Diabetes Care Plan for Briana

This assignment requires the development of a diabetes care plan for Briana, a young girl with type 1 diabetes. The focus is on educating Briana's parents about her condition, including managing her blood sugar levels and administering insulin. The plan emphasizes clear communication strategies to accommodate Tom's cognitive limitations, utilizing nonverbal cues and written instructions alongside verbal explanations.

Running Head: TYPE 1 DIABETES: CASE STUDY ANALYSIS
Type 1 Diabetes: Case Study Analysis
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TYPE 1 DIABETES: CASE STUDY ANALYSIS
1. Pathophysiology of Type 1 Diabetes
a. High blood glucose level
High blood glucose level in diabetes type 1 is directly related to the low levels and/or
lack of insulin in the body due to autoimmune response that destroys the pancreatic beta cells
(Cleland, 2017). The destruction of these insulin-producing cells leads to low and/or no
insulin in the blood. Without sufficient insulin which is supposed to enable the movement of
glucose from the bloodstream to body cells to be used as energy in metabolism, there
develops a glucose surge within the bloodstream.
b. Glucose in the urine
The high glucose level among type 1 diabetic patients which can sometimes exceed 160 –
180 mg/dl which is the Renal Threshold for Glucose makes the proximal tubules of the
kidneys overwhelmed making it to excrete glucose in urine. Children just like pregnant
women usually have low Renal Threshold for Glucose (below 7 mmol/L) beyond which they
develop glycosuria (Reznik & Cohen, 2013). Since the proximal tubule only reabsorbs
limited amounts of glucose, the excess glucose passes into the urine of the patient.
c. Increase urination
Also referred to as polyuria, the condition occurs when an individual has excess sugar
levels in blood. In normal circumstances, kidneys they reabsorb all glucose to be directed
back into the bloodstream (Cleland, 2017). However, type 1 diabetes leads to high glucose
levels in urine which pulls more water through osmosis from the bloodstream forming excess
urine within a short time.
d. Increased thirst
Increased thirst is referred to as polydipsia which is directly related to the increased loss of
water through excessive urination among type 1 diabetics. A high concentration of glucose in
the bloodstream beyond 200mg/dL the kidneys, can no longer reuptake glucose from water

TYPE 1 DIABETES: CASE STUDY ANALYSIS
(Weise et al, 2017). This leads to a high osmotic pressure in the in the urine within the
proximal tubules of the nephron. As a result, water cannot be any more absorbed into the
bloodstream but lost as urine leaving the body dehydrated. The increase in thirst therefore is
the body’s response to the low water levels in the bloodstream as result of its high loss
through urination.
e. Increased appetite
Increased appetite also referred to as polyphagia is caused by insufficient amounts of
glucose in the body cells. This, results from low or lack of insulin in the body; hindering the
movement of sugar from bloodstream into the tissues. In this case, hypoglycaemia develops
due to the body’s inability to convert the food in the body into energy and thus perpetually
starving cells (Reznik & Cohen, 2013). The body responds appropriately to prevent starving
of crucial tissues by making patients feel rapidly hungry and a need to feed.
f. Ketones
The lack of and/or low levels of insulin among type 1 diabetes patients makes the
body cells to starve due to lack of sugar and thus resort to breaking down fat for energy.
Ketones among type 1 diabetes patients result from the burning of fat in the cells instead of
glucose (Ogbera, 2014). This process leads also to the spilling of ketones that form in blood
into the urine. A loss of weight among diabetic patients also produces ketones since there is
no sufficient insulin to enable the body break down sugar to create energy.
g. Weight-loss
Patients with type 1 diabetes experience sudden weight-loss. The loss of weight is mainly
attributed to the body’s breakdown of fat to create energy. The fat which contributes to the
body weight in normal circumstances is broken down by cells to create energy since there is
no sugar in the cells due to lack of insulin (Ogbera, 2014). The body also burns the muscle

TYPE 1 DIABETES: CASE STUDY ANALYSIS
energy to compensate for the insufficient glucose levels leading to reduced overall body
weight.
2. The Nursing Responsibilities and Supporting Rationales Related to the
Administration of Aspart (Novorapid) Insulin Via FlexPen
A. Prior to administration
It is the responsibility of the Registered Nurse to ensure that they are able to
understand and interpret the insulin prescription sheet. The nurse should ensure that the
insulin prescription is not only complete, legible, unambiguous but also correct before
administering it to the patient (Pharmacy Today, 2017). This helps prevent wrong
administration of the dosage and possible side effects to the patient. The nurse also should
check insulin name and the dose against the patient’s insulin prescription chart from the
records to ascertain the correct type and prevent accidental administration. The identity of a
patient must also be confirmed before administering the insulin to ensure that the right person
is given the right medication (Kma, 2017). There is also need to ensure that the insulin has
not been administered already to a different person so as to prevent cross-contamination
and/or infections. The nurse should then wash their hands, wear gloves, confirm and record
blood glucose levels before administering the insulin for comparison purposes (Reznik &
Cohen, 2013). It is very important to confirm that insulin storage was appropriate and that it
has not expired yet. The nurse can then prepare the insulin FlexPen device with an 8mm
needle since Briana is not underweight.
B. During administration
During administration of NovoRapid by the FlexPen device the nurse should select an
appropriate injection site that has clean skin. There is need to avoid to use of alcohol wipes
since alcohol makes the injection to be more painful and hardens the skin which is not desired

