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 1.

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

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

Question 2.

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 3.  

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

Question 4.

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 5.

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

Answer 1

Q3. Family centered care for pediatric patient for any disease play important role for the growth and development of the child. Complex environment, social behavior, emotional factor is the part of psychological factor. For physical growth of a child family centered care includes the blood glucose level monitoring, insulin therapy, low saturated fat diet and children physical activity for his growth and development so that child doesn’t think that he is different from other. Some time the situation is challenging and give deep impact on the child memories, due to this the self esteem and complexes is generated but with the help health care professional guidance and strong interactive relationship between child and parent make the things possible and ideal for child. Involvement of parents in the care of child through participating, engagement and sharing help in empowerment and negotiation. It promotes the cooperation between family and healthcare professional as the motive of both are same.

Family involvement in the care help in gaining of trust of child and child will also understands that hospitalization is just for temporary bases and don’t get agitated. Finally, family centered care improves the health outcomes and promote the wellbeing of a child.

Q5. HbAc1 this test is used to track the diabetic and prediabetic in the individual. It is sued to measure the amount of blood glucose level attached to hemoglobin. It also refers to glycereted hemoglobin means hemoglobin which is used to bound with glucose, it usually develops when hemoglobin protein with red blood cells that carries blood, join with the glucose in blood called glycereted. In this test average blood plasma glucose is identify for 3 months as a lifespan of RBC is 12o days.

The higher the level of blood sugar more the sugar attached to Hemoglobin and higher the percentage of hemoglobin that is glycosylated.

It significance in management of DIBETIES, is once the hemoglobin is glycereted, it remain its way. A glycereted hemoglobin buildup within the RBC, therefore reflect the average level of glucose to which the cell has been expose its life cycle. measuring the level of HbAc1 assesses in the effectiveness of therapy by monitoring long term serum glucose regulation and best way to assess the blood glucose control over time.

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