401209 Health Variations 2-Chronic Illness And Disability

401209 Health Variations 2-Chronic Illness And Disability

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401209 Health Variations 2-Chronic Illness And Disability

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401209 Health Variations 2-Chronic Illness And Disability

2 Downloads6 Pages / 1,395 Words

Course Code: 401209
University: Western Sydney University

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Country: Australia

Questions:

Case study
You are a Registered Nurse working in the emergency department caring for Ben Summer who is 19 years of age.
Medical history
Ben visited his local doctor after experiencing increased appetite and excessive thirst. He has been unusually tired when playing football and hasn’t been able to perform at his best. He has lost 10 kilograms of weight over a two week period and has been frequently urinating at night. The doctor suspected type 1 diabetes and tested his urine, which was positive for glucose and ketones. A random capillary blood glucose level was 25.0mmol/L and blood ketone level was 1.5mmol/L. Ben was advised to attend the hospital emergency department immediately.
Social history
Ben lives with his mother (Susan), father (John) and 12 year old brother (Jacob). He attends university full time, studying engineering and works at McDonalds on a casual basis. Ben plays football on the weekends and trains two days during the week. He has a girlfriend Rachel and they both enjoy surfing at the beach.
Emergency department review
Two hours after review by the local doctor, Ben’s capillary blood glucose level was 26.0mmol/L and blood ketone level was 1.6mmol/L. Other vital signs were within normal limits. After review by the endocrinologist, Ben was given a provisional diagnosis of type 1 diabetes based on his symptoms and family history of autoimmune disease (His mother has hyperthyroidism, Graves’ disease). His blood test confirmed that he did not have ketoacidosis.
Treatment plan
Ben was prescribed subcutaneous insulin; Aspart (NovoRapid) Flexpen 10 units TDS and Glargine (Lantus) Solostar 30 units nocte. He was referred to the diabetes service for ongoing care.
Case study questions
Using the marking criteria and supporting academic references address the following questions.
Assessment Questions
Part A 
The nursing responsibilities related to the administration of Aspart (NovoRapid) insulin to Ben.

Explain the 11 components of a valid routine subcutaneous insulin medication order and why this is important. Supportyour answer with academic or clinical guideline 
Explain why Ben has been prescribed this  Relate to the pathophysiology of type 1 diabetes and The mechanism of action of NovoRapid insulin. Support your answer with academic

Whatis the onset, peak and duration of action for NovoRapid insulin according to Bullock and Manias (2017)? Explain when NovoRapid should be administered in relation to food intake and  Support your answer with academic references.
Discussthe definition, causes, symptoms and treatment of hypoglycaemia, a common adverse effect of Novo-Rapid. Support your answer with academic references.

Discussthe importance of understanding the medication prior to  Support your answer with academic references.
Discussthe 5 rights of medication administration and why it is important for nurses to follow this 

Support your answer with academic references.

Whatis the most appropriate insulin pen needle length for Ben and why? Support your answer with academic
Whatdiabetes specific nursing assessment would you conduct prior to administration of NovoRapid insulin to ben and why? Support your answer with academic references.

Identifythe site and angle you would inject the NovoRapid insulin and explain why this was selected for  Discuss infection control considerations. Support your answer with academic references.
Whatwould you document and where? Why is documentation important? Support your answer with academicor clinical guideline references.

 Explainthe diabetes specific nursing assessment you would provide for Ben post administration of insulin, when you would provide it and  Support your answer with academic references.

Part B 
The potential impact of type 1 diabetes on Ben.

Discussthe daily physical challenges of living with type 1 diabetes that Ben may  Support your answer with academic references.
Discusspotential emotional impacts of living with type 1 diabetes that Ben may  Support your answer with academic references.

 

Answers:
Components of Subcutaneous Insulin
There are eleven components of an effective subcutaneous insulin administration. First, the main aim of the components is to ensure a medication order of an effective routine subcutaneous insulin administering. It indicates the way of training nurses and doctors about the medication. The order must be adhered to as stipulated by the prescription. Secondly, the main instructions must be followed before the medication. All instructions should be documented in a clear form. Thirdly, the demographics are required in order to identify the nature of the disease. Demographics are significant as they ensure the patient gets the right insulin medication. The fourth component involves monitoring of the condition experienced by the patient. Monitoring ensures that the medical staff detects whether the condition of the patient worsens or improves (Dabelea et al., 2014). The fifth component encompasses monitoring of the records that indicate the variation of ketones and blood glucose levels. This monitoring directs the application of insulin in the body. The sixth component addresses the division of insulin orders into supplemental, stat and routine, and suggests whether the patient can take the combination of the three orders. He seventh component deals with the recording of insulin administration into records while the eighth component provides the comments section that are required for the communication between the medical staff and the patient. The ninth component provides instructions for managing hypoglycemia and indicates how to regulate negative effects of diabetes that might affect a patient like Ben. The tenth component addresses the use of hypoglycemia treatment for diabetic teenagers by use of cooperation and consciousness approaches while the final component involves the insulin pharmacy review in regards to administration and staff consultation.
All of the above components are very important when treating a type 1 diabetic patient like Ben. He was suffering from high levels of ketones and glucose. The treatment process will be easier and manageable if all the above components are adhered to (Dabelea et al., 2014).
Reason for the Prescription of Subcutaneous Medication
The doctors prescribed the medication to Ben because the levels of ketones and glucose were detected. The medication lowers the levels and hence avoid harmful effects. Bartholow (2016) indicates that physiology should be considered when treating type 1 diabetes. The immune system responds against the affected pancreatic cells in a rapid manner. One should balance both the environmental and genetic factors as these mechanism is always related to type 1 diabetes. The process is explained below:
The mechanism called the NovoRapid helps to generate insulin in the human body. It reduces the glucose concentration and acts within a few hours after every meal. Therefore, it acts faster than the rapid insulin action (Hovorka et al., 2014). Thus, this was medication was prescribed for Ben because he had a higher level of glucose.
NovoRapid
The onset duration of NovoRapid insulin action takes ten to thirty minutes while the normal human insulin takes thirty minutes. Its peak duration takes forty to fifty minutes while the normal human insulin takes eighty to one hundred and twenty minutes. The action duration takes three to five hours whereas the regular human insulin takes eight hours (Hovorka et al., 2014). The NovoRapid should be administered to Ben shortly after meals.
 
