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Diabetes Mellitus Case Study (45 min)

diabetes mellitus case study
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Miss Matthews is a 16-year-old female who is brought to the emergency department after collapsing at school. She is currently alert, but pale and weak. A blood glucose performed by the paramedics read meter Max or high.

Critical Thinking Check
Bloom's Taxonomy: Application

What additional nursing assessments should be performed at this time?

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Critical Thinking Check
Bloom's Taxonomy: Application

What history questions would you like to ask of the patient and/or her parents?

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Upon further questioning, the parents report that their daughter has been weak a lot lately. Miss Matthews reports but she’s always hot and exhausted. She reports a 10-pound weight loss over the last 2 months despite eating all the time and agrees that she has been thirsty and peeing a lot.

The nurse notes Kussmaul respirations and fruity breath.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What diagnostic tests should be run for Miss Matthews?

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A serum glucose revealed that Miss Matthews’ blood glucose is 523 mg/dL, and her urine was positive for ketones.   The provider explains that she is likely a diabetic. Her parents are shocked as she has always been a healthy and athletic child.  The parents ask the nurse “ How can she be diabetic when she is so skinny and exercises all the time?

Critical Thinking Check
Bloom's Taxonomy: Comprehension

What is an appropriate response by the nurse?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What treatments do you expect to be ordered for Miss Matthews at this time?

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Miss Matthews is treated for diabetic ketoacidosis over the next 2 days and is now feeling much better. The diabetic nurse educator comes by to teach Miss Matthews how to self-administer SubQ insulin using an insulin pen. Miss Matthews says “I  can’t stand needles, isn’t there a pill I can take instead?”

Critical Thinking Check
Bloom's Taxonomy: Comprehension

What is the most appropriate response by the nurse?

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Critical Thinking Check
Bloom's Taxonomy: Comprehension

What options does Miss Matthews have for insulin administration?

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Miss Matthews is able to demonstrate proper technique for glucose monitoring and self-administration of insulin with the insulin pen. Her blood glucose levels are stable between 140 and 180 mg/dL,  and the provider has said that she could go home today.

Critical Thinking Check
Bloom's Taxonomy: Application

In addition to the insulin education, she has already received, what other education topics should be included in discharge teaching for Miss Matthews?

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