Ben Summer

Case study You are a Registered Nurse working in the emergency department caring for Ben Summer who is 19 years of age. Medical history Ben visited his local doctor after experiencing increased appetite and excessive thirst. He has been unusually tired when playing football and hasn’t been able to perform at his best. He has lost 10 kilograms of weight over a two-week period and has been frequently urinating at night. The doctor suspected type 1 diabetes and tested his urine, which was positive for glucose and ketones. A random capillary blood glucose level was 25.0mmol/L and blood ketone level was 1.5mmol/L. Ben was advised to attend the hospital emergency department immediately. Social history (this part Is important for part B). Ben lives with his mother (Susan), father (John) and 12-year-old brother (Jacob). He attends university full time, studying engineering and works at McDonalds on a casual basis. Ben plays football on the weekends and trains two days during the week. He has a girlfriend Rachel and they both enjoy surfing at the beach. Emergency department review Two hours after review by the local doctor, Ben’s capillary blood glucose level was 26.0mmol/L and blood ketone level was 1.6mmol/L. Other vital signs were within normal limits. After review by the endocrinologist, Ben was given a provisional diagnosis of type 1 diabetes based on his symptoms and family history of autoimmune disease (His mother has hyperthyroidism, Graves’ disease). His blood test confirmed that he did not have ketoacidosis. Treatment plan Ben was prescribed subcutaneous insulin; Aspart (NovoRapid) Flexpen 10 units TDS and Glargine (Lantus) Solostar 30 units nocte. He was referred to the diabetes service for ongoing care. Case study questions Using the marking criteria and supporting academic references address the following questions.   Part A (60 marks, suggested 800 words) The nursing responsibilities related to the administration of Aspart (NovoRapid) insulin to Ben.   Question 1.   Explain the 11 components of a valid routine subcutaneous insulin medication order and why this is important. Support your answer with academic or clinical guideline references. About the 11 components of a valid subcutaneous insulin medication order and why this is important? Need to support every single answer in the assessment with a reference either academic reference or support with text book or journal article. For this question you need to look at this user guide for the national subcutaneous insulin chart, this is in module 2 learning martials there were reading for the weeks click on link and download pdf- use for reference. look at insulin chart. A medication order is valid only if the authorised prescriber enters all required items.

1. Patients URN, family and given names, address, DOB, sex on the address label.
2. First prescriber ID label checked
3. National Inpatient Medication chart (NIMC) has been marked.
4. Hospital details
5. Doctor to notify
6. Printed name and Signature od prescriber
7. Date
8. Name of insulin
9. Dose
10. Meal or time
11. Doctors initials

• Now include why it is important to have a valid order in full sentences.
• Remember: for question 1 you can use dot points;however, the rest of the qutesionsmust be full sentences.

                  Question 2. Explain why Ben has been prescribed this medication. Relate to the pathophysiology of type 1 diabetes and the mechanism of action of NoVo Rapid insulin. Support your answer with academic references. (10 marks). Think about why ben has ben prescribed NoVo Rapid, what’s actually happened to him, what happened inside his body to mean that the doctor has prescribed this medication- That’s what pathophysiology means. Why we are giving this medication to ben and how insulin actually works? Look up at pathophysiology text book.   Notes for Q2:

• You need to talk about the fact that there’s this autoimmune destruction of the beta cells and the beta cells actually make insulin, so ben has been diagnosed with type 1 diabetes, he can’t make insulin for himself anymore so it makes sense that we’re actually going to prescribe insulin to replace that.
• so, you do need to mention briefly that’s an autoimmune process, the beta cells stop making insulin, the glucose levels go high and therefore we need to keep in that insulin to bring the glucose levels down again.

  LECTURE NOTES: Insulin is a hypoglycemics hormone:

• lowers blood glucose levels
• promotes protein synthesis and fat storage
• Enhances membrane transport of glucose into most body cells-muscle and fat
• Inhibits the breakdown of glycogen to glucose
• Inhibits the conversion of amino acids or fats to glucose.

theses dot points is talking about how insulin actually works to lower the blood glucose levels and talks about enhancing the membrane transport of glucose, so it moves the glucose from the blood into inside the cells. When we move it from the blood inside the cells the glucose they will actually drop. This is from the anatomy and physiology text book, look it up explain it into your own words on chapter 16 from page 643 see the link: https://vuws.westernsydney.edu.au/bbcswebdav/pid-3539100-dt-content-rid-27066824_1/courses/401209_2018_spr/Marieb%20Chapter%2016.pdf     Insulin NoVo rapid mechanism of action:  

• Insulin lowers blood glucose levels by facilitating glucose uptake into the cells
• It inhabits glycogenolysis and glycogenolysis in the liver and stimulates glycogenesis.
• Insulin stimulates amino acid uptake into cells-protein synthesis and promotes fat storage. Use the pharmacology text book for this part for reference

 

3. What is the onset, peak and duration of action for NoVo Rapid insulin according to Bullock and Manias (2017)? Explain when NoVo Rapid should be administered in relation to food intake and why. Support your answer with academic references. (5 marks).

