N320 Metabolism Concept Part 1 of 2 Student prep PDF

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Download N320 Metabolism Concept Part 1 of 2 Student prep PDF

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Department of Nursing STUDENT PREP for Metabolism Concept Simulation Part 1 Name:

Date:

Instructions: 1. On the scheduled simulation session date, the student will wear the USD Nursing Clinical Uniform and Name ID Badge. 2. Bring a stethoscope, watch, black ink pen and your lap top computer. 3. Complete this prep worksheet PRIOR to the scheduled session and bring it to the session. 4. This preparation document covers both the Metabolism Part 1 and Part 2 simulation sessions. Objectives for the Simulation Based Learning Experience: Metabolism Simulation Part 1: 1. Demonstrate understanding of risk factors and clinical presentation of altered glucose metabolism. 2. Perform age appropriate assessment related to altered glucose metabolism. 3. Value the patient’s individual circumstances to create a plan of care. During this simulation learning experience, the participants will care for a Hispanic/Latino adolescent patient with new onset Type 1 Diabetes. Utilize assigned readings and class session materials for Metabolism Concept to complete this worksheet: 1. Physiology/Pathophysiology: a. Compare/contrast the exocrine verses endocrine functions of the pancreas. Endocrine function of the pancreas is secretion of the hormones insulin and glucagon to control blood sugar levels. Exocrine function of the pancreas is excretions of enzymes to breakdown proteins, lipids, carbs, and nucleic acids in food. Exocrine=digestion/Endocrine=blood glucose regulation b. Describe the function of the glucagon, somatostatin and insulin hormones in the human body. Glucagon causes the liver to convert stored glycogen into glucose. Somatostatin inhibits the secretion of glucagon and insulin from the pancreas and regulates the secretion of growth hormone and thyroid stimulating hormone from the pituitary gland. Insulin regulates how the body uses and stores glucose and fat, and it delegates when to send glucose from the blood to other cells for energy. c. Explain how ‘negative feedback’ works to regulate the hormone secretion. Regulates hormone secretion by the hypothalamus and pituitary gland 2. Scope of Altered Glucose Metabolism (Complete the chart below): Euglycemia is normal metabolism with blood glucose 70-140mg/dL (pre-and post-prandial) Hypoglycemia: blood glucose 140 mg/dL (severe 1800mg/dL) Signs and Symptoms Hypoglycemia Signs and Symptoms Hyperglycemia Sweating, fainting, fatigue, dizziness, nausea, Increased thirst, headaches, trouble Student Prep –Metabolism Concept Simulation: Part 1

2 vomiting, mental confusion, dryness, tingling lips, anxiety, headache, pallor, abnormal heart beat, slurred speech, tremors

concentrating, blurred vision, frequent urination, fatigue, weight loss

3. Describe the following risk factors for impaired glucose metabolism: a. Age: older, less muscle mass, weight gain b. Racial/Ethnicity: Native American, Latino, African American, Asian American c. Genetic Predisposition: more likely to experience if family history d. Environmental Factors: e. Metabolic Syndrome: impaired glucose tolerance, presence of damaging immune system cells f. Medical History: history of gestational diabetes, PCOS, hypertension, high cholesterol, thyroid destruction g. Stressors: stressors, obese, poor diet, poor exercise, trauma, cancer

4. During the simulation you will need to have a planned approach to obtain subjective and objective patient data. a. List a minimum of 5 questions you want to ask the patient about their reason for seeking healthcare: i. What are your symptoms? ii. When did the symptoms begin? iii. Any changes in the weight? iv. Medications? Steroids? v. Have you noticed urinating more frequently? vi. Have you experienced any extreme tiredness? b. List a minimum of 5 physical assessments you want to complete on the patient that relate to altered metabolism: i. Height ii. Weight iii. BMI iv. Waist measurements v. Skin assessment c. List a minimum of 3 psychosocial assessments you want to complete on the patient that relate to altered metabolism: i. Mental Status Exam (MSE) ii. Lifestyle history (diet, exercise) iii. Any stressors 5. Diagnosis, Planning and Developing Plan of Care: The most immediate patient needs will focus on adequate hydration, blood glucose stabilization and preventing injury. a. Describe the relationship between altered glucose metabolism and dehydration: Frequent and excessive urination may result from osmotic diuresis which is caused by excess glucose in the blood and urine. This is expected with an altered glucose metabolism. With diuresis, electrolytes are excreted and water loss is severe causing dehydration. Student Prep –Metabolism Concept Simulation: Part 1

