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Case Study

Case Study

Diabetes Mellitus Type 1

Scenario: A 25-year-old goes to her physician for an annual routine checkup. The woman has not seen her physician in a year. The woman recently had a visit to an urgent care center and was treated for strep throat. She is concerned about her weight gain. She states that no matter how much she eats she cannot gain weight and is hungry all the time.

Assessment:

Weight: 46.9 kg

Height: 66 in.

Heart rate: 122 beats per minute

Blood pressure: 106/64 mmHg

The woman is anxious, looks thin, and has dry lips and dry mucous membranes. Upon neck palpation the woman has several enlarged cervical lymph nodes and has a “sweet” odor to her breath. The remainder of the examination is within normal limits.

Highlight or place a check mark next to the assessment findings that require immediate follow-up by the nurse.

Assessment:

Weight: 46.9 kg

Height: 66 in.

Heart rate: 122 beats per minute

Blood pressure: 106/64 mmHg

Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided.

While assessing the woman, the nurse recognizes that _______1________, _______1_______ and ___1______ are signs of ______2_____, a possible diagnosis. The nurse anticipates the provider will order the following tests, _____3______, and _____3_____ to help confirm or rule out the diagnosis.

Options for 1	Options for 2	Options for 3
Dry mucous membranes	Diabetes mellitus	Urinalysis
Poor weight gain	Metabolic alkalosis	Blood sugar
Sweet breath odor	Respiratory alkalosis	Complete blood count
Anxiety	Hyperaldosteronism	Ultrasound
Enlarged cervical lymph nodes	Hypothyroidism	Thyroid test

Scenario: The primary care office does not have a glucometer available, so the provider orders a urinalysis dip stick test. The urinalysis shows a glucose of over 500 mg/dL with blood, leukocytes, and ketones. The results are shared with the woman along with the potential diagnosis and complications. The woman visibly upset and start asking the nurse questions about her health.

Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided.

Based on the available test results the nurse suspects the woman may be experiencing ____1____because of the ___1_____ and ____1____ in the urine. The nurse anticipates that the woman will need ____2_____ and ___2______ as soon as possible.

Options for 1	Options for 2
Diabetic ketoacidosis	PO glucagon
Metabolic alkalosis	IV regular insulin
Respiratory alkalosis	Fruit juice
Respiratory acidosis	IV long acting insulin
Glucose	IV fluid replacement
Ketones	5% dextrose
Leukocytes	Chocolate milk
Blood

Use an X to indicate whether the nurse’s responses to the woman are Therapeutic or Nontherapeutic.

Nurse’s Response	Therapeutic	Nontherapeutic
“There is no need to worry, this diagnosis is common.”
“By administering IV insulin and IV fluids, we can help you to feel better.”
“I understand all of this can be overwhelming, but we are here to support you through this new diagnosis.”
“Yes, you could have attributed to this problem by not limiting the amount of sugar you eat.”
“It is important that you understand that this is not something you could have prevented.”

Scenario: The woman is admitted to local hospital with diabetes mellitus type 1 for continued care, further evaluation, and education about her new diagnosis. After several days, the woman is ready for discharge. While the nurse is providing discharge education to the woman, the woman asks if she will be ever be normal again.

Which of the following responses by the nurse are appropriate? Select all that apply.

A. “You will always have diabetes mellitus type 1, but this does not mean that you cannot have a normal life.”

B. “You may have a hard time making friends who understand your diagnosis.”

C. “You will need to monitor your blood sugar and carbohydrate intake, but you can still participate in your favorite activities.”

D. “It will be hard for you to continue working and traveling now that you have been diagnosed with diabetes mellitus type 1.”

After providing discharge instructions to the woman, the nurse assess the woman’s understanding. For each statement, use an X to indicate whether the nurse’s discharge instructions were Effective (helped the woman understand the discharge instructions), Ineffective (did not help the woman understand the discharge instructions), or Unrelated (not related to the discharge instructions).

Statements	Effective	Ineffective	Unrelated
“I will need to monitor my blood sugar levels on a daily basis.”
“I will keep my medications in child proof containers and out of reach.”
“I will plan out my daily meals and count carbohydrates.”
“I will understand that the abdomen is the only location for an insulin injection site.”
“As long as I monitor what I eat, I should not need to use insulin.”
“It is important that I understand the signs and symptoms of hypoglycemia and hyperglycemia.”