Case Study: Assessment and Management of Patients With Diabetes

Case Study, Chapter 51, Assessment and Management of Patients With Diabetes

1. Sallie Smith, 42 years of age, is newly diagnosed with type 2 diabetes. During the patient education, the patient asks the nurse, “What should I do if I am sick and can’t eat; should I still take my medicine for the diabetes?” (Learning Objective 10)

a. What management strategies should the nurse provide the patient to deal with “sick days?”

2. Jerry Thomas is a 26-year-old type 1 diabetic. He was originally diagnosed at the age of 14, and currently manages his disease with an intensive regimen of insulin injections. Jerry is employed as a schoolteacher and soccer coach. He presents today with a 2-day history of vomiting and diarrhea. He has been closely monitoring his blood glucoses, and is using regular insulin for high blood glucose levels. He has only been able to tolerate liquids such as Gatorade, but today he is unable to even tolerate that, and comes to the clinic for evaluation of possible diabetic ketoacidosis (DKA). (Learning Objective 9)

a. Describe the pathophysiology of DKA and why it occurs in patients with type 1 diabetes.

b. Based on the diagnosis of DKA, what assessment findings does the nurse correlate to this disorder?

c. The physician orders a complete metabolic panel, and Jerry’s blood glucose is 425. Other lab values include a serum sodium of 152, serum potassium of 3.0, and BUN of 64. What is your assessment of these results?

d. Explain why it is important for Jerry to continue to take his insulin even though his oral intake is decreased.