Question

You are a new graduate registered nurse working in the paediatric ward of your local hospital.

Sam Nicolaides is a nine-year-old boy who until recently has been in good health. Sam lives with his mother and father and two siblings. Following a respiratory virus a few weeks ago he has been slow to recover, lacking in his usual energy. He has been hungry and thirsty all the time, and has recently begun wetting the bed, which he has not done for many years.

Sam presented to the Accident and Emergency department two day ago with nausea, abdominal pain and feeling generally unwell. His observations taken on admission were:

Blood pressure 80/50mmHG, pulse 140, respiratory rate 28 deep and sighing with an unusual sweet smell to the breath, oxygen saturation 100%, temperature 37.2 degrees Celsius. Urinalysis SG1025, pH 5, sugar++++ ketones+++ no other abnormalities. BGL 28mmol/L.

A medical diagnosis of Diabetes type 1 with keto-acidosis was made.

Question

Briefly explain the pathophysiology causing the following symptoms Sam was experiencing on admission:

1. Glycosuria
2. Thirst
3. Ketonuria
4. Kussmaul breathing

Question

List four (4) ongoing nursing assessments, other than vital signs, that will be required to monitor Sam’s fluid status and ensure safe fluid replacement therapy over the next 48 hours.

Question

Explain the concept of family centred care and why this is important to the physical and psychological care for Sam.

Question

For the ongoing management of type 1 diabetes, current best practice recommends an intensive insulin therapy regime called multiple dose insulin (MDI) or basal/bolus regime. Explain:

1. What this insulin regime involves and
2. Discuss why this is considered best practice management for type 1 diabetes.

Question

Explain what the HbA1c test is and why it is important in the management of patients with diabetes.

SORRY FOR POSTING 5 QUESTIONS BUT ITS ALL BASED ON THE SAME SCENARIO

Could you use Australian standard

Answer 1

Diabetes type 1

Diabetes is a group of metabolic diseases where by a person has high blood sugar due to an inability to produce or inability to metabolize sufficient quantities of hormone insulin. Type 1 Diabetes also called Juvenile diabetes. It is a type of Diabetes, in which the pancreas produces insufficient amount of insulin/ no insulin.

Pathophysiology

a. Glycosuria

Glycosuria is thf presence of sugars, especially glucose in the urine often as a result of Diabetes Mellitus.

Type 1 Diabetes

?

Insufficient insulin production from pancreatic cells.

?( leads to)

Increased blood glucose level

?

Renal tubule, especially proximal tubule are unable to reabsorb the glucose from the glomerular filtrate beyond a level ( known as transport maximum) , at a BGL of 160 - 180 mg / dL

?

Excess glucose is excreted in the urine ( Glycosuria)

b. Thirst

During the condition of Diabetes, one can't metabolize the blood glocose, as a result, glucose can accumulate in the blood. Kidneys are forced to expell excessive sugar from the blood. In order to pass the extra sugar from the body , kidneys need to make more urine. This process make use of more water from your body, even the water from tissues also got pulled out. This resulting in more urination. This loss of water from the body leads to excessive thirst to hydrate the body again.

c. Ketonuria ( presence of ketones in urine)

Insufficient production of Insulin from pancreas leads to the inability of body to metabolize glucose for the production of energy. Body breaks down fats and muscles to produce energy, necessary for physical activities. Ketones are the End products of fat metabolism. This production of ketones leads to increased ketones in the bood and kidney filters the ketones from blood and excrete into urine. This leads to Ketonuria.

d. Kussmaul breathing

Kussmaul breathing is A form of labored breathing and hyperventilation associated with metabolic acidosis , renal failure and diabetes. Diabetic ketoacidosis is the major cause of Kussumaul breathing. Ketone accumulation in the blood ( as described in the ketonuria pathophysiology) due to insufficient insulin production, leads to acid build up in your body as ketones are highly acidic in nature. This condition of ketoacidosis triggers respiratory system for faster breathing, as through the breathing excessive Carbon dioxide can expell from the body. Carbon dioxide is an acidic compound. This condition leads to deep , fast breathing ( Kussumaul breathing) to expell more Cabon dioxide .

Nursing Assessment to monitor fluid status and to ensure safe fluid replacement therapy:

Other than vital signs monitoring the nurse can assess:

* Blood glucose monitoring

* Monitoring of ketones in the blood ( 0.5mmol/ L/ hr)

* Monitoring Serum potassium ( 4 - 5.5 mmol/ L)

* Urinalysis for glucose and ketones

* Assess the neurological status or mental status of the child every 2 hr.

* Asess the skin turgor and mucous membrane to know the hydration status.

* Check for any shivering or chills.

3. Family centered care is important in care of Diabetes Mellitus, especially Juvenile diabetes. The family has to take care of the child's condition and care especially diet. As low calorie and low fat diet is healthy for everyone, the whole family can adapt the healthy dietary pattern. Encourage protein and vitamin rich diet with more fiber in the diet. As the child is may feel frustrated, whole family can avoid sweets and sugary drinks. Parents has to learn the insulin regime and administration and should assist the child in insulin administration. Psychological support and the family support is needed for child to thrive the situation and in life.

4. a. Insulin regime for Type 1 diabetes

basal insulin is long acting insulin

bolus insulin reduces the Blood sugar level ( as a result of dietary consumption of carbs )

b. Intensive insulin therapy can mimic natural production of Insulin.