15 Jun Adolescent With Diabetes Mellitus (DM) Case Studies ?? According to the case 1 (Check File 1) 1. Why was this patient in metabolic acidosis? (One paragraph
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__________________________________________________________________________________
Part 1: Adolescent With Diabetes Mellitus (DM) Case Studies
According to the case 1 (Check File 1)
1. Why was this patient in metabolic acidosis? (One paragraph)
2. Do you think the patient will eventually be switched to an oral hypoglycemic agent? give a rationale (One paragraph- Write in the first person)
3. How would you anticipate this life-changing diagnosis is going to affect your patient according to his age and sex? give a rationale (Two paragraphs- Write in the first person)
4. The parents of your patient seem to be confused and do not knowing what to do with this diagnoses. What would you recommend to them? Give a rationale (Two paragraphs- Write in the first person)
Part 2: Esophageal_Reflux
According to the case 2 (Check File 2)
1. Why would the patient be instructed to avoid tobacco and caffeine? give a rationale (One paragraph)
2. Why did the physician recommend 6 weeks of medical management? (One paragraph)
3. How do antacid medication work in patients with gastroesophageal reflux? (Two paragraphs)
4. What would you approach the situation, if your patient decided not to take the medication and asked you for an alternative medicine approach? give a rationale (Two paragraphs- Write in the first person)
Part 3: Literature Review Assignment
Healthcare legislature: Children’s Health Insurance Program (CHIP)
1. Introduction (One paragraph)
2. Describe the purpose for the creation of healthcare legislature (One paragraph)
For example, health insurance is a problem within the USA. The ACA bill was created and passed into law
3. Discuss the historical background of the legislation including
a. Person(s) who presented the bill. (One paragraph)
b. The committees the bill went through (One paragraph)
c. Revision of the bill until it was passed into law (One paragraph)
4. Select three articles that address the healthcare legislature development and explain
a. How and why these articles were selected (One paragraph)
b. Compare and contrast the selected articles selected (One paragraph)
5. Discuss the implication of the healthcare legislation to nursing practice according to the selected articles (Two paragraph)
6. Discuss what you have drawn from reviewing the literature so far (One paragraph)
7. Where might the discussion proceed? (One paragraph)
8. Conclusion (One paragraph)
Part 4: Nursing Role and Scope- Course reflection (Write in the first person)
Purpose: The purpose of this assignm3nt is to provide the student an opportunity to reflect on selected RN-BSN competencies acquired through the Nursing Role and Scope course.
1. Introduction (One paragraph) includes:
a. BSN role with the course focus
2. Reflect on your acknowledgment about
a. Use standardized terminology in a care environment that reflects nursing’s unique contribution to patient outcomes (Two paragraphs)
b. Participate in evaluation of information systems in practice settings through policy and procedure development (Two paragraphs)
c. Communicate effectively with all members of the healthcare team, including the patient and the patient’s support network (Two paragraphs)
3. Conclusion (Two paragraphs)
Part 5: Physical health assessment Course reflection (Write in the first person)
Purpose: The purpose of this assignm3nt is to provide the student an opportunity to reflect on selected RN-BSN competencies acquired through the Physical assessment in health care course.
1. Introduction (One paragraph) includes:
a. BSN role with the course focus
2. Reflect on your acknowledgment about
a. Demonstrate the application of psychomotor skills for the efficient, safe, and compassionate delivery of patient care (One paragraph)
b. Create a safe care environment that results in high-quality patient outcomes (Two paragraphs)
c. Revise the plan of care based on an ongoing evaluation of patient outcomes (Two paragraphs)
d.. Demonstrate clinical judgment and accountability for patient outcomes when delegating to and supervising other members of the healthcare team (Two paragraphs)
3. Conclusion (One paragraph)
Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition
Adolescent With Diabetes Mellitus (DM) Case Studies
The patient, a 16-year-old high-school football player, was brought to the emergency room in a coma. His mother said that during the past month he had lost 12 pounds and experienced excessive thirst associated with voluminous urination that often required voiding several times during the night. There was a strong family history of diabetes mellitus (DM). The results of physical examination were essentially negative except for sinus tachycardia and Kussmaul respirations.
