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Diabetes Mellitus UNFOLDING R

Jack Anderson, 9 ye

Primary Conc Glucose Regula

History of Present Problem: Jack Anderson is a 9-year-old boy who presents to the emergency d breathing is “not normal;” it is deeper and faster, according to his pa weeks ago but has since recovered. Jack began feeling more tired a abdominal pain, headache, muscle aches, and consistently being hun during the day and at night. His mother reports a normal full-term pr medical conditions.

Personal/Social History: Jack lives with both parents and two siblings; a younger sister four y as middle school teachers in the community. Jack is in the 4th grade active and plays soccer on the school team. What data from the histories are RELEVANT and must be interpr (NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential Reduc

RELEVANT Data from Present Problem: - more sleepy - abnormal breathing (deeper/faster) - respiratory virus 2 weeks ago - complaining of abdominal pain, headache, muscle aches - constant hunger/thirst -urinating more frequently RELEVANT Data from Social History:

Clinical Significan

  

Clinical Significan

     

Current Assessment: GENERAL SURVEY: NEUROLOGICAL:

HEENT:

RESPIRATORY: CARDIAC:

ABDOMEN: GU: INTEGUMENTARY:

Lying on the bed with eyes closed, w odor to the breath. Lethargic, responding to parents wit time, and situation (x4); muscle stren bilaterally. Head normocephalic with symmetry bilaterally, conjunctival sac pink bila dry, tacky mucosa, chapped lips. Breath sounds clear with equal aerat anteriorly, posteriorly, and laterally, Pink, warm & dry, no edema, heart s with palpation at radial/pedal/post-ti audible and regular, S1 and S2, note beats or murmurs. Abdomen round, soft, and tender to feeling nauseated Voiding large amounts of clear light Skin warm, dry, itchy, flushed, intac cap refill 38.5 C (>101.3 F)

PRIORITY Setting: 5. Which Orders Do You Implement First and Why? (Managemen Care Provider Orders: Order of Priority: Rat   • Obtain finger stick blood   glucose  • Start IV insulin after bolus   is given and monitor blood    glucose carefully   • Obtain VS   • Accurate I and O  • Place on a cardiac monitor   • Initiate two large bore IVs   and administer fluid bolus    followed by  maintenance/replacement



7. What body system(s) will you assess most thoroughly based on (Reduction of Risk Potential/Physiologic Adaptation)

PRIORITY Body System:   

PRI     

8. What psychosocial/holistic care PRIORITIES need to be a (Psychosocial Integrity/Basic Care and Comfort)

Psychosocial PRIORITIES:



PRIORITY Nursing Interventions:

Rationale:

CARE/COMFORT:

  

   

EMOTIONAL (How to develop a therapeutic relationship):    

  

Current VS: T: 98.9 F/37.2 C (oral) P: 92 (reg) R: 24 (reg)

Admission (4 hours): Current P T: 100.4 F/38.0 C (oral) Provoking P: 136 (regular) Quality: R: 44 (deep/rapid) Region/Ra

BP: 100/60 O2 sat: 98% on RA Blood Glucose: 442

BP: 80/48 O2 sat: 98% on RA

Current Assessment: GENERAL SURVEY: NEUROLOGICAL: HEENT:

RESPIRATORY: CARDIAC:

ABDOMEN: GU: INTEGUMENTARY:

1.

Severity: Timing:

Pleasant, in no acute distress, calm, b comfortably. Alert & oriented to person, place, tim upper and lower extremities bilateral Head normocephalic with symmetry bilaterally, conjunctival sac pink bila moist. Breath sounds clear with equal aerat anteriorly, posteriorly, and laterally, Pink, warm & dry, no edema, heart s radial/pedal/post-tibial landmarks, b S2 noted over A-P-T-M cardiac land Abdomen round, soft, and nontender Voiding without difficulty, urine cle Skin warm, dry, intact, normal color seconds, Hair soft-distribution norm turgor elastic, no tenting present.

What data is RELEVANT and must be interpreted as clinicall (NCSBN: Step 1 Recognize cues/Reduction of Risk Potential/Health Pr

2. Has the status improved or not as expected to this point? Does modified in any way after this evaluation assessment? (NCSBN Physiological Adaptation)

Evaluation of Current Status: Jack is visibly improving. Blood glucose is trending down at an appropriate rate. RR remains high but no signs of kussmal retractions. Cardiac monitor reflects NSR. No signs of dehydration.

Modifications t .  

3. Based on your current evaluation, what are your CURRENT n (NCSBN: Step 4 Generate solutions/Step 5: Take action/Management

CURRENT Nursing PRIORITY:



PRIORITY Nursing Interventions:     

Rationale:    

It is now the end of your shift. Effective and concise handoffs are es adversely impact the care of this patient. You have done an excellen following SBAR report to the nurse who will be caring for this patie (Management of Care)

Situation:   BRIEF summary of primary problem:     Name/age:

RELEVANT lab values:

TREND of any abnormal clinical data (stable-increasing/d

How have you advanced the plan of care?

Patient response: INTERPRETATION of current clinical status (stable/unst

Recommendation: Suggestions to advance the plan of care:



Education Priorities/Discharge Planning What educational/discharge priorities will be needed to develop a t (Health Promotion and Maintenance)

Education PRIORITY: Topics Teach: -PRIORITY What is DM type 1 andtohow it can affect the patients life. - How to manage "sick day" - Insulin delivery methods; what method is most appropriate for the patient (injections, pen, pump)

 Rati   

Use Reflection to Develop Clinical Judgment What did you do well in this case study?

What kn

I recognized signs of DKA and dehydration

recogni complic

What did you learn?

How wil

I learned about sick day management of diabetes and that the same amount of insulin should be administered and patient should drink carbs if unable to eat.

this cou manage...