93006 Clinical Practice In Diabetes


Case study

You are a Registered Nurse working in the emergency department caring for Ben Summer who is 19 years of age.

Medical history

Ben visited his local doctor after experiencing increased appetite and excessive thirst. He has been unusually tired when playing football and hasn’t been able to perform at his best. He has lost 10 kilograms of weight over a two week period and has been frequently urinating at night. The doctor suspected type 1 diabetes and tested his 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. Ben was advised to attend the hospital emergency department immediately.

Social history

Ben lives with his mother (Susan), father (John) and 12 year old brother (Jacob). He attends university full time, studying engineering and works at McDonalds on a casual basis. Ben plays football on the weekends and trains two days during the week. He has a girlfriend Rachel and they both enjoy surfing at the beach.

Emergency department review

Two hours after review by the local doctor, Ben’s capillary blood glucose level was 26.0mmol/L and blood ketone level was 1.6mmol/L. Other vital signs were within normal limits. After review by the endocrinologist, Ben was given a provisional diagnosis of type 1 diabetes based on his symptoms and family history of autoimmune disease (His mother has hyperthyroidism, Graves’ disease). His blood test confirmed that he did not have ketoacidosis.

Treatment plan

Ben was prescribed subcutaneous insulin; Aspart (NovoRapid) Flexpen 10 units TDS and Glargine (Lantus) Solostar 30 units nocte. He was referred to the diabetes service for ongoing care.

Part A

The nursing responsibilities related to the administration of Aspart (NovoRapid) insulin to Ben.

  1. Explain the 11 components of a valid routine subcutaneous insulin medication order and why this is important. Support your answer with academic or clinical guideline references. (5 marks)
  2. Explain why Ben has been prescribed this medication. Relate to the pathophysiology of type 1 diabetes and the mechanism of action of NovoRapid insulin. Support your answer with academic references. (10 marks)
  3. What is the onset, peak and duration of action for NovoRapid insulin according to Bullock and Manias (2017)? Explain when NovoRapid should be administered in relation to food intake and why. Support your answer with academic references. (5 marks)
  4. Discuss the definition, causes, symptoms and treatment of hypoglycaemia, a common adverse effect of Novo-Rapid. Support your answer with academic references. (5 marks)
  5. Discuss the importance of understanding the medication prior to administration. Support your answer with academic references. (5 marks)
  6. Discuss the 5 rights of medication administration and why it is important for nurses to follow this procedure.
  7. What is the most appropriate insulin pen needle length for Ben and why?
  8. What diabetes specific nursing assessment would you conduct prior to administration of NovoRapid insulin to Ben and why?
  9. Identify the site and angle you would inject the NovoRapid insulin and explain why this was selected for Ben.
  10. Discuss infection control considerations.
  11. What would you document and where? Why is documentation important?
  12. Explain the diabetes specific nursing assessment you would provide for Ben post administration of insulin, when you would provide it and why.

Part B

The potential impact of type 1 diabetes on Ben.

  1. Discuss the daily physical challenges of living with type 1 diabetes that Ben may face.
  2. Discuss potential emotional impacts of living with type 1 diabetes that Ben may face.
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