Question

Marshall, a 25-year-old manual laborer, visits his physician to have the stitches removed from a wound on his right arm. Dr. Geer notes that the incision is not healing well. He also observes that Mr. Marshall seems lethargic, so he decides to do a physical examination and some routine laboratory work.

Mr. Marshall’s history reveals a recent weight loss of 8 pounds, lethargy, polydipsia, and polyuria. His fasting blood glucose is elevated (425 mg/dL) and the urine is positive for ketones. There is a family history of diabetes mellitus. Dr. Geer admits Mr. Marshall to the hospital to control his diabetes. The client is started on 10 units of U-100 regular insulin and 25 units of NPH U-100 insulin before breakfast. A sliding scale of U-100 regular insulin dosage based on the results of the QID blood glucose testing is established. The nurse checks Mr. Marshall’s Accucheck at 7:30AM. The reading was 230mg/dL

1. How much insulin and types will he receive (in total) this morning?

<150 0 units

151 – 200 2 units

201 – 250 4 units

251 – 300 6 units

301 – 350 8 units

351 – 400 10 units

In addition to this treatment, Mr. Marshall receives instruction concerning a 2,200-calorie diabetic diet. After several days, his fasting blood glucose is approaching normal value (150 mg/dL). He reports feeling better. A client education program is begun, with individual sessions 4 days a week and group sessions once a week. Mr. Marshall seems to be doing well and can administer his own insulin, but one day, a setback occurs.

At about 4:00 pm he begins to perspire profusely, develops a headache, and experiences a tremor in his hands. In addition, he feels nauseated.

2. What type of diabetes (type 1 or 2) does Mr. Marshall appear to have? Explain your answer

3. Are his initial symptoms characteristic of this type of diabetes. Mellitus? Explain your answer

4. Why is Mr. Marshall placed on two types of insulin?

5. Can the regular insulin and the NPH insulin be missed in the same syringe? Explain your answer

6. What skills and knowledge about diabetes must Mr. Marshall acquire to care for himself adequately? Explain your answer

7. What was the nature of the setback that Mr. Marshall experienced? Explain your answer

8. What should the nurse do? Explain your answer

During this hospitalization, Mr. Marshall is started on an intensive insulin therapy regimen with insulin glargine and Humalog.

9. Explain this regimen in terms of its benefit, dosing schedule, possible adverse effects, and patient teaching
10. Indicate the sites that can be used for insulin injections
11. What would you teach Mr. Marshall regarding insulin administration and site rotation?

Answer 1

●He will receive 14 units of insulin for the reading of 230mg/dl (201_250 4 units) because the fixed dose if 10 units in morning is there.In addition e5 units of NPH also yo be administered. So in morning he will be administered 39 units

●He is experiencing type 1 diabetes in which the insulin doesn't respond to control the glucose level

●His initial signs of Wright loss,lethargy,poor wound healing, polyuia and polydipsia are characteristics of diabetes.The three main symptoms are polyuia,polyphagia,polydipsia

●The regular insulin is a fast acting insulin and its action starts within 15 to 30 minutes and lasting for 8 hours. while NPH is an intermediate acting insulin .It action starts at about 90 minutes and the duration of action lasts for about 24 hours.Thus giving this two types of insulin  enables to keep his sugar under control the whole day

●The regular insulin and NPH insulin can be mixed together before administration. First the plain insulin to be taken and then the intermediate insulin becaue when taken together it binds together ans is ready for injection.Then it should be administered within 15 minutes

●Some of the skills which Marshall should develop are

• Good control of his blood sugar level
• Knowledge about the medication and its use and side effects
• To administer insulin
• To track and monitor his blood sugar level at home
• Should be aware of the hypoglycemia and ways to handle
• Proper diet management
• Proper wound care to promote healing
• Teaching about hypoglycemia

●He has experienced a low blood sugar level (the common symptoms are nausea,headache, dizziness, tremors,sweating,agitation)It occurred mainly because the medication administered to control his blood sugar kevel

●The nurse should immediately assess his vitals and blood sugar level.If conscious and aware oral glucose  can be given if not conscious an lV dextrose to be administered immediately