Question

H.B. is a 62-year-old male in the rehabilitation center. He is recovering after a spinal cord injury. The night nursing assistant checks H.B.'s blood glucose level at 6:45 AM. The day shift nurse assesses the value and compares it to the sliding scale at 7:25 AM. The day shift nurse then administers his medication at 7:50 AM. H.B.'s breakfast arrives at 8:35 AM. The patient voices concern with the nurse that there is such a long time span between the blood glucose check, the insulin administration, and the meal. Should the nurse also be concerned (provide detail rational for your response)? 1. 2. Describe the concept of sliding scale insulin. 3. Write one test question for this sceneng, Question is to be short essay.

Answer 1

Scenario -1

1.dont worry H. B by using slinding scale I cn read ur glucose level now and given d medication to u and after that i vl give ur meal by sliding scale we can estimate the action of medication and how much carbohydrate have to take for correct insulin levels and when we have to take next medication.

2concept of sliding scale

The sliding scale is one way of working out how much insulin to take before each meal. Doctors developed it several decades ago as a guide to insulin dosage,we are using now  

We have to creates this chart with the individual. They base it on how the person's body responds to insulin, their daily activity, and a carbohydrate intake that they will agree on.

Insulin dosage will vary, depending on two factors:

Pre-meal blood glucose level: This usually appears on the left-hand side on the chart, from low to high, with higher doses of insulin toward the bottom of the chart. The more blood sugar a person has, the more insulin they will need to deal with it.

Mealtime: This usually appears along the chart's top row. This row will show breakfast, then lunch, then dinner.

Throughout the day, the dose will change. This is because insulin sensitivity — the way the body responds to insulin — can change as the day progresses.

The composition of meals can also change through the day, and we have to take that into consideration.item -1

Function of ductus arteriosus-

In the developing fetus, the ductus arteriosus, also called the ductus Botalli, is a blood vessel connecting the main pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus's fluid-filled non-functioning lungs.

During birth it usually closes as lungs starts working and remain as ligamentous arteriousus.

When it's not close during birth the blood flowing pulmonary artery going to aorta Where the blood is not purified mixing of deoxygenated blood with oxyganeated blood As lungs are open few amount of blood is oxygenated . Lungs may congested due to low amount of blood flowing through it and they will easily tiring, fast breathing or breathelessness, poor eating, poor growth, increased heart rate

Murmurof pda - the hallmark physical finding of patent ductus arteriosus (PDA) has been referred to as a machinery murmur, which is continuous. ... Also, because flow through the left ventricle into the aorta is increased, an aortic ejection murmur may be present.

Management by cardiac catheterization or surgical ligation.

A PDA is almost always present at birth. In some children, the PDA does not close. Although exact reasons why this happens in some patients and not in others are not known, the most common association for a PDA is prematurity.

PDA can also occur in combination with other heart defects.

Item 2

NORMAL HEART TETRALOGY OF FALLOT enated blood oxygenated blood from lungs frem body VENA CAVA VENA CAVA PULMONARY VEINS PULMONARY VEINS RIGHT ATRIUM RIGHT ATRIUM LEFT ATRIUM LEFT ATRIUM MITRAL VALVE RICUSPID VALVE ealth Hype VENTRICLE LEFT NTRICLE OGHT VENTRICLE 4 PULMONARY ARTERY ORTA AORTA deoxygenated blood to lungs
memem

Scenario-2

Metformin, like many medications, may pass into breast milk in very small quantities. NICE also recommend that taking Metformin is safe during breastfeeding.as is post labour women she is recommended by metaformin.metaformin is a widely used oral, biguanide hypoglycemic drug for the management of type 2 diabetes. Having any kidney disease will not to take metaformin because it may leads to lactic acidosis,.

She has diabetes, she likely need a blood glucose meter to measure and display the amount of sugar (glucose) in your blood.Using a blood glucose meter can help you better manage your diabetes by tracking any fluctuations in your blood glucose level.

No insulin is formally approved for use during pregnancy. Human insulins—regular (Humulin R, Novolin R/ReliOn) and NPH (Humulin N, Novolin N/ReliOn)— are generally considered safe and effective.metformin is known to cross the placental barrier, researchers are continuing to study whether it is safe. Humalin -Nnighis a intermediate-acting insulin to cover blood sugar increases between meals and during the night. Humalin -r isShort-acting insulin to cover blood sugar increases from meals eaten within 30 minutes. Humulin N consists of zinc-insulin crystals dissolved in a clear fluid. It takes effect within 30 minutes and has a duration of activity of approximately 4 to 12 hours.pros-Comparing once daily dosing of humalin N70/30IU/ml at the largest carbohydrate meal of the dayshowed no increase in rates of nocturnal hypoglycaemia cons-Making changes to dosing to account for things like change in diet, exercise, other medications can take up to three days to take effect.
Clear guidance is required if a patient cannot eat or keep down fluids.

Signs and symptoms of low blood sugar include hunger, trembling, heart racing, nausea, and sweating. In severe cases, it can lead to coma and death.