Health of Adults: A Case Study on Hypoglycemia and Interprofessional Care Model

This case study analyzes the medical conditions of a patient suffering from hypoglycemia and bone fractures. It discusses the pathophysiology, nursing care, and interprofessional care model for optimum care. It also highlights nursing standards and national safety and quality health service standards.

Running head: HEALTH OF ADULTS
HEALTH OF ADULTS
Name of the Student:
Name of the University:
Author Note:

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Introduction
The present case study represents the conditions of the patient Mrs. Marla Anthony who
has been admitted to the emergency department of the hospital after going through an accident.
She had a number of fractures and multi-trauma for which she underwent several operations.
While recovering from her surgeries, she had an attack and was suspected with risks of
hypoglycemia. This paper highlights the medical conditions suffered by the patient, using the
pathophysiological and pharmaceutical approach in order to analyze the given condition.
Additionally the paper elaborates an interprofessioal healthcare model that can be implemented
in order to provide the patients with optimum care, and meet all their health needs. Lastly the
paper illustrates the national safety and quality health service standards aim to provide protection
to the public from suffering and help to elevate the quality of health services.
Discussion
Analysis of the assessment data
The case study represents the health conditions of a patient named Mrs Marla Anthony,
of 35 years, who has undergone an accident while her car hit the tree while she was in the
passenger seat. The accident caused multi-trauma, for which she is now admitted at the HHHS
ward 1. Initially she was admitted to the emergency department after the multi-trauma. She
suffered fractures in both of her legs. Due to being trapped in a car for a period of 15 minutes,
she had inhaled mild smoke, although did not show any signs of burns. The social history of the
patient was collected which revealed that the patient works at a local supermarket on a full time

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basis. She is estranged from her former previous partner. He is an active smoker although does
not drink alcohol. For recreational uses she has taken IV methamphetamines and cocaine,
however showed no signs of drug use prior to admission in the hospital. Her food habits were
vegan. There was type 2 diabetes mellitus reported in her past medical history. After admission
to the hospital, she had several surgeries which made her take trips of the operation theatre. Day
one she was taken for left distal closed transverse tibia and left distal comminuted fibula
fractures (ankle). Day two for gamma nail insertion on the left for femur fracture of the left neck.
On the present day she had been scheduled for washing of her wound of right thigh laceration in
addition to reduction and fixation (ORIF) of her ankle internally.
According to the nursing notes, the following observations were revealed. The patient
was having a restless night. She had not taken any food, as a preparation for the operation theater
in the morning. She showed no signs of pain overnight. She had required a pre-op checklist along
with the pre-op medications and obs as was charted. The next notes revealed that after
completion of her daily, she weighed 80kgs. The notes again stated that Marla had not slept well
the previous night and was worried regarding surgery in the morning. Her FBS and
neurovascular vitals were continued to be charted. The later notes showed that while she was
called by the theatre nurses, she could not respond verbally. She looked sweaty and scared. Her
vitals were soon noted as is presented in the appendix in the observation chart. The doctor, Dr.
Leon and his team was called upon, who suspected risks of hypoglycemia.
Pathophysiology
The abnormal results of the patient evidently showed risks of hypoglycemia. The
pathophysiological condition that occurs due to reduction in the concentration of plasma glucose
level that might shows symptoms of altered mental status and other stimulations of the

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sympathetic nervous system (Seaquist et al. 2013). This leads to sweating, anxiety, palpitation
and other signs which were shown by the patient. This condition is often triggered by the
presence of previous history of blood sugar which was possessed by the patient. Often
hypoglycemia is triggered by fasting and starvation. Often use of recreational drugs can cause
the disorder (Rosenstock et al. 2014). The patient has been starving throughout the night for
getting ready for the theatre in the morning that might have led to the onset of signs of the
disorder. Her vitals also showed blood sugar level below 50 mg/dL, which is one of the
persistent signs of hypoglycemia onset. The doctor had called for a dose of glucagon, which is a
glucose-elevating agent that is used to treat cases of hypoglycemia (Sherr et al. 2013).
Nursing Care and management
Nursing management and care for patients are required in case of sever hypoglycemia.
The aim of the nurse providing care to such patients should be adoption of interventions in order
to bring down the blood glucose level. This should be immediately done before any
neuroglycopenic effects. For providing appropriate care to Mrs. Anthony blood glucose level
will be checked after every five minutes interval. Rapid-active treatment at an interval of every
5-10 minutes will be given to the patient, until there is increase of the blood glucose above
4mmol/l. There is a requirement to monitor the patientsHbA1c-glycosylated hemoglobin for
Mrs. Anthony. This is a measure of blood glucose over the previous 2 to 3 months. A level of
6.5% to 7% is desirable. There should be assessment for anxiety, tremors, and slurring of speech.
Treatment of hypoglycemia will be done with 50% dextrose. These are signs of hypoglycemia
and D50 is treatment for it. Assessment of feet for temperature, pulses, color, and sensation
should also be done by the nurses. Physical activity helps lower blood glucose levels. Therefore
the patient will be involved in regular exercise, which is a core part of diabetes management and