TYPE 1 DIABETES: CASE STUDY ANALYSIS
in insulin administration (Davis et al, 2010). The nurse should inject insulin into sub-
cutaneous tissue and/or the soft fat but not the muscle. Therefore the nurse needs to raise the
skin before administering. There is need to continue raising the injected skin and holding the
FlexPen in place for about 10 seconds so as to enable the dispersion of insulin from the site
(Kma, 2017). The nurse should ensure that they do not withdraw insulin from a prefilled pen
by use of a needle as this contaminates the vial and thus interfering with FlexPen dose
determination accuracy (Davis et al, 2010). NovoRapid should be administered
subcutaneously using an injection in the wall of the abdomen, the thigh, upper arm, deltoid
region and also in the gluteal region. This sites should however be rotated to ensure that there
is minimal lipodystrophy risk. Since the NovoRapid is characterised with a faster onset of
actions, the nurse should administer the medication immediately before the patient takes a
meal.
C. After administration
After administration, the nurse should remove FlexPen device with the needle and
dispose them among other sharps used in the procedure to prevent probable reuse and
nosocomial infections through accidental pricks (Davis et al, 2010). The nurse should record
the dose administered, timing and the site of injection. These records are for follow up
process in managing the patients current and future sugar levels. In case the patient bleeds at
the injection site, there is visible insulin at his site and/or the patient feels too much pain, the
nurse should report to the supervisor (Pharmacy Today, 2017). This could mean the need to
re-administer the vial as I is likely that it was injected into the muscles when it should not.
The nurse should use a needle remover to remove the needle before disposing it into the
sharps safety box. This procedure prevents needle-stick injuries.
3. Potential Impact of Type 1 Diabetes on Briana And Her Family

TYPE 1 DIABETES: CASE STUDY ANALYSIS
a. Emotional
Briana is likely to suffer from emotional ill-health due to the diabetes subsequent
management. Research indicates that one in every three people suffers depression as a result
of diabetes diagnosis and this impairs their normal functioning, individual adherence to
medication and the required glycaemic control (Reznik & Cohen, 2013). Briana’s parents
will also be affected emotionally as they will develop anxiety, depression among other
phobias that are related to their child’s health condition. Considering that Mr Tom, Briana’s
father already has a mental health problem, his situation is likely to deteriorate he receives
special counselling on homecare procedures for Briana. The mother will most likely have to
undergo the emotional effects of caring for both the father and Briana to prevent any
deterioration in their health. Both parents will be concerned that their child might face
discrimination from friends due to the condition and thus become anxious and unnecessarily
over-protective.
b. Physical
Diabetes leads to nerve damages and this leads to slowed rate of stomach emptying,
constipation, bloating, urine retention, dizziness while standing, tingling, numbness in the
feet and hands among patients. Due to damages caused to the blood vessels, diabetes results
to vision impairment, chronic kidney disease, arteriosclerosis among other cardiovascular
diseases (Ogbera, 2014). Briana is thus at the risk of developing the above health conditions.
Understanding this risk will make the parents physically worn out in managing their child’s
health condition. The management of sugar levels, providing special diet for Briana and
ensuring that she is take out for safe physical exercises are all physically demanding practices
to the parents.

TYPE 1 DIABETES: CASE STUDY ANALYSIS
4. How to Adapt Your Nursing Care of Briana and Her Family to Accommodate
Tom’s Intellectual Disability
Tom as a parent needs to be involved in caring for Briana. However as a nurse I will
ensure that I communicate the procedures and care option to him in the most effective way
knowing well that he has communication difficulties due to his intellectual disability. In this
regard I will use nonverbal communication and encourage his wife to use this approach to
meet Tom’s cognitive and communication needs as indicated in Turan (2017). I will speak
directly to him with his permission after confirming from the wife how he speaks and
communicates. I would also encourage Tom to use his communication device if any before I
brief him of Briana’s condition and the necessary homecare activities needed, using simple
but direct sentences. It is likely that Mr Tom will not understand all the procedures in one
sitting and I will therefore encourage him and the family to be coming back to the facility for
a continued instruction of their daughter’s care. Further, I will provide written instructions to
the family for everyone including Tom to understand the treatment regimen for Briana as
suggested in Turan (2017). The written instructions are important as they serve as reference
for the family to rely on in managing Briana’s sugar levels and administering insulin.

TYPE 1 DIABETES: CASE STUDY ANALYSIS
References
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with type 2 diabetes. Practical Diabetes, 34(6), 210-213.
Davis, E., Sexson, E., Spangler, M., & Foral, P. (2010). An evaluation of prefilled insulin
pens: a focus on the Next Generation FlexPen®. Medical Devices: Evidence and
Research, 41.
E, L. (2013). Type 1 Diabetes and Physical Activity in Children and Adolescents. Journal of
Diabetes & Metabolism, 01(S10).
Kma, A. (2017). Application of Premixed Insulin NovoMix®30 and NovoRapid® as
Multiple Daily Injections or as Basal Bolus Format in Selected Diabetic Patients:
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Ogbera, A. (2014). I.13 Pathophysiology of Type 1 diabetes mellitus. Diabetes Research and
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Turan Gurhopur, F. (2017). Family Burden among Parents of Children with Intellectual
Disability. Journal of Psychiatric Nursing.

TYPE 1 DIABETES: CASE STUDY ANALYSIS
Updated guideline on use of oral medications to manage type 2 diabetes. (2017). Pharmacy
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