• Should he take it before he eats after he eats or while he is eating. Answer is before food. Need to explain why this is the best time to give to him and use pharmacology text book for reference.
• Onset time between 0 to 0.25 hrs which means 15 mins so when you inject the insulin within 15 mins usually starts to wear off. Its peak affect is 1 hr which means it works its best after an hour. And it starts to wear off around 3 to 5 hours.
• So that’s what you need to include in that particular question.
• Reference from pharamalogical textbook.

https://ebookcentral.proquest.com/lib/wsudt/reader.action?docID=5185076&ppg=1 Use this reference to mention that insulin must be taken before f

4. Discuss the definition, causes, symptoms and treatment of hypoglycaemia, a common adverse effect of Novo-Rapid. Support your answer with academic references. (5 marks).

• Meaning: what cause it? What symptoms you see in the patient and how are we going to treat it?
• Answer is on lecture
• Use text-boo, just from (crouch) which is a pathophiology. Textbook.

  lecture Notes for answer Q4: Remember, these are the answers however u should be able to look further on the links provided and use own words.Also: you don’t have much words. write it quiet briefly, this is very general so if wanting more marks have a little bit of a reflection and think about how you can write it and apply it to ben some way for extra marks.  Hypoglycaemia:

• Definition: Low blood glucose- less than 4mmol/L as tested via a blood glucose meter
• Causes: An imbalance between insulin, carbohydrates (glucose) and activity
• Symptoms: Mild- tachycardia, Pallor, sweating (diaphoresis), tremors, hunger and restlessness. Sever- seizures, coma and death.
• Treatment: Immediate replacement of glucose. Quick acting carbohydrate for example fruit juice, sugar or honey, jellybeans.Slow acting carbohydrate for example sandwich or piece of fruit.

 

5. Discuss the importance of understanding the medication prior (before) to administration? Support your answer with academic references. Must be comprehensive discussion.

• Use the fundamentals of nursing text book and one article to support your answer that must be from (2014 to 2018
• Reflect why it is important for nurses to be able to understand it before we actually give the medication.

 

6. Discuss the 5 rights of medication administration and why it is important for nurses to follow this procedure. Support your answer with academic references. (5 marks)

The 5 rights of medication are the right medication, right dose, right time, right patient and right route.

• You need to mention why it is important to follow the 5 rights
• Use the NSW health policy document:https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_043.pdf

      7.What is the most appropriate insulin pen needle length for Ben and why? Support your answer with academic references. (5 marks)    

• For ben we need to aim for a needle length of: 4mm-6 millimetres. We want a short needle specifically for ben because he’s lost a lot of weight. So, it is not a huge amount of subcutaneous fat and when we’re giving this interesante we are giving it via subcutaneous route. So, the doctors had ordered it be subcutaneous, so we need to make sure it goes into the appropriate route. However, if we are giving something that’s too long we’re going to end up with and intramuscular injection and that’s not the way the medication was ordered but also that’s not how the insulin is going to work effectively for Ben.
• Remember to relate it specifically to ben.

Lecture notes to use for answer 7.    Needle length: 4mm-6mm, due to think subcutaneous fat layer (weight loss), ensure the insulin id delivered to the subcutaneous route not intramuscular as per the medication order.   Appropriate injection site: Abdominal wall to ensure patient comfort and effective delivery to subcutaneous route and consistent absorption of insulin.   Inject insulin at appropriate angle: 90 degree, to ensure subcutaneous delivery.   Use this link to support the answer which will talk about where you inject it, what angle and the reason why you are doing it : https://www.adea.com.au/wp-content/uploads/2015/11/Injection-Technique-Final-digital-version2.pdf         8.What diabetes specific nursing assessment would you conduct prior to administration of NovoRapid insulin to Ben and why? Support your answer with academic references. (5 marks) only (40 words for this answer). May use only one reference for this one.

