Nursing Care for Diverse Patients

This assignment delves into diverse patient care scenarios encompassing medical-surgical nursing. It examines the management of type 1 and type 2 diabetes, gestational diabetes prevention strategies, and critical care for unconscious patients following cardiac arrest. The document also analyzes factors influencing outcomes in traumatic brain injury and outlines evidence-based nursing interventions for falls prevention.

Running head: CRITICAL ANALYSIS OF A CASE STUDY
Critical analysis of a case study
Name of the student:
Name of the University:
Author note:

1CRITICAL ANALYSIS OF A CASE STUDY
Table of Contents
Introduction:...............................................................................................................................1
Admission Summary:.................................................................................................................1
Analysis:.....................................................................................................................................2
Unconsciousness:...................................................................................................................2
Right leg deep wound:...........................................................................................................3
Elevated blood glucose level:.................................................................................................3
Definition of Gestational Diabetes Mellitus:.............................................................................3
Incidence of GDM:....................................................................................................................4
Pathology of GDM:....................................................................................................................4
Effect of GDM in relation with case study:...............................................................................5
Long term effects of head injury:...............................................................................................6
Physical:.................................................................................................................................6
Emotional:..............................................................................................................................6
Cognitive:...............................................................................................................................7
Behavioral:.............................................................................................................................7
Family Dynamics:..................................................................................................................7

2CRITICAL ANALYSIS OF A CASE STUDY
Conclusion:................................................................................................................................7

3CRITICAL ANALYSIS OF A CASE STUDY
Introduction:
Mrs. Mary Waxman (31) is a computer system analyst and manages the Australian unit of the
company. While returning from her business trip, she fell down from the escalator of
Melbourne airport. This fall resulted in severe head injury, soft tissue injury in neck,
laceration and grazes to her arms and legs and a deep wound in right leg.
This critical analysis of the case study will discuss the severe head injury she is going
through. Due to this head injury, she is unconscious from last 48 hours. this case study
discussion will discuss the admission history and the progression of the patient, analysis of
three nursing care needed including diagnosis, expected outcomes, nursing interventions,
rational and evaluation method. Her past medical complication, gestational diabetes mellitus
and its relation to her recent accident is also going to be discussed. Finally, the effect of this
head injury on Mrs. Waxman’s physical, emotional, cognitive and behavioral potential is
going to be discussed.
Admission Summary:
After facing the dangerous accident on Melbourne airport, Mrs. Waxman has been taken to
the intensive care department of the hospital. She spent 48 hours in the intensive care unit and
then taken to the neurological department. She is unconscious from last two days and has
nasogastric tube intravenous line and indwelling urinary catheter in situ in her body. She has
several visible and invisible injuries on her body such as head injury, neck tissue injury, deep
wound on leg and grazes and lacerations. However, no evidences of skull crack has been
found through CT scan and X-ray reports.

4CRITICAL ANALYSIS OF A CASE STUDY
Her breath rates are slightly high than normal (12 to 18 per minute) and her blood pressure is
high as well. She is having moderately high body temperature with 38o C. her pupils are
equal and are reacting to light, however she is unconscious and not responding to painful
stimuli. She is diabetic and her blood glucose level is excessively high, which can hinder the
healing process of her wounds. Dressing of her lacerations and grazes has been done.
However, her wound on the right leg is still inflamed and oozing purulent discharge. Her
catheters are draining properly that indicates proper functioning of her kidneys.
Analysis:
From this above nursing assessment, three nursing care needs has been chosen to address the
client problem. These are –
 Unconsciousness
 Right leg deep wound
 High blood glucose level
Unconsciousness:
The patient has been unconscious from last 48 hours and it is a matter of concern. There are
several levels of unconsciousness such as stupor, delirium, automatism, semi coma and coma
and so on that can affect the health of the patient adversely. The interventions that need to be
applied here are maintaining patent airway by elevating the head by 30 degree to prevent
aspiration (Lindner et al., 2013). Protection of such client is very important as they can fall
from the bed. Hence, padded side rails should be present in her bed and the nurse need to talk
to the patient in between the procedures to notice any sign of consciousness. Evaluation of
the intervention should be done hourly by recording the pulse and breathing rates (Nolan et
al., 2015).