|
Studies |
Results |
|
Serum glucose test (on admission), p. 227 |
1100 mg/dL (normal: 60–120 mg/dL) |
|
Arterial blood gases (ABGs) test (on admission), p. 98 |
|
|
pH |
7.23 (normal: 7.35–7.45) |
|
PCO2 |
30 mm Hg (normal: 35–45 mm Hg) |
|
HCO2 |
12 mEq/L (normal: 22–26 mEq/L) |
|
Serum osmolality test, p. 339 |
440 mOsm/kg (normal: 275–300 mOsm/kg) |
|
Serum glucose test, p. 227 |
250 mg/dL (normal: 70–115 mg/dL) |
|
2-hour postprandial glucose test (2-hour PPG), p. 230 |
500 mg/dL (normal: <140 mg/dL) |
|
Glucose tolerance test (GTT), p. 234 |
|
|
Fasting blood glucose |
150 mg/dL (normal: 70–115 mg/dL) |
|
30 minutes |
300 mg/dL (normal: <200 mg/dL) |
|
1 hour |
325 mg/dL (normal: <200 mg/dL) |
|
2 hours |
390 mg/dL (normal: <140 mg/dL) |
|
3 hours |
300 mg/dL (normal: 70–115 mg/dL) |
|
4 hours |
260 mg/dL (normal: 70–115 mg/dL) |
|
Glycosylated hemoglobin, p. 238 |
9% (normal: <7%) |
|
Diabetes mellitus autoantibody panel, p. 186 |
|
|
insulin autoantibody |
Positive titer >1/80 |
|
islet cell antibody |
Positive titer >1/120 |
|
glutamic acid decarboxylase antibody |
Positive titer >1/60 |
|
Microalbumin, p. 872 |
<20 mg/L |
Diagnostic Analysis
The patient’s symptoms and diagnostic studies were classic for hyperglycemic ketoacidosis associated with DM. The glycosylated hemoglobin showed that he had been hyperglycemic over the last several months. The results of his arterial blood gases (ABGs) test on admission indicated metabolic acidosis with some respiratory compensation. He was treated in the
( Copyright © 2018 by Elsevier Inc. All rights reserved. )
Case Studies 2
emergency room with IV regular insulin and IV fluids; however, before he received any insulin levels, insulin antibodies were obtained and were positive, indicating a degree of insulin resistance. His microalbumin was normal, indicating no evidence of diabetic renal disease, often a late complication of diabetes.
During the first 72 hours of hospitalization, the patient was monitored with frequent serum glucose determinations. Insulin was administered according to the results of these studies. His condition was eventually stabilized on 40 units of Humulin N insulin daily. He was converted to an insulin pump and did very well with that. Comprehensive patient instruction regarding self- blood glucose monitoring, insulin administration, diet, exercise, foot care, and recognition of the signs and symptoms of hyperglycemia and hypoglycemia was given.
,
Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition
Esophageal Reflux Case Studies
A 45-year-old woman complained of heartburn and frequent regurgitation of “sour” material into her mouth. Often while sleeping, she would be awakened by a severe cough. The results of her physical examination were negative.
|
Studies |
Results |
|
Routine laboratory studies |
Negative |
|
Barium swallow (BS), p. 941 |
Hiatal hernia |
|
Esophageal function studies (EFS), p. 624 |
|
|
Lower esophageal sphincter (LES) pressure |
4 mm Hg (normal: 10–20 mm Hg) |
|
Acid reflux |
Positive in all positions (normal: negative) |
|
Acid clearing |
Cleared to pH 5 after 20 swallows (normal: <10 swallows) |
|
Swallowing waves |
Normal amplitude and normal progression |
|
Bernstein test |
Positive for pain (normal: negative) |
|
Esophagogastroduodenoscopy (EGD), p. 547 |
Reddened, hyperemic, esophageal mucosa |
|
Gastric scan, p. 743 |
Reflux of gastric contents to the lungs |
|
Swallowing function, p. 1014 |
No aspiration during swallowing |
Diagnostic Analysis
The barium swallow indicated a hiatal hernia. Although many patients with a hiatal hernia have no reflux, this patient’s symptoms of reflux necessitated esophageal function studies. She was found to have a hypotensive LES pressure along with severe acid reflux into her esophagus. The abnormal acid clearing and the positive Bernstein test result indicated esophagitis caused by severe reflux. The esophagitis was directly visualized during esophagoscopy. Her coughing and shortness of breath at night were caused by aspiration of gastric contents while sleeping. This was demonstrated by the gastric nuclear scan. When awake, she did not aspirate, as evident during the swallowing function study. The patient was prescribed esomeprazole (Nexium). She was told to avoid the use of tobacco and caffeine. Her diet was limited to small, frequent, bland feedings. She was instructed to sleep with the head of her bed elevated at night. Because she had only minimal relief of her symptoms after 6 weeks of medical management, she underwent a laparoscopic surgical antireflux procedure. She had no further symptoms.
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