Clinical Case of Diabetes

This clinical case of diabetes discusses the interpretation of normal and abnormal subjective and objective data. It explores the implications of high blood glucose levels, low blood pressure, frequent urination, and other symptoms. The case highlights the need for immediate nursing interventions to stabilize blood glucose levels and prevent complications. No specific course code, course name, or college/university information is mentioned.

Clinical case of diabetes 1
CLINICAL CASE OF DIABETES
By,
Course
Tutor
University
City and State
Date

Clinical case of diabetes 2
Interpret
Normal (subjective and objective) Abnormal (subjective and objective)
RR 20
Absence of ketones on urinalysis
Soft abdomen, No rebound tenderness on
abdominal examination
Bowel sounds present
BP 90/50
HR 120 Bpm
Temperature 37.9 degrees
BGL 34 mmol/l
SPO2 94%
Course air entry and cough
Frequent urination
Poor skin turgor
Glycosuria
Relate and infer
Mrs. Nancy is a known type 1 diabetic patient. The above abnormal data is as a result of
exacerbation of her condition. Diabetes is caused by an increase in the blood sugar levels above
normal range. The normal blood glucose range is 3.1 -7.8 mmol/l (Miller, 2015). The objective data
of Mrs. Nancy revealed that her blood glucose levels were 34mmol/l. This shows that her blood
sugar levels were quite alarming and could result into severe complications such as microvascular
damage, hyperosmolar hyperglycemic state and renal failure. Given the history of the patient, the
quick escalation of blood sugar levels could be explained by the fact that she took a lot of coffee and
soft drinks that have a high sugar content. Type 1 diabetes results from inadequate and impaired
insulin production by beta cells of the pancreas (Bergenstal et al, 2016). This hormone controls
blood glucose levels and ensures glucose intake and utilization by cells and tissues. Due to intake of
these high sugar fluids, there was no insulin to induce glucose intake by cells thus resulting in a
quick escalation of the blood sugar levels. Diet and lifestyles have a major impact when it comes to

Clinical case of diabetes 3
blood sugar levels regulation in diabetic patients.
Nancy’s blood pressure level was lower than normal on measuring. The normal blood pressure
level for an average person is 120/80 mmHg. Mrs. Nancy had blood pressure levels of 90/50. This
signifies a hypotensive state as the blood pressure is lower than normal. It can be easily deduced
from this results that she had a low blood volume as blood pressure levels are important signals of
blood volume. The low blood volume state could have resulted from significant body fluid loss as
indicated by frequent urination in her clinical case. The frequent urination in diabetic states can be
attributed by significant glucose loss in the nephrons (Kostic et al, 2015). Increased glucose
elimination in the nephrons leads to increased water loss by the kidneys as well because of osmotic
gradient and force. Therefore more water loss leads to a low blood volume that is monitored by
blood pressure levels. The increased urine output and increased water loss could also account for the
patient’s poor skin turgor as it signifies dehydration. The heart rate of the patient was higher than
normal. The normal heart rate of a person is 60-100 Bpm. Because the blood volume was low, the
body adapted to these changes by an increase in the heart pumping activity (Bluestone et al, 2015).
The increased heart rate is therefore a physiological response to increase blood supply to the rest of
the body parts as the decreased blood supply to tissues might result to ischemia and necrosis. Due to
decreased blood volume, the demand for oxygen by tissues increased significantly.
Predict
Nancy’s case requires immediate attention and implementation of nursing interventions. Failure to
contain her blood glucose levels can lead to significant consequences. Since her blood glucose
levels are too high, if no action the patient might go into a hyperosmolar hyperglycemic state. This
state is characterized by severe dehydration due to increased osmolality, weakness, leg cramps and
vision problems (Rewers and Ludvigsson, 2016). It can result in altered consciousness and lead to a

Clinical case of diabetes 4
coma state thus putting the patient’s life in danger. Other complications that are highly linked to
type 1 diabetes such as microvascular damage can lead to further decreased blood volume and send
the patient into shock.
Develop, Articulate and Prioritize nursing diagnoses
The nursing diagnoses I would prioritize from Mrs. Nancy include:
1. Unstable blood glucose
2. Risk for infection
3. Risk for deficient blood volume
Goals, actions and evaluation
Diagnosis 1 Goals Related actions Rationale Evaluate
outcomes
Unstable blood
glucose
Ensuring that the
patient blood
glucose levels are
stabilized and the
patient adopts
adequate glucose
monitoring.
As the registered
nurse the first
action I would
take in assisting
the patient
achieve blood
glucose stability
is to assess and
educate the
patient on
adequate glucose
self-monitoring
and
The rationale for
specific nursing
actions aims at
understanding the
reason for the
nurse to take the
action and how it
relates to the
patient’s
pathophysiology
and physiological
changes. The first
action of
To evaluate the
effectiveness of
the actions taken,
I would engage
the patient for
feedback and
encourage regular
checkups even
after discharge

