Case Study 1

Wayne Hastie, 8 years, admitted to hospital with a 3-week history of weight loss, polyuria and polydipsia. He woke up with a sore throat and started breathing heavily. Both past medical and family history were unremarkable. Wayne was stable and alert on admission. GCS score 15/15. Kussmaul breathing present. >5% dehydration. Weight 30 kg  BGL 19 mmol/L, blood ketones 1.2 mmol/L. The diabetes specialist team ordered commencement of IV rehydration with an initial bolus of 400mL of 0.9% normal saline.  3 units of Actrapid (0.1 unit/kg) were given SC. The patient was admitted to PICU for IV insulin and rehydration. He was started on twice- daily SC Protaphane and Novorapid 24 hours later. Diagnosis of Diabetes Mellitus Type 1. Wayne’s mother and grandparents are with him during admission and are very concerned. Wayne’s family are asking you what has caused this disorder

1)Describe the normal anatomy, physiology and endocrine functions of the pancreas

2)Describe the pathophysiological development of:

a)Type 1 Diabetes

b)Type 2 Diabetes

c) Gestational diabetes

3)Wayne’s mother is concerned that she will not be able to manage his condition at home. Describe for her the resources available including funding sources that she may access to help manage Wayne’s condition.

Joshua Busch, 27 years, has Type 1 Diabetes Mellitus diagnosed at 19 years.

Current medication includes Lantus 25 units nocte and 2 units of Novorapid per carbohydrate exchange. Weight is 78 kg and height 165 cm. Joshua is an apprentice locksmith. Recreational activities include fishing and hunting. Joshua is a non-smoker and social drinker. BGL target range is 408mmol/L. At review by the diabetes educator last month, his HbA1c was 6%. BP was 120/82 eGFR was > 90. Lipid levels were within normal range. An eye examination last year was normal. The past medical history includes an episode of pancreatitis resulting in a 3 day stay in ICU. Last year a compound fracture of the left ankle took 6 months to heal. Joshua was non-weight bearing for 4 months.

4)Provide a description of the signs and symptoms and management  of the following problems

a.Ketoacidosis

b.Hyper Osmolar non-ketonic coma

c.Hypoglycaemia

d.Psychosocial issues including factors related to self-esteem

Batool Dirani, 67 years, diagnosed with Diabetes Mellitus at 51 years. Her height is 152 cm and weight 95kg.  Current medication is Metformin 850mg bd. History of MI at 50 years, insertion of 6 stents for coronary artery occlusion 2 years ago. She has had a left lower leg ulcer for the past 9 months. She smokes 35 cigarettes per day and drinks two scotch and coke each evening. At a GP review 3 weeks ago BP was 139/92, LDL 4.3mmol/L, triglycerides 2.9mmol/L, HDL 1.0 mmol/L and eGFR =9%.

5)Provide a description of the signs, symptoms and management of the following problems:

a)hyperglycaemia

b) retinopathy-

c) infection

d) Microvascular and macro vascular disease

6)Identify the health promotion goals for Batool and their expected outcomes in relation to the following activities:

a) exercise

b) diabetic diet

c) weight loss (body mass index or waist to hip ratio)

d) Smoking cessation

e) foot and eye care

7) Identify issues in relation to diabetes care delivery and diabetes related services

8)There is a high rate of Diabetes Mellitus in the Australian population. This number is expected to increase dramatically in the next decade.Â

a) What are the environmental and social factors that lead to this incidence?Â

b) List the factors that increase the risk of Diabetes Mellitus for Aboriginal and Torres Strait Islander communities

9)Whilst on professional experience you are required to provide nursing care and management for 2 people with diabetes including:

•a person who has become hypoglycaemic

•a person who has become hyperglycaemic

In addition you are required to provide nursing care and management of 1 person with diabetes in the workplace or a simulated environment including:

a person who is demonstrating signs/symptoms of ketoacidosis

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