Case Study



Aim of the assessment

The purpose of this assessment is to enable students to demonstrate:

– An understanding of safe, appropriate and responsive quality nursing practice when administering pharmaco-logical interventions to people with type 1 diabetes

–An understanding of the relationship between pharmacological interventions and the cause, pathophysiology and clinical manifestations of type 1 diabetes

– An understanding of the impact of type 1 diabetes on the individual

– An evaluation of relevant literature to support an understanding of the pharmacological and nursing management of a person with type 1 diabetes and express this in a clear and succinct writing style

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

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.
Assessment Questions

Part A (60 marks, suggested 800 words)

The nursing responsibilities related to the administration of Aspart (NovoRapid) insulin to Ben.

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. (5 marks)
2.Explain why Ben has been prescribed this medication. Relate to the pathophysiology of type 1 diabetes and the mechanism of action of NovoRapid insulin. Support your answer with academic references. (10 marks)
3.What is the onset, peak and duration of action for NovoRapid insulin according to Bullock and Manias (2017)? Explain when NovoRapid should be administered in relation to food intake and why. Support your answer with academic references. (5 marks)

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)
5.Discuss the importance of understanding the medication prior to administration. Support your answer with academic references. (5 marks)
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)
7.What is the most appropriate insulin pen needle length for Ben and why? Support your answer with academic references. (5 marks)
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)
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)
10.What would you document and where? Why is documentation important? Support your answer with academic or clinical guideline references. (5 marks)
11.Explain the diabetes specific nursing assessment you would provide for Ben post administration of insulin, when you would provide it and why. Support your answer with academic references. (5 marks)

Part B (10 marks, suggested 200 words)

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

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 ci-tations and reference list.

NOTES: The assessment must comply with the following:

–Students must respond to each of the questions provided using academic writing - question/answer format using full sentences and paragraphs
– An introduction and conclusion are NOT required.
– Please type your responses on the template provided in the assessment tab on vUWS.
– The assessment has double -spaced lines. Arial 12 size font.
– Referencing must be presented in American Psychological Association (APA) (6th ed.) referencing style as per the Western Sydney University (2016) American Psychological Association referencing style guide. Available from: https://library.westernsydney.edu.au/main/sites/default/files/cite_APA.pdf

– Every answer should have in-text references. In-text references should be throughout the answer and not only at the end of a whole paragraph.
– No initials of authors’ first name are used in the in-text references.
– Reference list is on a new page.
– References are listed in alphabetical order based on the first author’s surname.
– Hanging indent has been used in the reference list.
– Title of text book and name of journal and volume is in italics.
– Every in-text reference matches with a reference in the reference list.
– Only references used in-text should appear in the reference list.
– There is a limit of 1000 words +/- 10%. Use your computer to total the number of words used in your assignment.
– The questions and reference list are not included in the word limit.
– 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 1100 words.
– Academic references include journal articles, textbooks, Australian clinical guidelines and creditable organi-sational websites/reports such as The Australian Diabetes Educators Association.
– High quality academic references are current (within 5 years) and specifically relevant to type 1 diabetes or insulin administration.

Resources:

i. Examples may be available on the vUWS site.

ii. There are a number of textbooks and resources available through the Western Sydney University Library that may assist you. Please refer to the unit’s vUWS site for specific unit resources

Literacy resources: The School of Nursing and Midwifery have qualified staffin the teaching of English language and literacy who are available to support all students in Professional Communication and Academic Literacy (PCAL) Skills on each campus. Contact details below. Please email for PCAL Support workshops, small group and individual appointments.

Hawkesbury Campus NM_Hawkesbury_Literacy_Tutors@westernsydney.edu.au Campbelltown Campus NM_Campbelltown_Literacy_Tutors@westernsydney.edu.au Parramatta Campus NM_Parramatta_Literacy_Tutors@westernsydney.edu.au Liverpool Campus NM_Liverpool_Literacy_Tutors@westernsydney.edu.au


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