Question

1. Scenario: During your shift at the local emergency department, patient H.G., a 47 year of age female, is brought in by her friend. According to the friend, she and H.G. had been participating in a fund-raising walk for breast cancer awareness when H.G. began to complain of feeling “shaky and nervous”. The neighbor explains how, since these complaints did not seem to be “too serious”, H.G. decided to avoid calling an ambulance and instead have her friend bring to the hospital to be “checked out”. The friend reports that while on the way to the hospital, H.G. “passed out” and wouldn’t wake up. Upon brief inspection, you note H.G. to be unresponsive and to be wearing a blouse that is saturated in perspiration. Upon concluding that H.G. likely has experienced a severe hypoglycemic episode, you check her blood glucose which is revealed to be 18.

1. In terms of pharmacological interventions, what would be your priority action at this time? (2 points)

2. Upon being stabilized, H.G. is diagnosed with type II diabetes mellitus and is to begin a new prescription for metformin (Glucophage). While you are providing H.G. with education on her new medication, she reports, “I thought people with a diabetes had to take insulin shots.” As the nurse, how are you going to respond to this statement?           (2 points)

3. In speaking with H.G. in regard to her experience, she expresses concern related to the fact that her symptoms had came on “all of a sudden”. In considering the information you had gotten in report from H.G.’s friend: What information could you offer to H.G. as a likely explanation for why her blood sugar had dropped so suddenly? What pharmacological-related education could you provide to her in order to mitigate the likelihood of a similar incident occurring in the future? (2point)

4. H.G. is ultimately discharged but subsequently calls the facility several days later requesting clarification on some of the education provided. While reading through the literature that was provided to her with her new medication, H.G. noticed that it instructed her to carefully limit her amount of alcohol consumption. In addition to alcohol’s effects on blood glucose levels, what other alcohol-related teaching, specific to her new medication, should you provide to H.G.? (2 points)

Answer 1

A.In terms of pharmacological interventions, what would be your priority action at this time?

In this case patient H.G is experiencing severe hypoglycemia therefore initiating IV glucose is the prompt action .D50% needs to be given 10 to 25gm as IV ie 20 to 50ml of the solution .

A.Upon being stabilized, H.G. is diagnosed with type II diabetes mellitus and is to begin a new prescription for metformin (Glucophage). While you are providing H.G. with education on her new medication, she reports, “I thought people with a diabetes had to take insulin shots.” As the nurse, how are you going to respond to this statement?   

H.G will be told about type 1 and type 2 diabetics .Type 1 diabetics is an insulin dependent diabetics happening due to the decreased production of insulin from the pancreas and thus leading to increased blood sugar.Therfore type 1 diabetics should be treated with insulin therapy.But in your case you have type 2 diabetics ,which is due to the insulin resistance therefore oral anti diabetic agents best choice for maintaining the normal blood sugar.

a.In speaking with H.G. in regard to her experience, she expresses concern related to the fact that her symptoms had came on “all of a sudden”. In considering the information you had gotten in report from H.G.’s friend: What information could you offer to H.G. as a likely explanation for why her blood sugar had dropped so suddenly? What pharmacological-related education could you provide to her in order to mitigate the likelihood of a similar incident occurring in the future? (2point)

H.g will be told that skipping meals, eating less than normal, or exercising more than usual can cause low blood sugar levels.As you were waking a lot by skipping meals could be a reason for your hypoglycemia.

H.G will be taught about the ways to avoid hypoglycemic episodes in the future on the metformin therapy by taking a balanced diet at the right time,avoid sternous exercises,avoid excessive alcohol intake and don't combine any other antidiabetic medications without doctors prescription.

a.H.G. is ultimately discharged but subsequently calls the facility several days later requesting clarification on some of the education provided. While reading through the literature that was provided to her with her new medication, H.G. noticed that it instructed her to carefully limit her amount of alcohol consumption. In addition to alcohol’s effects on blood glucose levels, what other alcohol-related teaching, specific to her new medication, should you provide to H.G.? (2 points)

Heavy Alcohol intake in metformin taking patient can develop hypoglycemia and lactic acidosis.Therefore H.G should be told to avoid alcohol intake .