Question

case study questions 1-6

Diabetes Mellitus Case Study Ms. W. was brought to the first aid tent provided for participants in a charity marathon. She is a 24-year-old, type 1 diabetic well maintained on a regimen of self-monitoring of blood glucose, insulin, and diet. She states that she feels cold, she has a headache, and her fingers feel numb. She took her usual dose of insulin this morning, but was unable to eat her entire breakfast because of a lack of time. She completed the entire marathon in a personal best time. Objective data: • Slurred speech and unsteady gait • Pulse 120 bpm • Appears confused • Capillary blood glucose level: 48 mg/dl 1. Describe what Ms. W. could have done to prevent this hypoglycemic event. 2. What is the etiology of the signs and symptoms displayed by Ms. W.? 3. How would you expect to treat Ms. W's hypoglycemia? 4. What teaching is appropriate for this patient once her condition has been stabilized? 5. What adjustments in her diabetic regimen could Ms. W. make to allow her to continue with her exercise habits? 6. Based on the assessment data presented, write 3 appropriate nursing diagnoses.

Answer 1

Hypoglycemia

Hypoglycemia is a condition characterised by  too low level of blood glucose in the body. It is rare in normal people. It may occur in associated with the treatment of Diabetes Mellitus.

1. To prevent hypoglycemic event:

One has to be consistent about the amount and timing of the Breakfast or snacks and meals. Diabetics who receive insulin dose should never delay or skip the meals and before they go for a Marathon they have to ensure that they start exercise at a glucose level 130mg/ dl, or they have to reduce the insulin dose. They should eat before 30-60 minutes before exercise. When going for a long run , one can take glucose with him.

( According to subjective data, Ms.W couldn't eat her breakfast completely because of lack of time and also excessive exercise contributed to her hypoglycemic attack. )

2. Etiology

Ms.W had the symptoms such as headache, feeling of cold, numbness in fingers, slurred speech, unsteady gait, confusion, low blood glucose levels ( 48mg/ dl) are indicating the episode of Hypoglycemia.  

Etiology of hypoglycemia

* High dose of insulin or other antidiabetic medications.

* Skipping the meals or fasting ( in people who receive diabetic treatment)

* Excessive alcohol drinking: liver cell destruction due to continuous alcohol consumption may block the release of glucose to blood from liver .

* Excessive exercise, than normal routine.

( Hypoglycemia in Ms. W caused due to her incomplete intake of breakfast, excessive exercise along with morning dose of insulin).

3. Treatment

In emergency conditions, Hypoglycemia can be treated by 15 to 20 grams of fast acting glucose such as glucose powder or  tablet, fruit juice, sugary candy or soft drinks.

4. Patient teaching

* Never skip or delay the meals or snacks, If you are in treatment with insulin.

* Adjust the dose of insulin, after consulting with your physician, when you are planning to go for a Marathon.

* Eat before 30 minutes of exercise.

* Take a sugar candy or fast acting glucose tablet with you , when you go for a long run and have it when you feel too tired .

5. Adjustments in diabetic regimen

Doing marathons , even when you have diabetes, can help you to be active. Type 1 diabetic patients are in need of taking daily dose of insulin as their body immune system fight against their own beta cells of pancreas ( where the insulin production occur). They have to check their blood glucose level regularly before, during and after running a Marathon and have to take a glucometer with them.

Those people with Type 1 diabetes, who are interested to participate in Marathons, should closely work with their physician and other health care providers and make insulin dose adjustments. They have to carry sugar candy or glucose tablets with them, while they are in run.

6. Nursing diagnosis

I. Risk for altered cerebral tissue perfusion related to inadequate glucose supply to the brain.

II. Activity intolerance related to inadequate energy sources as evidenced by unsteady gait

III. Impaired verbal communication related to fatigue as evidenced by slurred speech.