Causes, Signs, and Treatment of Hypoglycaemia
Diabetic patients can be affected by hypoglycaemia when there is no enough sugar in the body. This condition also occurs because of other reasons such as diet, lack of exercise and medications among others. Those affected suffering from hypoglycemia should record the time and date to be shared with the medical staff for necessary medication. Hypoglycemia symptoms include hunger, pale skin, weakness, sweating, dizziness, headaches, anxiety, and confusion. The treatment of hypoglycemia involves eating or drinking fifteen grams of fast-acting carbohydrates such as a cup of milk, 3-4 glucose tablets, 1 tube of glucose gel, 4-6 pieces of hard candy, a half a cup of fruit juice and half a cup of soft drink (Mauer et al., 2013).
Importance of Understanding the Medication
Comprehending the significance of medication before administration is vital for diabetic patients like Ben. Mauer et al. (2013) clarify that it is the only way to comprehend activities associated with our daily lives. Ideally, one should prepare the medication correctly, follow the rights, monitor the patient, deliver the right medication information and education and assess the results of the medication on the status of the patient.
The Five Rights
They include the right patient, the right dose, the right route, the right time and the right drug. They should be considered as the main objective of the medication. They influence the personnel performance and counteract obstacles to task completion (Steinberger and Daniels, 2013).
Pen Needle Length
4-6 mm because Ben had thin subcutaneous fat layer due to his weight loss.
Diabetes-Specific Nursing Assessment
A nursing insulin assessment should be done for Ben to highlight his medical history
Since Ben’s condition was serious, he had to be given the medication without a prescription. His parents should be informed of his condition and treatment. The medication shouldn’t be changed abruptly.
Injection Site
Ben should be injected on the outer part of the buttocks, thighs, and abdomen at ninety degrees to ensure his comfort and efficient drug delivery to the subcutaneous route.
Documentation
I would record his glucose level, blood pressure, medication and history for future reference and treatment by other practitioners.
Nursing Assessment
I would check his dietary pattern assessment to evaluate the level of ketones and glucose, his smoking condition because it is important that he stops and also if he is given educational support. Thereafter, I would arrange for future meetings to check on his health status.
Part B: Physical Challenges that May Affect Ben
First, Ben may be affected by the neuropathy condition that leads to nerve damage. The condition occurs when a lot of sugar in blood damages the blood vessels that nourish the nerves, particularly in the legs (Bergenstal et al., 2010). This condition leads to pain, numbness, and tingling. Secondly, Ben may suffer from the skin and mouth infections as diabetes can cause fungal and bacterial infections. Also, diabetes might injure the retinal blood vessels and hence may lead to blindness or other rigorous vision diseases such as glaucoma. Ben may also suffer from the foot damage condition due to damage of the nerves in the feet. Lastly, Ben may be at risk of developing high blood pressure (Bergenstal et al., 2010).
Emotional Impacts of Type 1 Diabetes
It is very tough to live with type 1 diabetes. In this case, Ben may be overwhelmed as the pressure to maintain and control glucose level can rise and make him feel angy easily, guilty, or become demotivated when the anticipated results are not achieved. It is vital to note that living with type 1 diabetes can be difficult indeed.
Teenagers forget that the high level of glucose in the blood may affect the mood and make one to feel angry and short-tempered. It is advisable that Ben eats or injects himself to manage the condition.
 
References
American Diabetes Association. (2017). 2. Classification and diagnosis of diabetes. Diabetes Care, 40(Supplement 1), S11-S24.
Bartholow, R. (2016). Manual of hypodermic medication. JB Lippincott & Company.
Bergenstal, R. M., Tamborlane, W. V., Ahmann, A., Buse, J. B., Dailey, G., Davis, S. N., … & Willi, S. M. (2010). Effectiveness of sensor-augmented insulin pump therapy in type 1 diabetes. New England Journal of Medicine, 363(4), 311-320.
Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J., … & Liese, A. D. (2014). Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. Jama, 311(17), 1778-1786.
Diabetes Prevention Trial-Type 1 Diabetes Study Group. (2012). Effects of insulin in relatives of patients with type 1 diabetes mellitus. New England Journal of Medicine, 346(22), 1685-1691.
Hovorka, R., Canonico, V., Chassin, L. J., Haueter, U., Massi-Benedetti, M., Federici, M. O., … & Wilinska, M. E. (2014). Nonlinear model predictive control of glucose concentration in subjects with type 1 diabetes. Physiological Measurement, 25(4), 905.
Mauer, M., Zinman, B., Gardiner, R., Suissa, S., Sinaiko, A., Strand, T., … & Klein, R. (2013). Renal and retinal effects of enalapril and losartan in type 1 diabetes. New England Journal of Medicine, 361(1), 40-51.
Steinberger, J., & Daniels, S. R. (2013). Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation, 107(10), 1448-1453.

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