5CRITICAL ANALYSIS OF A CASE STUDY
Right leg deep wound:
Her right leg is still inflamed and purulent discharge has been observed. Nursing
interventions for this problem management of its surrounding skin should be done to prevent
further deterioration. Nurses should be aware of the dressing procedures for such unconscious
patient and should focus on pain, dressing and healing aspects of the treatment. Her increased
blood glucose level is a hindrance in the healing procedure (Tzeng et al., 2012). Therefore,
first interventions to treat the elevated blood glucose level should be enforced to overcome
the wound oozing problems and inflammation. However, proper dressing of the wound
should be time at suitable time intervals. Evaluation of healing process of the wound can be
done on daily basis (Ignatavicius& Workman, 2015).
Elevated blood glucose level:
Hyperglycemia or elevated blood glucose level can affect the patient adversely as her wounds
can take longer time to heal. One of the prime reasons for her elevated result can be stress. As
she is working in a multinational company and has a poor food habit, her blood glucose level
is always high. Excess glucose in the blood causes increased thirst, hunger and polyuria
(Inzucchi et al., 2012). Furthermore, another rationale can be head injury that leads the brain
to use more glucose than normal and leading to hyperglycemic condition. Nursing
intervention for such patient should include, proper care of her diet, as she is unable to eat
food directly. She should also be provided with basal level of insulin to balance the glucose
level. Evaluation of these interventions can be done by testing the blood samples after
ingestion of insulin (American Diabetes Association, 2015).
Definition of Gestational Diabetes Mellitus:

6CRITICAL ANALYSIS OF A CASE STUDY
Gestational Diabetes Mellitus (GDM) can be described as a condition a woman
without diabetes develops. It includes glucose intolerance with high amount of blood sugar.
The occurrence of gestational diabetes includes the risk of developing pre-eclampsia,
depression and the probability of having a caesarean section (American Diabetes Association,
2014). The babies also have the risk of having low blood sugar, jaundice. These babies born
to the mothers with gestational diabetes, has the risk of being large. If the condition is left
untreated, the babies born to the mothers with gestational diabetes can be stillborn.
Incidence of GDM:
A study revealed that 8-10% of women in Australia are affected by GDM during their
pregnancies. Most of the women who suffer from gestational diabetes have previously
unrecognized diabetes mellitus. There are many risk factors, which causes GDM. These
include a family history of diabetes mellitus, polycystic ovary, previous incidence of
macrosomia and obesity (Koivusalo et al, 2016). GDM increases the risk of the mother to
acquire diabetes mellitus in future. The HAPO study (Hyperglycemia and Adverse Pregnancy
Outcome) investigated the fetal and maternal effect of gastrointestinal hyperglycemia and
found a strong relation between GDM and birth weight. In means thjat maternal obesity
increases the risk of worse fetal outcomes.
Pathology of GDM:
The women with DM and GDM should maintain a standard 75gm OGTT during the
pregnancy period.
ADIPS and IADPSG criteria for the diagnosis of GDM:
Fasting: (≥5.1 mmol/L)

7CRITICAL ANALYSIS OF A CASE STUDY
1 hour pre gestation: (≥10.0 mmol/L)
2 hour Pre Gestation: (≥8.5 mmol/L)
The doctors make the diagnosis of GDM based on these criteria. There is confusion about the
pathology of GDM in Australia. Some pathology providers are using these criteria, which are
the modified version of the previous criteria, and some of the general practitioners are using
the old criteria (Ozougwu et al, 2013). About the management of GDM, a study of Australian
Carbohydrate Intolerance in Pregnant Women found a result, which states that, the severe
outcomes like death, bone fracture, shoulder dystocia and nerve palsy is reduced in women
who receives treatment for GDM, than those with the untreated women. The blood glucose
targets of fasting and after the commencement of meal of 1 and 2 hours should be –
 fasting capillary BG: ≤5.0 mmol/L
 1 hour after commencing meal BG: ≤7.4 mmol/L
 2 hours after commencing meal BG: ≤6.7 mmol/L.
Effect of GDM in relation with case study:
Mrs. Waxman had also suffered from GDM during her last pregnancy, which was
resolved after the birth of her baby. Mrs. Waxman works as a computer system analyst at a
firm and manages the branch of the company. She is subjected to obesity as she works for
long hours at the office and her food habits are bad as her consumption of food is mainly junk
food. Because of this food habit and lack of exercise, she has gained 20 kgs in a span of 12
months. The relationship between diabetes mellitus, obesity and gestational diabetes mellitus
has been proved. It is not stated in the case study that if Mrs. Waxman has the family history
of diabetes mellitus or not. However, it can be stated that the occurrence of gestational
diabetes increased the risk of her having diabetes mellitus in later life. With this, risk her food

