Assessment : Essay Case History Review with Guided Questions

Word count: 1500 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10% word count.

If you exceed the word limit by more than 10% the marker will stop marking at 1650 words.

Aim of assessment

The purpose of this assessment is for students to demonstrate an understanding of:

• alterations in glucose regulation in type 1 diabetes

• the pathophysiology of type 1 diabetes symptoms

• safe, appropriate and responsive quality nursing practice when administering pharmacological interventions to people with type 1 diabetes

• the impact of type 1 diabetes on the individual and family

• the nurses role in providing appropriate person-centred care to people with intellectual disability

Details

Case study: Briana Martin

You are a Registered Nurse working in the emergency department caring for a 7 year old girl, Briana Martin.

Medical history

Briana's parents, Robyn and Tom state that they attended an appointment with their local family doctor earlier today, as Briana has 'wet the bed' the past 2 nights and they thought that she might have a urinary tract infection.

Her parents also noticed that she has been eating and drinking a lot, but weren't concerned as they thought that she was going through a growth spurt and the weather has been hot. The local doctor weighed Briana (18kg) and noticed a loss of 5 kilograms since her last appointment one month ago when reviewed for a cold (possible viral cause).

The doctor suspected type 1 diabetes and tested her urine, which was positive for glucose and ketones. A random capillary blood glucose level was 25.0mmol/L and blood ketone level of 1.5mmol/L. Briana's parents were advised to attend the hospital emergency department immediately.

Social history

Briana lives with her mother, father and 4 year old brother (Bailey). Both parents work full time. Briana
attends primary school and is in Year 2. She loves to play sport and has dance classes two times per week and netball on Saturdays. Briana attends after school care most afternoons until her mother returns home from work.

Emergency department review

Two hours after review by her local doctor, Briana's capillary blood glucose level (BGL) was 26.Ommol/L and blood ketone level was 1.6mmol/L. Other vital signs were within normal limits.

After review by the paediatric endocrinologist, Briana was given a provisional diagnosis of type 1 diabetes based on her symptoms and family history of autoimmune disease (Mother: Robyn has coeliac disease). Her blood test confirmed that she did not have ketoacidosis.

Treatment plan

Briana was prescribed a subcutaneous injection of Aspart (NovoRapid) insulin, 2units via FlexPen TDS with meals and Glargine (Lantus Solostar) 5units, nocte. She was referred to the diabetes service for ongoing care.

Care of Briana and her family

When you are speaking with Briana's family you notice that her father, Tom is becoming overwhelmed and is asking a lot of questions. Tom discloses that he has a mild intellectual disability and is having trouble understanding some of the medical information that has been provided by the doctors.

Assessment instructions

Using the criteria on pages 11-15 and supporting academic references, address the questions below. Use the template on vUWS, include headings: Question 1, Question 2, Question 3, Question 4, references and sub-headings where appropriate. Headings are not included in your word count. An introduction and conclusion is NOT required.

Assessment Questions

Question 1.

Explain the pathophysiology of Briana's clinical manifestations of Type 1 diabetes

1. High blood glucose level

2. Glucose in the urine

3. Increased urination

4. Increased thirst

5. Increased appetite

6. Ketones

7. Weight loss

Question 2.

Discuss the nursing responsibilities and supporting rationales related to the administration of Aspart (NovoRapid) insulin to Briana via a FlexPen.

1. Prior to administration

2. During administration

3. After administration

Question 3.

Discuss the potential impact of type 1 diabetes on Briana and her family.

1. Emotional

2. Physical

Question 4.

Explain how you would adapt your nursing care of Briana and her family to accommodate Tom's intellectual disability.

Language Use (5 marks)

Sentences are well constructed, expression and meaning is clear, basic written language rules are followed.

Referencing and in-text citations (5 marks)

The APA referencing style is used correctly for both in-text citations and reference list.