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401209 Health Variations 2: Chronic Illness and Disability

Question

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Question:

Details:

Case study You are a Registered Nurse working in the emergency department caring for Zach Forbes who is 15 years of age.

Medical history:  

Zach visited his local doctor after experiencing increased appetite and excessive thirst. He has been unusually tired when playing cricket and hasn’t been able to perform at his best. He has lost 10 kilograms of weight over a two week period and has been frequently urinating at night. The doctor suspected type 1 diabetes and tested his urine, which was positive for glucose and ketones. A random capillary blood glucose level was 25.0mmol/L and blood ketone level was 1.5mmol/L. Zach was advised to attend the hospital emergency department immediately.

Social history: Zach lives with his mother (Susan), father (John) and 10 year old brother (Jacob). He is in year 10 at high school and works at McDonalds on a casual basis. Zach plays cricket on the weekends and trains two days during the week. Emergency department review Two hours after review by the local doctor, Zach’s capillary blood glucose level (BGL) was 26.0mmol/L and blood ketone level was 1.6mmol/L. Other vital signs were within normal limits. After review by the endocrinologist, Zach was given a provisional diagnosis of type 1 diabetes based on his symptoms and family history of autoimmune disease (His mother has hyperthyroidism, Graves’ disease). His blood test confirmed that he did not have ketoacidosis.

Treatment plan:  Zach was prescribed subcutaneous insulin; Aspart (NovoRapid) Flexpen 8 units TDS and Glarg.

Tasks:

1.

Explain why Zach has been prescribed insulin. Relate to the pathophysiology of type 1 diabetes and insulin mechanism of action. Support your answer with academic references.

2.

Discuss the appropriate timing of Zach’s NovoRapid insulin administration in relation to food. Relate to the insulin action profile of NovoRapid, hyperglycaemia and hypoglycaemia. Support your answer with academic references.

3.

Discuss the rationale for testing Zach’s blood glucose level (BGL) before and after his first NovoRapid insulin injection in the hospital setting. Support your answer with academic references.

4.

Discuss the daily physical challenges and potential emotional impacts of living with type 1 diabetes that Zach may experience once he is discharged from hospital. Support your answer with academic references.

401209 Health Variations 2: Chronic Illness and Disability

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