Aim of assessment
The purpose of this assessment is to enable students to demonstrate:
– An understanding of safe, appropriate and responsive quality nursing practice when administering pharmacological interventions to people with type 1 diabetes.
– An understanding of the relationship between pharmacological interventions and the cause, pathophysiology and clinical manifestations of type 1 diabetes.
– An understanding of the impact of type 1 diabetes on the individual.
– An evaluation of relevant literature to support an understanding of the pharmacological and nursing management of a person with type 1 diabetes and express this in a clear and succinct writing style.
Details: Case study
You are a Registered Nurse caring for Sarah Burns who is 5 years of age.
Medical history
Sarah’s parents visited their local doctor after noticing that Sarah had increased appetite and excessive thirst. She has been unusually tired lately, often falling asleep at school. She has lost 5 kilograms of weight over a two week period (22kg down to 17kg) and has been frequently urinating at night often wetting the bed. The doctor suspected type 1 diabetes and tested her urine, which was positive for glucose and ketones. A random capillary blood glucose level was 25.0mmol/L and blood ketone level was 1.5mmol/L. Sarah’s parents were advised to attend the hospital emergency department immediately.
Social history
Sarah lives with her mother (Kathy - works full time as an accountant), father (Jake - works full time as an electrician) and 10 year old brother (Ben). She is in kindergarten at school and attends after school care three days a week.
Sarah goes to swimming lessons on Saturday mornings and dance classes on Wednesday afternoons.
Emergency department review
Two hours after review by the local doctor, Sarah’s capillary blood glucose level (BGL) was 26.0mmol/L and blood ketone level was 1.6mmol/L. Other vital signs were within normal limits. After review by the paediatric diabetes specialist doctor (endocrinologist), Sarah was given a provisional diagnosis of type 1 diabetes based on her symptoms and family history of autoimmune disease (Her mother has coeliac disease). Sarah’s blood test confirmed that she did not have ketoacidosis.
Treatment plan
Sarah was prescribed subcutaneous insulin; Aspart (NovoRapid) Flexpen 3 units TDS (three times per day) and Glargine (Lantus) Solostar 8 units nocte (at night). She was referred to the diabetes service for ongoing care.
Assessment instructions
Using the marking criteria and supporting academic references address the following questions.
6
Assessment Questions
Question 1. (10 marks)
Explain why Sarah has been prescribed insulin. Relate to the pathophysiology of type 1 diabetes and the mechanism
of action of insulin. Support your answer with academic references.
Question 2. (5 marks)
a) What is the onset, peak and duration of action for NovoRapid
b) When should NovoRapid be administered in relation to food and why?
Support your answer with academic references.
Question 3. (10 marks)
a) Define hypoglycaemia
b) What causes hypoglycaemia?
c) What are the symptoms of hypoglycaemia?
d) How is hypoglycaemia treated?
Support your answer with academic references.
Question 4. (5 marks)
a) What is the most appropriate insulin pen needle length for Sarah?
b) Why is this length appropriate?
Support your answer with academic references.
Question 5. (10 marks)
Why does Sarah require a blood glucose level (BGL) test prior to an insulin injection?
Support your answer with academic references.
Question 6. (5 marks)
a) What is an appropriate site on Sarah’s body to inject the NovoRapid insulin?
b) What injection angle is appropriate for Sarah?
c) Why are these appropriate for Sarah?
Support your answer with academic references.
Question 7. (5 marks)
a) When would Sarah’s BGL need to be tested after administration of NovoRapid?
b) Why would a BGL be required at that time?
Support your answer with academic references.
Question 8. (10 marks)
Discuss the daily physical challenges of living with type 1 diabetes that Sarah may face.
Support your answer with academic references.
Question 9. (10 marks)
Discuss potential emotional impacts of living with type 1 diabetes that Sarah may face.
Support your answer with academic references.
Language Use (5 marks)
Sentences are well constructed, expression and meaning is clear, basic written language rules are followed.
Referencing and in-text citations (5 marks)
The APA referencing style is used correctly for both in-text citations and reference list.