3 b. What would be the expected prescribed interventions for achieving the outcome of adequate hydration? Oral fluids, IV fluids 6. Pharmacologic agents play an important role in improving metabolism of glucose and managing the long term effects of diabetes. Research the following medications which may be used in the scenarios: Medication Generic Name Rapid Acting Insulins Lispro (Humalog) Aspart (Novalog) Short Acting Insulins Regular (Humalin R, Novolin R)

Intermediate Acting Insulins Isophane (NPH) Very Long Acting Insulins Glargine (Lantus)

Onset

Peak

Duration

Route

Nursing Implications

0.25 0.25

0.5-1.5 1-3

5 3-5

Sub Q

15 minutes before or after a meal 10-15 before meals

0.5 0.5

2-4 2.5-5

5-7 8

30 minutes before meals

0.5-1

6-14

24

Sub Q, IV (only one, normal saline) Sub Q

0.25

None

24

Sub Q

After meals, bedtime snack

Once or twice daily, can’t mix or give IV

a. NOTE: Review your skills procedure on how to administer insulin by using an insulin syringe to draw insulin from a vial-then select injection site and administer. Also review how to administer insulin by using a pre-manufactured insulin pen. b. Refer the following insulin administration protocols for the hospitalized patient. You will be expected to use these guidelines during the simulation.

  

Sliding Scale Regular Insulin If glucose below 70 or symptomatic use hypoglycemic protocol (use 15/15 rule) Obtain a laboratory glucose level stat Notify prescribing healthcare provider assigned to patient

Fingerstick Glucose 181-200 201-250 251-300 301-350 351-400 401-500 Greater than 500

Level A (Low) 2 units 3 units 4 units 5 units 6 units 8 units

Level B (Medium) 4 units 6 units 8 units 9 units 11 units 12 units Give insulin regime for glucose 401-500 Draw Stat Glucose and send to lab Call HCP with results

Student Prep –Metabolism Concept Simulation: Part 1

Level C (High) 6 units 8 units 10 units 12 units 14 units 16 units

4 c. The endocrinologist uses a supplemental insulin scale when a patient maybe on and off of NPO status or the patient remains hyperglycemic with only the usual sliding scale insulin. The nurse must: i. Check the patient’s finger stick blood glucose ii. Evaluate how many carbohydrates the patient has eaten iii. The add the two amount of insulin doses from the scales so one injection is given Correction Bolus based on Carbohydrate Intake (For every 15 g add one unit of Aspart/Regular Insulin when glucose is above 180 mg/dL and Patient is NOT NPO for a procedure) Up to 15 g 15-30 g 30-45 g 45-60 g

1 unit 2 units 3 units 4 units

d. EXAMPLE INSULIN DOSE CALCULATION: At 1130 (pre-meal) the patient’s finger stick blood glucose is 274, the patient eats the following lunch: 1/3 cup Spanish rice, 1/3 cup Black beans, 3oz of grilled chicken, ¼ slice cantaloupe and an 8oz class of iced tea sweetened with sucralose. How many units of rapid acting insulin would the patient need (Use the medium dose scale) 8 units? e. Two hours after a meal, the nurse may want to check the patient’s glucose or if the patient is symptomatic to double check to make sure the glucose is in the normal range. Explain the rationale for more frequent monitoring of the patient’s response to insulin in the hospital setting. The patient’s glucose could get low or could experience an allergic reaction or side effects of glucose 7. Preventing injury is the next priority. List a minimum of five nursing diagnoses and/or collaborative problems that the nurse would include in the plan of care: i. Risk of infection ii. Risk for injury iii. Risk for unstable blood glucose iv. Risk for imbalanced nutrition v. Risk for impaired skin integrity

Student Prep –Metabolism Concept Simulation: Part 1...