8CRITICAL ANALYSIS OF A CASE STUDY
habit and lack of exercise also increased the risk of her suffering from DM in later life. After
this accident, it was seen that her BGL is actually 25mmol/L, which is way much higher than
the normal level of BGL which is 4-5m mmol/L.
Long term effects of head injury:
There is some existing evidence, which states that the patients who suffer from major to
moderate head injury may declines cognitively many years after the injury.
Physical:
It is proved that, even a minor head injury can propel the occurrence of concussion
and the normal brain function can be impaired temporarily (Romner, & Grände, 2013). The
difficulties can lead to make the patient suffer from headache, fatigue, dizziness, irritability
and memory problem. Mrs. Waxman has suffered from a major head injury and has spent the
first 48 hours in intensive care unit. Her possibility of developing these symptoms is higher
than normal (Carroll et al, 2014). ‘
Emotional:
The people who suffer from head injury can develop some emotional changes for later
in life. If the injury affects their basic cognitive works such as the ability to speak, they
become more difficult to handle. The people deal with a patient with head injury who is
showing emotional changes must show patience and sensitivity to the patient as the emotional
change might lead to the patient having severe mental illness. Sometimes brain injury can
lead a person to change their natural personality.

9CRITICAL ANALYSIS OF A CASE STUDY
Cognitive:
Brain injury can affect the natural cognitive function of a person. It can change the
whole process of the way of thinking, learning and remembering. Head injury can also give
rise to memory loss in some person (Spitz et al., 2012). Mrs. Waxman is an intelligent person
as she manages the Australian branch of her company. If the brain injury affects her
cognitive function, it might become traumatic for her.
Behavioral:
A brain injury can lead to a change of behavior in a person. If the head injury impairs
the natural cognitive function of the patient, it might bring change in her behavior. The
patient is currently working for a computer farm as a head. If she becomes impaired in some
aspects, it might affect her natural behavior (Hou et al, 2012).
Family Dynamics:
The patient Mrs. Waxman has three children and her husband is a writer who stays at
home and usually watches the children, while Mrs. Waxman works for long hours. After she
is discharged from the hospital, the children would feel happy; as she would spend, more
time at home (Ponsford et al, 2014). However, in a long run, if she is subjected to any
cognitive, physical and behavioral change, it might affect her relationship with her husband
and children.
Conclusion:
The report is about Mrs. Waxman, who is suffering from major head injury and other injuries
like neck injury and edema. The report discussed some major details about her injuries and
the nursing care needs. The patient has also suffered from GDM. The report discusses its

10CRITICAL ANALYSIS OF A CASE STUDY
relation with the current condition of high BGL level of the patient. The report also analyses
the possible outcomes that can result from the head injury of the patient.

11CRITICAL ANALYSIS OF A CASE STUDY
References:
American Diabetes Association. (2014). Diagnosis and classification of diabetes
mellitus. Diabetes care, 37(Supplement 1), S81-S90.
American Diabetes Association. (2015). 2. Classification and diagnosis of diabetes. Diabetes
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Carroll, L. J., Cassidy, J. D., Cancelliere, C., Côté, P., Hincapié, C. A., Kristman, V. L., ... &
Hartvigsen, J. (2014). Systematic review of the prognosis after mild traumatic brain
injury in adults: cognitive, psychiatric, and mortality outcomes: results of the
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Hou, R., Moss-Morris, R., Peveler, R., Mogg, K., Bradley, B. P., & Belli, A. (2012). When a
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Matthews, D. R. (2012). Management of hyperglycaemia in type 2 diabetes: a patient-
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12CRITICAL ANALYSIS OF A CASE STUDY
Koivusalo, S. B., Rönö, K., Klemetti, M. M., Roine, R. P., Lindström, J., Erkkola, M., ... &
Andersson, S. (2016). Gestational diabetes mellitus can be prevented by lifestyle
intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL). Diabetes
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Lindner, T. W., Langørgen, J., Sunde, K., Larsen, A. I., Kvaløy, J. T., Heltne, J. K., ...
&Søreide, E. (2013). Factors predicting the use of therapeutic hypothermia and
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Ozougwu, J. C., Obimba, K. C., Belonwu, C. D., & Unakalamba, C. B. (2013). The
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