Question

Source for Case study #1: Winningham, M.L. & Preusser, B.A. (1996). Critical thinking in medical-surgical settings, A case study approach. St. Louis, MO: Mosby

Case Study #1:

Scenario

P.W. Is a 40-year old disabled man who recently lost his wife to metastatic breast cancer. His brother has taken him into his home. P.W. has a 22-year history of insulin-dependent diabetes mellitus (Type-1). Until recently, he has taken responsibility for the management of his disease and has been actively involved in the local chapter of the American Diabetic Association.

PMH includes 2 amputated toes on his R foot, retinopathy and visual impairment in both eyes, and angina on exertion from coronary artery disease that severely restricts his activity. Since he began treatment with an Ace-inhibitor 2 years ago, his blood pressure has gone from 182/128 to 126/78 mm Hg. Currently, he is 71” tall and weighs 135 lb. P.W.’s sister-in-law, who is an LPN says P.W. has lost about 12 lbs in the past 3 weeks. Over the past few years, P.W. has been administering a multidose (3 injections) regimen of regular Humulin insulin to himself before meals and at night. Recently his BG levels have been increasingly inconsistent and labile, and he has been labeled “noncompliant.” It is Monday. You are the home care nurse assigned to visit P.W. 3 times per week for teaching and evaluation. P.W.’s brother and sister-in-law express concern that P.W. seems to be indifferent about his nutritional and pharmacologic regimens.

1. List the measures you normally would address in teaching for both hypoglycemia and hyperglycemia (6 each).

· Hyperglycemia

· Hypoglycemia

Note: Current practice promotes tighter glucose management to prevent long-term complications of DM. In the past, patients’ glucose often would be allowed to swing to 180 mg/dl or higher.

The American Diabetes Association criteria for screening and diagnosis of diabetes is listed below. Also, more or less stringent glycemic goals may be appropriate for each individual.

As you start to review the above measures with P.W., you notice he already seems aware of what he should do to control his blood glucose. You are concerned that he seems too distracted and drifts off in the middle of a discussion; his affect also appears flat.

Answer 1

Hypoglycemia, also known as low blood sugar, occurs when levels of glucose (sugar) in the blood are too low. Hypoglycemia is common in people with diabetes who take insulin and some (but not all) oral diabetes medications.Hyperglycemia is the technical term for high blood glucose (blood sugar). High blood sugar happens when the body has too little insulin or when the body can't use insulin properly.