Harrison Johnson, aged 21, was diagnosed with Type 1 diabetes mellitus when he was 12 years old after a viral illness. He and his family learned to manage his diabetes although his teenage years were difficult with episodes of low and high blood glucose. He is now a 3rd year nursing student and enjoys the course very much. However, at times he has found the study and PEP stressful, and this has made managing his blood glucose difficult at times. He is very active and enjoys running and football, and nights out with his friends. Harrison acquired both a continuous glucose monitor and an insulin pump 3 months ago. He is still learning how to use them effectively. Last week Harrison developed a heavy cold with a significant green mucus discharge. He has been feeling very unwell, experiencing episodes of rigors and fever. He has a productive cough. He has presented to the clinic feeling even worse, very tired, thirsty, and urinating more frequently. Collect cues Vital signs: RR: 28 bpm SpO2: 100% BP: 95/55 mmHg (MAP 68 mmHg) HR: 110 bpm Temp: 37.8 oC Peripheral blood glucose monitoring BGL: 38 mmol/L Ketones: 0.6 mmol/L (ref range <0.1 mmol/L) Fluid status assessment: weak peripheral pulses dry mucous membranes poor skin turgor pale and cool to touch capillary refill 3 sec thirsty (polydipsia) • voiding frequently (polyuria) Ward urinalysis: clear, pale Take action Hourly vital signs Hourly blood glucose and ketones Intravenous therapy Insulin infusion Fluid balance monitoring and hydration status assessment Ward urinalysis for every void With reference to anatomical structures use physiological and pathophysiological mechanisms to explain, step-by-step, the development of these cues of Harrison’s presentation.
Consider the person
Harrison Johnson, aged 21, was diagnosed with Type 1 diabetes mellitus when he was 12 years old after a viral illness.
He and his family learned to manage his diabetes although his teenage years were difficult with episodes of low and high blood glucose.
He is now a 3rd year nursing student and enjoys the course very much. However, at times he has found the study and PEP stressful, and this has made managing his blood glucose difficult at times.
He is very active and enjoys running and football, and nights out with his friends.
Harrison acquired both a continuous glucose monitor and an insulin pump 3 months ago. He is still learning how to use them effectively.
Last week Harrison developed a heavy cold with a significant green mucus discharge. He has been feeling very unwell, experiencing episodes of rigors and fever. He has a productive cough.
He has presented to the clinic feeling even worse, very tired, thirsty, and urinating more frequently.
Collect cues
Vital signs:
RR: 28 bpm
SpO2: 100%
BP: 95/55 mmHg (MAP 68 mmHg) HR: 110 bpm
Temp: 37.8 oC
Peripheral blood glucose monitoring
BGL: 38 mmol/L
Fluid status assessment:
-
weak peripheral pulses
-
dry mucous membranes
-
poor skin turgor
-
pale and cool to touch
-
capillary refill 3 sec
-
thirsty (polydipsia)
• voiding frequently (polyuria) Ward urinalysis: clear, pale
Take action
-
Hourly vital signs
-
Hourly blood glucose and ketones
-
Intravenous therapy
-
Insulin infusion
-
Fluid balance monitoring and hydration status assessment
-
Ward urinalysis for every void
With reference to anatomical structures use physiological and pathophysiological mechanisms to explain, step-by-step, the development of these cues of Harrison’s presentation.
Step by step
Solved in 3 steps