• Think about what specific assessment you would do that relates to diabetes before you give insulin which is checking the patients’ blood glucose levels (BGL). so. Monitoring the patients BGL. Mention why is it important to check BGL before giving insulin.
• The recommended target BGL range for most patients is 5-10mmol/L.
• Use this link to support answer: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0007/196639/User_guide_for_Insulin_Chart_Final.pdf
• And use https://www.safetyandquality.gov.au/wp-content/uploads/2018/01/User-guide-to-the-national-subcutaneous-insulin-chart-Acute-facilities-October-2017.pdf

    9.Identify the site and angle you would inject the NovoRapid insulin and explain why this was selected for Ben. Discuss infection control considerations. Support your answer with academic references. (5 marks) (90 words)     Lecture notes:   Appropriate injection site: Abdominal wall to ensure patient comfort and effective delivery to subcutaneous route and consistent absorption of insulin.   Inject insulin at appropriate angle: 90 degree, to ensure subcutaneous delivery.   ALSO: Use this link to support the answer which will talk about where you inject it, what angle and the reason why you are doing it : https://www.adea.com.au/wp-content/uploads/2015/11/Injection-Technique-Final-digital-version2.pdf  

• For infectious control part reference the fundamentals of nursing for reference : https://vuws.westernsydney.edu.au/bbcswebdav/pid-3513862-dt-content-rid-26882522_1/courses/401209_2018_spr/Fundamentals_of_Nursing_and_Midwifery_----_%28Chapter_35_Medications%29%281%29.pdf

          10.What would you document and where? Why is documentation important? Support your answer with academic or clinical guideline references. (5 marks)  

• For this answer mention where the nurses actually need to fill out on the insulin chart after you’ve given the insulin. Think about where you going to document and must mention why that is important.

   

• Insulin chart : https://vuws.westernsydney.edu.au/bbcswebdav/pid-3539100-dt-content-rid-27038022_1/courses/401209_2018_spr/Insulin-chart-quick-start-guide-2017-Handout%281%29.pdf
• https://www.safetyandquality.gov.au/wp-content/uploads/2018/01/User-guide-to-the-national-subcutaneous-insulin-chart-Acute-facilities-October-2017.pdf

              11.Explain the diabetes specific nursing assessment you would provide for Ben post (after)administration of insulin, when you would provide it and why. Support your answer with academic references. (5 marks).  

• Think back to what nursing assessment specifically for diabetes before you gave insulin. Think about when to do it? How long after you giving to the injection you’re going to come back and do the blood sugar levels assessment. Is it an hour later? Two hrs later? And explain why?
• Try to relate it to ben as much as possible.
• Support with academic reference.

                Part B (10 marks, suggested 200 words) Discuss the potential impact of type 1 diabetes on Ben.  

1. Discuss the daily physical challenges of living with type 1 diabetes that Ben may face. Support your answer with academic references. (5 marks) (100 WORDS)

 

• What is it like for ben every single day? What does he actually have to do to take care of his diabetes?
• Daily physical challenges NOT the symptoms.
• Reflect on the information of ben social life. For example, going to university, playing sports. Look at what diabetes requires every day to look after themselves and how could that actually effect ben in his routine? For example; With having type 1 diabetes and being treated with insulin make any difference with playing sports.
• Note these examples are from lecture, need to use own words. An example of a challenge to use is a routine of having medication and to always remember his medication. That’s a challenge to think about a complete new routine. and insulin injection is another daily physical challenge that ben will have.
• Talk only about two challenges that he might face, very briefly in 100 words.
• Use teenagers physical challenges journal article to support answer.

               

2. Discuss potential emotional impacts of living with type 1 diabetes that Ben may face. Support your answer with academic references. (5 marks)

• Being diagnosed with type 1 diabetes, a long-term chronic illness which is a lot to take in for a young adult he may face emotional impacts in a lifelong condition.
• Find a good journal article from 2014 to 2018 about teenagers living with type 1 diabetes about emotional impacts.
• Link to his relationship also.

    Extra references must use: https://vuws.westernsydney.edu.au/bbcswebdav/pid-3513862-dt-content-rid-26882523_1/courses/401209_2018_spr/Diabetes_Book_Third_Edition%281%29.pdf https://vuws.westernsydney.edu.au/bbcswebdav/pid-3513862-dt-content-rid-26882524_1/courses/401209_2018_spr/Danne%2C%20T.%2C%20Bangstad%2C%20H.%20J.%2C%20Deeb%2C%20L.%2C%20Jarosz-Chobot%2C%20P.%2C%20Mungaie%2C%20L.%2C%20Saboo%2C%20B.%2C%20...%20%26%20Hanas%2C%20R.%20%282014%29.%20Insulin%20treatment%20in%20children%20and%20adolescents%20with%20diabetes.%20Pediatr%20Diabetes%2C%2015%28Suppl%2020%29%2C%20115-134%281%29.pdf     language use:sentences must be well constructed, expression and language are clear, basic written language rules are followed. Referencing and in text citation: The APA referencing style is used correctly for both in text citation for both in text citations and reference list. Remember to use high quality references within 5 years and specifically for type 1 diabetes and insulin.  Must reference every single question. Remember: link to ben’s case study as much as you can through your answers. For the best mark, you should provide a High level of understating for each question.