Question

Mrs. McLaughlin is your 42-year-old female patient who is being discharged following an episode of symptomatic hypoglycemia with seizure. Mrs. McLaughlin admits to not taking her medication properly because in the past it made her blood sugar get way too low and she didn’t have any candy or orange juice around. She ended up going into a “coma” that time too, and an ambulance had to bring her to the hospital.

Mrs. McLaughlin’s vital signs are as follows:

Height 5’5” Weight 118 lbs   TPR   97.9/72/16      BP 118/78 mm HG

Mrs. McLaughlin’s medication list prior to admission included the following:

Glyburide 10 mg p.o. b.i.d.

Ortho-tri-cyclen daily

Mrs. McLaughlin wants to take better care of her diabetes but doesn’t understand why she has to take a medication that can make her blood sugar get low and risk a hypoglycemic coma. Her best friend has diabetes and takes a different kind of pill. She says her friend tells her that there is no risk of low blood sugar with that medicine; Mrs. McLaughlin wants to know why she can’t take that medicine as well. She says she asked her Dr. and the Dr. just said no.

She is understandably afraid to take her medication after the experience that she had. You are concerned that she will not take her medication anymore when she goes home. She doesn’t understand why she has to take a medication with this side effect when her friend has the same disease and can take something different. We know that patients are more inclined to adhere to a therapeutic regimen if they understand the rationale. Based on the information provided, what will you tell her? (Identify the problem – 5 points)

Can you explain, in some detail and in language she can understand, why she cannot take the same medication as her friend? (Rationale -- 5 points).

The night before discharge, Mrs. McLaughlin is feeling almost back to normal. Her son comes to visit her and sneaks in some food from a local fast food establishment that is her favorite. She doesn’t mention it to staff, but she fills up on fast food! The next morning she wakes up with crampy abdominal pain and explosive diarrhea. She tells you that she has already had three almost uncontrollable bowel movements and she knows she won’t even make it home in the car. She is asking for something to stop her diarrhea so she can go home.

How do you counsel this patient? Do you advocate for antidiarrheal medication? If so, which medication will you request of the resident when you call? If not, why not? (5 points)

List two appropriate references (outside of course materials) to support your response. (5 points)

Analyze implications for nursing practice in general. Are you able to take what you’ve learned in this unit – and in this case – and make any improvement to your own practice? How can it impact your current nursing role? (5 points)

Answer 1

Mrs Mc Laughlin is having type 2 diabetes. Glyburide is an oral medicine that helps control blood sugar levels.

Glyburide is not for treating type 1 diabeties( her friend might have type 1).

• Proper diet is the first step in managing type 2 diabetes with exercise programme.
• Pt on glyburide should take care not to let the blood sugar get too low. It can occur if u skip a meal, exercise too long, drink alcohol, are under stress.

In severe cases of type 2 diabeties combination of metformin and glyburide can be priscribed

Mrs Mc Laughlin is having explosive diarrhoea which will not stop on immediate basis. Treatment will involve managing the symptoms while u wait for the diarrhoea to pass. The primary treatment would be to replace fluids and electrolytes. Electrolytes are minerals in the body fluids that conducts the electricity ur body needs to function.

It is important to rehydrate. Keep sipping water and other fluids. Stick to a diet of clear liquids for a day or 2 until the diarrhoea stops.

Avoid sugary fruit juices, caffeine, carbonated drink, dairy products and foods that are greasy, overly sweet or high in fiver.

Antidiarrheal medicine can be priscribed ie available over the counter e.g. loperamide ...for safety patient can be discharged wearing an adult diaper.