Skyler Hansen GRQ - Vsims PDF

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Medical Case 5: Skyler Hansen Guided Reflection Questions How did the scenario make you feel? I was a little confused because there were no standing orders, no meds and no labs done. But I started with vitals and my assessment and as the Pt was found to be in hypoglycemic shock, I paged the provider for orders. What management options would have been appropriate if Skyler Hansen had been alert and could swallow? If Skylar could swallow, I would have given him some juice, glucose gel or some form of fast acting carbohydrates to stabilize is glucose level. If Skyler Hansen’s acute hypoglycemic episode had not have been treated immediately, what could have happened? If Skyler episode was not dealt with right away, he may have gone into a coma, DKA state or died. His condition also could cause long term complications like heart disease, stroke, vision impairment, and renal damage/failure. It can also affect the blood vessels and nerves throughout the body. If too much glucose were administered to Skyler Hansen while the health care team was trying to correct his blood glucose level, what could occur? The Pt would become hyperglycemic, in this state the Pts signs and symptoms are Fruitysmelling breath, Nausea and vomiting, Shortness of breath, Dry mouth, Weakness, Confusion, Coma, Abdominal pain. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. Situation: Skyler Hansen, 18yr old male, brought to ED by friends. Friends report he started acting "weird" while playing basketball. Pt is drowsy, wakes with stimulus, has slurred speech, diaphoretic, and is acting irrational Background: Current orders: cardiac monitoring, Vital signs q 5 mins, O2 to maintain SpO2 > 92%, Basic metabolic panel, Obtain IV access, Medication- 50mL dextrose 50% in water slow IV push, may repeat for glucose less than 70 mg/dL following first amp. Glucagon 1 mg IM if unable to obtain IV access, give carbs and proteins, reinforce diabetes education and selfmanagement. Assessment: Pt not oriented X3. Took Pt vitals: BP 129/77 mm Hg, Sp02 97%, RR 19/min unlabored and equal bilaterally, pulse 90/min strong and regular, temp 99 F, skin turgor normal, skin is cool and sweaty, Pain unassessed due to unoriented Pt went into hypoglycemia crisis, blood glucose measured: 63 mg/dL, provider contacted immediately.

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Pt IV access inserted right forearm, administered 50 mL of dextrose 50% in water IV as ordered. Raised HOB Re-assessed vitals, Pt stable: blood glucose 201 mg/dL, Pt now A&O x3 Attached 3-lead ECG and Spo2 monitor as ordered Provided Pt with protein and carbs orally as ordered Recommendation: Nutrition consult and diabetic education continued. Continue to monitor blood glucose and vital signs

Describe age-appropriate patient teaching for Skyler Hansen and resources that may be helpful to him. Skyler is at an adult level and I believe this is probably a wakeup call for him at this point. I would teach him to pay special attention to his diet and I would teach him the signs and symptoms of glycemic reactions I would want to make sure he knows the correct way to administer insulin, how to use a glucometer and also the importance of keeping a snack available. I would supply Skyler handouts of nutritional information and I would also advise the patient to speak with his medical provider and request a referral to an endocrinologist and a nutritionist for diabetic management and nutritional teaching.

Discuss confidentiality and legal empowerment of 18-year-old patients such as in Skyler Hansen’s case. Legally 18 is considered an adult and responsible for their own healthcare decisions. The HIPPA privacy keeps all medical information confidential so the patient would need to sign a release form if he would like to have a parent or significant other updated on his medical condition or care.

What would you do differently if you were to repeat this scenario? How would your patient care change? I honestly wouldn’t do anything differently, I started everything before standing orders. Assessed the Pt and once I realized he wasn’t stable and had the information to present to the provider I took the next step. Once orders were in place it was easy to take it one step at a time and once he became oriented I assessed again and monitored in progress.

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