Case Study 109 Severe Hypoglycemia Difficulty: Intermediate Setting: Outpatient clinic Index Words: hypoglycemia, type 1 diabetes mellitus (DM), crisis management Giddens Concepts: Clinical Judgment, Glucose Regulation,
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Case Study 109 Severe Hypoglycemia Difficulty: Intermediate Setting: Outpatient clinic Index Words: hypoglycemia, type 1 diabetes mellitus (DM), crisis management Giddens Concepts: Clinical Judgment, Glucose Regulation, Patient Education, Safety HESI Concepts: Assessment, Clinical Judgment, Glucose Regulation, Nursing Interventions, Patient Education, Safety T.R. is a 22-year-old college senior who lives in the dormitory. His friend finds him wandering aimlessly about the campus appearing pale and sweaty. He engages T.R. in conversation and walks him to the campus medical clinic, where you are on duty. The friend explains to you how he found T.R. and says T.R. is “diabetic” and takes insulin. T.R. is not wearing a medical warning tag. It is 1015. 1.What do you think is going on with T.R.? 2. What is the first action you would take? 3. Which assessment findings would support the premise that T.R. is experiencing a hypoglycemic reaction? 4. If no glucose meter were available, would you treat T.R. on the assumption he is hyperglycemic or hypoglycemic? Explain your rationale. 5. It is 1025. T.R.'s glucose reading is 50 mg/dL. What should your next action be? 6. When you enter the room to administer the juice, T.R. is not responsive enough to drink the juice safely. What should you do?. 7. T.R. is breathing at 16 breaths/min and has a pulse of 112 beats/min and regular. Because outpatient resources vary, describe your next actions if (1) your clinic is well equipped for emergencies or (2) your clinic has no emergency supplies. CASE STUDY PROGRESS A few minutes after administering 2 mg glucagon, T.R. begins to awaken. He becomes alert and asks where he is and what happened to him. You orient him and then explain what has transpired. 8. What questions would you ask to find out what precipitated this event? 9. What further action do you need to take at this time? 10. At 1045, you recheck T.R.'s glucose and the reading is 64 mg/dL. His vital signs are 120/72, 18, 92. Has his status improved or not? Defend your response. 11. What would your next action be? 12. At 1110, you recheck T.R.'s glucose and the reading is 104 mg/dL. What should you do now? CASE STUDY PROGRESS T.R. tells you he took 35 units glargine (Lantus) insulin and 12 units of regular (Humulin R) insulin at 0745. He says he was late to class, so he just grabbed an apple on the way. 13. Based on this information, why did T.R. experience this episode of hypoglycemia? 14. Based on your knowledge of the types of insulin T.R. is receiving, when would you expect T.R. to experience a hypoglycemic reaction? 15. He says he had two similar low-blood sugar episodes recently. He treated them by eating a candy bar. He says he is on a 2000-calorie, carbohydrate-controlled diet but has been checking his blood glucose levels every "couple of days" only. What common mistake in previously treated episodes of hypoglycemia did T.R.
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