Bachelor of Nursing : Case Study

Running head: BACHELOR OF NURSING
Bachelor of Nursing
Name of the Student
Name of the University
Author Note

1BACHELOR OF NURSING
1. From the case study, it is reported that the Sarah was prescribed to use
insulin as a treatment of diabetes type 1. In this autoimmune disease the
insulin secreting pancreatic beta cells are destroyed by the T cells and as a
result, there is not adequate amount of insulin production in the body. Due to
less amount of insulin present in the body, the blood glucose level is
enhanced. The activation of the insulin after binding with the insulin
receptors, insulin stimulate the glycogen synthesis in the liver and thereby
reduce the high concentration of blood glucose (Gradel et al., 2018).
2. a) According to the Bullock and Manias (2017), it is reported that, the onset
time of Novorapid is almost 0-0.25 hours. Peak effect of this medicine is 1-3
hours and the duration of action for this medicine is almost 3.5- 5 hours.
b) Insulin associated with reduction of blood glucose levels of the body.
Hence, if the subcutaneous insulin is absorbed in the body in an empty
stomach, then the blood glucose levels of the body will be lower than that of
the normal blood glucose levels of the body. So, before administering the
subcutaneous novorapid, eating of food is recommended (Bullock, S., &
Manias, 2013).
3. a) Hypoglycaemia refers to the lowering of the blood glucose levels than
that of the normal levels of the body’s blood glucose level. This condition is
mainly related to the treatment the diabetes.
b) The main reason of developing hypoglycaemia is associated with the
reduction of the blood glucose levels in the body. In case of a diabetic patient
application of external insulin may reduce the amount of blood glucose levels
to a very low level and thereby causes hypoglycaemia (Shah, Rahman,
Demirbilek, Güemes, & Hussain, 2017).

2BACHELOR OF NURSING
c) The main symptoms of hypoglycaemia are as follows-
 Pale skin
 Anxiety
 Sweating
 Irritability
Irregular heart rhythm and weakness (Shah, Rahman, Demirbilek, Güemes,
& Hussain, 2017).
d) After noticing the signs of hypoglycaemia among the patients,
immediately, sugar lump, candy, fruit juice should be given to the patients to
raise the blood glucose level (Shah, Rahman, Demirbilek, Güemes, &
Hussain, 2017).
4. a) According to the case study of Sarah, it is reported that, Sarah is only 5 years
old child. According to the standardized guidelines of insulin pen needle size, it can
be stated that, in case of children under the age group of 2-6 years, a needle of 4mm
length can be used. So, in case of Sarah, the needle of 4 mm length can be used
(Australian Diabetes Educators Association, 2015).
b) The length of needle is crucial as a longer needle may cause fear in the individual
and as a result the patient may have fear and thereby may refuse to take the insulin
treatment. So, it is very crucial to use appropriate needle (Australian Diabetes
Educators Association, 2015).
5. Before delivering insulin injection to the patients it is very crucial to measure the
blood glucose level the patients. According to the study of Gradel et al. (2018), it is
reported that, the concentration of the blood glucose level may alter before and after
meal condition of the patients. Hence, after taking foods, the blood glucose level

3BACHELOR OF NURSING
must be measured and after that the doses of insulin should be decided. In case of
Sarah this protocol must be followed so that accurate dose of the insulin can be
given.
6. a) For injecting the Novorapid insulin in Sarah’s body the skinfold of the buttocks
can be used as in a study, it is reported that the skinfold thickness of the buttock
region is almost 15.5 mm (SCT layer). Moreover, insulin injection in thick SCT region
will cause less pain feeling among the patient. Therefore, this region will be
appropriate for Sarah (Australian Diabetes Educators Association, 2015).
b) For Sarah, the injection angle will be 90 degree as it is recommended for the 4mm
needles in case of 2-6 years old children (Australian Diabetes Educators
Association, 2015).
c) Sarah may has the diabetes type 1 due to the presence of autoimmune gene in
her body transmitted from her mother (Atkinson, Eisenbarth & Michels, 2014).
Hence, it is very crucial to address the problem in an urgent manner. As Sarah is 5
years old and under the age group of 2-6 years and so those criteria will be
applicable for Sarah.
7. a) As per the book of Bullock and Manias (2017), it is reported that, the medicine
NovoRapid has the medicine has the onset time of 0-0.25 hours and the after 1-3
hours, the peak effect of the medicine is reported. Duration of action of this medicine
is almost 3.5 to 5 hours. Hence, after this time period, the BGL of Sarah can be
tested.
b) In case of Sarah, the testing of the blood glucose level is important as it will help
to assess the effectiveness of the Novorapid in the body of Sarah and if there is not
satisfactory effect on her body, then the doctor may prescribe an alternative one.

4BACHELOR OF NURSING
9. Physical activity is very crucial for the management of diabetes type 1 and it is
reported that the physical activity along with diet management of the individual. For
managing the T1D among the children, it is very crucial to maintain balance in
between the energy expenditure and physical activity. It is reported that, the overall
physical activity of the children with T1D is lesser than that of the children without
T1D (Streisand & Monaghan, 2014). Hence, in case of Sarah, it can be said that, the
physical activity of Sarah must be restricted and managed as per the condition of the
T1D of Sarah.
10. As a part of the emotional impact of the T1D on the children, it can be said that,
due to the disease the patient may face stress as they are not allowed to participate
in all kind of physical activity. As they are restricted to participate in games like
other children of their age group, it may affect their emotions in a negative manner.
Apart from that they also may feel sad as they cannot eat all types of food (Streisand
& Monaghan, 2014). The emotions of Sarah can be affected by these aforesaid
factors.

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References
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The
Lancet, 383(9911), 69-82. doi.org/10.1016/S0140-6736(13)60591-7
Australian Diabetes Educators Association (2015). Clinical Guiding Principles for
Subcutaneous Injection Technique. Australian Diabetes Educators Association.
Retrieved from- https://www.adea.com.au/wp-content/uploads/2015/11/Injection-
Technique-Final-digital-version2.pdf
Bullock, S., & Manias, E. (2013). Fundamentals of pharmacology. Pearson Higher
Education AU.
Gradel, A. K. J., Porsgaard, T., Lykkesfeldt, J., Seested, T., Gram-Nielsen, S.,
Kristensen, N. R., & Refsgaard, H. H. F. (2018). Factors affecting the absorption
of subcutaneously administered insulin: effect on variability. Journal of diabetes
research, 2018. doi.org/10.1155/2018/1205121
Shah, P., Rahman, S. A., Demirbilek, H., Güemes, M., & Hussain, K. (2017).
Hyperinsulinaemic hypoglycaemia in children and adults. The Lancet Diabetes &
Endocrinology, 5(9), 729-742. doi.org/10.1016/S2213-8587(16)30323-0
Streisand, R., & Monaghan, M. (2014). Young children with type 1 diabetes:
challenges, research, and future directions. Current diabetes reports, 14(9), 520.
doi: 10.1007/s11892-014-0520-2