intensive_care.pdf American Diabetes Association. Cure, Care, Commitment. http://www.diabetes.org/about_diabetes.jsp www.diabetesguidelines.com/health/dwk/pro/guidelines/ispad/05.asp www.diabetes.org/wisdom Database Edition 06.4.1.002 http://www.fda.gov/mediawatch www.drugs.com/cdi/emla_cream.html Endocrine Society (2004) Adelaide, Australia, 5000 www.Novonordisk.com.au/media/CMI/Inshvialcmi7 Read More