Clinical case of diabetes 5
administration of
insulin. This
involves
assessing the
patient’s glucose
levels before
meals and at
bedtime to ensure
that the glucose
levels are within
the normal levels
and if not so
encourage
administration of
insulin.
The second
action is to assess
the patient’s
current
knowledge and
understanding of
dietary changes
prescribed.
assessing and
encouraging
glucose
monitoring helps
the patient
understand when
she should
administer
insulin. The
normal glucose
level should be
between 140-180
mg/l. Failure to
monitor blood
glucose levels
can lead to
exacerbation of
the disease as
seen in Nancy.
The rationale for
the second action
would be the fact
that avoiding

Clinical case of diabetes 6
sugary diet can
help maintain
blood glucose
levels (Pociot and
Lernmark, 2016).
Diagnosis 2 Goals Related actions Rationale Evaluate
outcomes
Risk for infection Preventing
development of
infection
associated with
diabetes
The first action
would be to
identify and
observe the
patient for any
signs of infection
and inflammation
and act towards
managing them if
any
The second
action I would
undertake for the
patient would be
to teach and
promote good
The rationale for
the first action
would be the fact
that increased
glucose
predisposes
someone to
infections.
Diabetes mellitus
is one of the
diseases that
affects and
compromises the
integrity of the
immune system
(Millman et al,
To evaluate
outcomes, I
would assess the
patient for signs
of improvement. I
would be keen to
identify if the
antibiotics
administered
have proven to be
effective in case
of infection and
offer alternatives
in case of
resistance.

Clinical case of diabetes 7
hand and general
hygiene for the
patient
2016).
Individuals with
the disease can
therefore easily
develop
nosocomial
infections hence
the need for
prevention
The second
action aims at
preventing and
reducing cross
contamination.
Good hygiene
helps prevent
healthcare
associated
infections as
bacteria and other
microorganisms
cannot invade the
body (Mayer-

Clinical case of diabetes 8
Davis et al,
2017).
REFERENCES
Bergenstal, R.M., Garg, S., Weinzimer, S.A., Buckingham, B.A., Bode, B.W., Tamborlane, W.V.
and Kaufman, F.R., 2016. Safety of a hybrid closed-loop insulin delivery system in patients with
type 1 diabetes. Jama, 316(13), pp.1407-1408.
Bluestone, J.A., Buckner, J.H., Fitch, M., Gitelman, S.E., Gupta, S., Hellerstein, M.K., Herold,
K.C., Lares, A., Lee, M.R., Li, K. and Liu, W., 2015. Type 1 diabetes immunotherapy using
polyclonal regulatory T cells. Science translational medicine, 7(315), pp.315ra189-315ra189.
Kostic, A.D., Gevers, D., Siljander, H., Vatanen, T., Hyötyläinen, T., Hämäläinen, A.M., Peet, A.,
Tillmann, V., Pöhö, P., Mattila, I. and Lähdesmäki, H., 2015. The dynamics of the human infant gut
microbiome in development and in progression toward type 1 diabetes. Cell host & microbe, 17(2),
pp.260-273.
Mayer-Davis, E.J., Lawrence, J.M., Dabelea, D., Divers, J., Isom, S., Dolan, L., Imperatore, G.,
Linder, B., Marcovina, S., Pettitt, D.J. and Pihoker, C., 2017. Incidence trends of type 1 and type 2
diabetes among youths, 2002–2012. New England Journal of Medicine, 376(15), pp.1419-1429.
Miller, K.M., Foster, N.C., Beck, R.W., Bergenstal, R.M., DuBose, S.N., DiMeglio, L.A., Maahs,
D.M. and Tamborlane, W.V., 2015. Current state of type 1 diabetes treatment in the US: updated
data from the T1D Exchange clinic registry. Diabetes care, 38(6), pp.971-978.
Millman, J.R., Xie, C., Van Dervort, A., Gürtler, M., Pagliuca, F.W. and Melton, D.A., 2016.
Generation of stem cell-derived β-cells from patients with type 1 diabetes. Nature communications,
7, p.11463.
Pociot, F. and Lernmark, Å., 2016. Genetic risk factors for type 1 diabetes. The Lancet, 387(10035),

Clinical case of diabetes 9
pp.2331-2339.
Rewers, M. and Ludvigsson, J., 2016. Environmental risk factors for type 1 diabetes. The Lancet,
387(10035), pp.2340-2348.