MedSurg Diabetes case study

Guidelines for Submission of Case Study assignments:

Students are expected to use the nursing process (assessment, nursing diagnosis, planning, intervention, and evaluation) when answering the questions to anticipate what will happen next in the situation. Questions should be answered correctly and completely. Answers will be presented in students’ own words and not a copy-and-paste verbatim of the textbook. All citations and references must be within the guidelines of evidence based practice i.e. not older that five years and written in APA format. The due dates for each case study are stated in the syllabus and must be submitted on due date no later than midnight. As noted in the above outcomes, responses must reflect critical thinking, analysis of the nursing situation, knowledge of the nursing process and the integration of prior course work acquired thus far in the nursing program. Please attach rubric at the end of your paper.

Diabetic Case study

L.M. is a 22 year old male that came to the hospital with his sister with complaints of decreased appetite. L.M. is cognitively impaired and his sister provides the information. She says that he is drinking cranberry and apple juice. Past medical hx is DM 2. L.M ask for some juice shows no signs of distress. L.M. only takes glipizide 5mg po bid; and he has not taken a does since he has not been eating.

Subjective data:

  • Glucose level at home is high and the machine is unable to read the blood glucose level.
  • Abdominal pain, mouth and tongue is appears dry.

Objective data

  • Vital signs: T – 97.7, pulse – 136, Respirations – 17, O2 sat – 97%, weight 70.2 kg, height 61

Labs:

  • BMP
    • BUN – 39 H, Creatinine – 2.25 H, Glucose level – 1023 CH, Sodium – 144, Potassium – 6.6 CH
    • Chloride – 93 L, CO 2 – 18 L, Osmolality 348 H, Calcium -11.4 H, Albumin 5.3 H
    • Magnesium 3.4 H, Bilirubin 1.9H
  • CBC
  • Hemoglobin 17.8, Hematocrit 56.5 H
  • Drug screen is negative
  • Urinalysis
  • Specific gravity 1.027, pH 5.0, leukocytes- negative, nitrate-negative, protein-negative,
  • Glucose-3+, Ketones 1+
  • ABG
  • pH- 7.17 CL, pO2 – 36 CL, HCO3 -14.2, Allen test positive
  • CT scan of abdomen impression: Short segment intussusception within the upper abdomen without evidence of obstruction.

L.M. is given 10 units of Novolin R and started on Novolin insulin gtt at 6units/hr and sent to the unit. His sister says he is DM type 2 and is confused to the treatment plan. She asks the nurse the following questions and demands answers before she would allow her brother to be given insulin.

  1. What is the difference between type 1 diabetes and type 2?
  2. What is the difference between DKA and HHS?
  3. Can he have water or sugar free beverages to drink?
  4. What other test should the physician order for him?
  5. What is the nurse monitoring to ensure he is being treated correctly, she demands the rationales to your answer?
  6. What is the result of the CT scan to his abdomen and will he have surgery?
  7. Is there any important information that is required for when he goes home?
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