Question

The patient is a 48-year-old unconscious woman admitted to the ED. She has a known history of type 1 diabetes mellitus. Her daughter accompanies her and tells the staff that her mother has had the “flu” and has been unable to eat or drink very much. The daughter is uncertain whether her mother has taken her insulin in the past 24 hours.

The patient’s vital signs are temperature 101.8° F; pulse 120, weak and irregular; respiration 22, deep, and fruity odor; and blood pressure 80/42 mm Hg. Blood specimens and arterial blood gases are drawn and an IV infusion begun.

1. During the first 24 hours, what complications should the nurse monitor for in this patient? Why?
2. Which aspect of diabetic self-care should the nurse discuss with this patient before her discharge?

The patient is to be discharged on a mixed-dose regimen for insulin. She is to receive 10 units regular insulin and 18 units NPH insulin before breakfast and another 5 units regular insulin and 12 units NPH at dinnertime.

3. What should the nurse discuss with this patient about diabetes, insulin, and illness?
4. What can this patient do to prevent future emergency episodes?

Answer 1

During the first 24 hours, what complications should the nurse monitor for in this patient? Why?

During the first 24hrs, the nurse should monitor for

• Pneumonia- It occurs due to the weakened immune system and diabetes.
• Bronchitis - Flu virus triggers the respiratory system.
• Heart problems - Due to the influenza virus infection that too the patient has an irregular pulse and low BP.
• Dehydration - Dehydration is one of the serious complication of flu. In addition, the patient was unable to drink properly.
• Hyperglycemia or hypoglycemia - Unknown status of insulin intake and improper diet may cause an alteration in the blood glucose level.
• Diabetic ketoacidosis - It occurs due to hyperketonemia as a result of fluid and electrolyte loss.

Which aspect of diabetic self-care should the nurse discuss with this patient before her discharge?

Diabetic self-care should begin at the time of admission itself. The patient's ability and other family support should be taken into account. The nurse should discuss community support for diabetic management in case of an emergency. Discuss her insulin therapy, dosage, frequency. Educate about the insulin administration and symptoms of hypoglycemia. Discuss her diet pattern for control of blood glucose level. Provide leaflet for insulin therapy and follow-up of care.

What should the nurse discuss with this patient about diabetes, insulin, and illness?

The nurse should discuss the understanding of patient about her condition and the importance of insulin for her condition. The nurse also discusses the complication of diabetes and her lifestyle pattern. The nurse should discuss the regular use of insulin and monitoring of blood glucose periodically. The nurse should discuss the insulin storage, refrigeration, mixing, and subcutaneous injection site.

What can this patient do to prevent future emergency episodes?

The patient can prevent the future episodes of emergency by following the proper hygiene, washing of hands before meals, avoid touching of eyes, mouth, nose by hands. Intake adequate nutrition, fluid, and medication will prevent future episodes. Visit the physician at early symptoms of flu will avoid complication. Regular insulin therapy and Prevention of infection will reduce diabetic complication.