Answering all aspects of each case assigned 40 pts
Sharing rationale or references for major points you make in the discussion 40pts
Identify knowledge gained in researching the case and personal practice implications 15pts
Correct spelling, grammar, and APA 6th format 5pts
CASE STUDY: SELF-MONITORING OF BLOOD GLUCOSE Patient’s name is J who is a man, 60 years of age, with a history of type 2 diabetes. He was brought to the emergency department after his neighbor found him at home with confusion, lethargy, right-side weakness, and slurred speech. Medical exam and work up in the emergency department revealed that Patient J was severely dehydrated and that his blood glucose was 860 mg/dL. He was diagnosed with HHNS, an acute complication of type 2 diabetes. He was admitted to the medical unit on an insulin drip and for intravenous fluid and electrolyte replacement. After Patient J’s blood glucose and electrolytes returned to normal levels, his mental status cleared and he was free of any neurological manifestations. While in the hospital, he was seen by the diabetes educator. He received instruction on diet, insulin administration, and blood glucose monitoring. His discharge plan was to return home on insulin injections with follow-up and teaching by a home healthcare nurse.
1. What areas of concern do you see within the above case and how would you go about addressing them?
2. Describe a theoretical basis for working with this patient.
3. List open ended questions you might ask to explore her life situations.
Case Study: Self-Monitoring of Blood Glucose
The areas of concern in Patient J’s case living arrangements, risk of recurrence of hyperosmolar non-ketotic syndrome (HHNS), and poor adherence to treatment plan. Patient J perhaps lives alone may be at risk of forgetting to take medications or adopt recommended dietary plans may be due to lack of social companion at home and/or his age. Since type-2 diabetes mellitus is not curable, there is a risk of recurrence of HHNS in the future perhaps due to poor management of the condition. Similarly, the patient is relatively old in age (60 years); hence, he may forget to take medications or adhere to the treatment plan as intended.
A holistic care approach together with aggressive management of type-2 diabetes is required. Holistic care implies that the functioning of the pulmonary, cardiovascular, the central nervous systems and the renal system must be monitored and supported since HHNS can have negative impacts in these organ systems. If HHNS is left untreated is may lead to death due to extreme dehydration. Evidence-based management of HHNS includes resuscitation with aggressive administration of intravenous fluids, heparin, and insulin (Hazmi & Manning, 2018). Besides, a homecare nurse should educate and monitor the patient’s self-management and monitor capable daily. Dietary knowledge, disease self-management capacity, and good adherence to the treatment plan can be reinforced through a continuous patient-education program (Polonsky et al., 2011). The homecare nurse should evaluate the patient and determine on whether he is capable of self-managing, self-monitoring, and deciding on which particular situations in which he consult ambulance or care services. If patient J demonstrates self-monitorimg capacity he should be provided the blood glucose strips to monitor his blood glucose level on a daily basis (Kerr, 2011). However, if her is not capable some else will have to do it for him; perhaps, the homecare nurse.
List of open-ended questions to be asked by the home health care nurse
- Do you have any other underlying chronic or acute illness apart from typ-2 diabetes mellitus since it may affect treatment plan decisions?
- Are you taking other applications; if so, how many types so as to prevent possibly of polypharmacy issues?
- Are you capable of adoption the dietary and behavioral intervention plans as advised by the diabetes educator? Was the education your received relating to management of the condition helpful?
- Have many episodes o HHNS has occurred in your life?
- How have you been managing type-2 diabetes mellitus?
Hazmi, A.A., & Manning, S. (2018). Limb ischemia in a patient with hyperosmolar hyperglycemic state. Clin Pract Cases Emerg Med., 12(4), 348-352. DOI: 10.5811/cpcem.2018.9.39920.
Kerr, D. (2011). Self-monitoring of blood glucose and type 2 diabetes: New tricks for the old dog? J Diabetes Sci Technol., 5(2), 209-211. DOI: 10.1177/193229681100500201.
Polonsky, W.H., Fisher, L., Schikman, H., Hinnen, D.A., Parkin, C.G., Jelsovsky, Z., Petersen, B. Schweitzer, M., & Wagner, R.S. (2011). Levels in poorly controlled, noninsulin-treated type 2 diabetes. Diabetes Care, 34(2), 262-267. https://doi.org/10.2337/dc10-1732