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reduces risk for cardiovascular complications. The nurses will take care to make the patient
consume some starchy carbohydrate (Clayton, Woo and Yale 2013). The oxygen requirements
are important therefore a patent airway should be maintained. Therefore vitals like the heart rate
of the patient along with cardiac rhythm and blood pressure will be monitored. The nurses need
to administer a saline bolus to the patient if she suffers from hypotension. In case the patient
decreases consciousness level, a large bore intravenous line will be established. A nasogastric
tube will be established to provide the patient with glucose rich liquids. Glucagon can be given
as SC, IM or IV (Haidar et al. 2013). Here the study mentions that the patient has been
administered with IM glucagon in the dose of 1 mg. this drug is used to treat low blood sugar or
hypoglycemia. It makes the body release glucose into the bloodstream in order to bring back the
level of blood sugar. 1 mg is the standard dose of glucagon that is administered in case of
hypoglycemia. The nursing care plan in response to hypoglycemia should also include care for
risk for unstable blood glucose, risk for infection, risk for disturbed sensory reception, deficiency
of knowledge, powerlessness, risk for in jury, risk for ineffective therapeutic regimen
management, nutrition imbalance that is less than the body requirements, risk for deficiency of
fluid volume and risk for impaired skin integrity (American Diabetes Association, 2016). The
patient, Mrs. Anthony is suffering with type 2 DM and who is using insulin as part of the
treatment plan is generally at increased risk for hypoglycemia. Signs and symptoms of
hypoglycemia may keep changing among the patient but tend to be consistent in her case
(Vincent et al. 2016). The manifestations seen in the patient are the result of both adrenergic
activity that is increased and decreased glucose delivery to the brain. Therefore, the patient is
also experiencing symptoms like tachycardia, diaphoresis, dizziness, headache, fatigue, and
visual changes. Hypertension is commonly associated with diabetes. Control of BP

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prevents artery disease, stroke, retinopathy, and nephropathy (Munshi et al. 2016). It is required
to instruct the patient to avoid heating pads and always to wear shoes while walking as the
patients have decreased sensation in the extremities due to peripheral neuropathy (Bahrmann et
al. 2015).
Interprofessional care model
Interprofessional practice is gaining importance in the healthcare field in the recent years.
One of the nurse-led, practices of interprofessional collaboration model had been developed in
order to provide primary care to the population who are medically indigent. This has led to the
enhancement of the understanding of the experienced clinicians belonging to various disciplines
(Weinstock et al. 2015). Mrs. Anthony is provided with a team-based model that includes
clinicians form the background of nursing, nutrition, medicine, optometry, mental health, social
work and various other fields. This model helped to appreciate and form a better understanding
of the other members of the team that helped to enhance the communication rates between the
clinician and other health professionals who belonged to the various disciplines (Giorda et al.
2015). This interporfessional care model made the professionals more intended to working as a
multidisciplinary team within a collaborative and interporfesssional practice model of care.
For providing effective care to Mrs. Anthony who is suffering with complex diabetic
conditions, along with bone fractures, such health conditions require care from professional who
are trained and qualified, to meet their health requirements. Therefore interventions are
implemented for her care by a multidisciplinary team can help in faster healing, health
maintenance and less discomfort for the patients. A nurse practitioner is also involved who is
able to provide comprehensive care to the patient as she suffering from hypoglycemia through a
multidisciplinary approach, where various healthcare professionals meet the needs of the patients

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(Lee, C.J., Clark, J.M., Schweitzer, M., Magnuson, T., Steele, K., Koerner, O. and Brown, T.T.,
2015). Here the patient has been suffering from bone fractures in addition to hypoglycemia,
therefore the nurse practitioner must make sure that collaboration is present between the
physicians of the orthopedic department along with that of the diabetic care department. In order
to meet the needs of the growing population suffering from diabetes, there is a need for the
strengthening of the infrastructure of the clinical practice while facilitating the task delegations.
This involves broadening of the caregiver spectrum according to the new model of care. Through
this protection to the patients can be provided has they are able to access all types of the
healthcare professionals. This will provide optimum care to the patients. This model involves the
cost savings by allowing the different providers who are able to offer more cost-effective models
in order to achieve good outcomes.
The team consists of orthopedic surgeons, the diabetic specialist, the orthodist, the
podiatry and diabetic nurse specialist along with other nurses. The preliminary aim is to
optimally control the diabetic control, along with local effective wound care, pressure injuries
and the fractures (Ahrén 2013). The multidisciplinary role involves gaining of diabetic control
through diabetic CNS in order to mage the insulin levels along with the dietary changes. The
vascular status of the patient needs to be initially assessed and tested regularly. The orthotics
help with the options of loading off because of the fractures present. The orthopedics reviewed
the structural changes of the present in order to ensure that the patient required no more theaters.
The registered nurses and the CNS provided the wound care. Along with this the podiatry
provided offloading at the wound site (Marvin, Inzucchi and Besterman, 2013).

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Nursing Standards (2016) and national safety and quality standards
The national safety and quality health service standards aim to provide protection to the
public from harm and helps to increase the health services. According to this, there are 10
standards (Safetyandquality.gov.au 2018). Here in relation to the given case study, some of these
standards can be directly linked to the care of the patient Mrs. Marla Anthony. Standard 6 about
the clinical handover, describes “the systems and strategies for effective clinical communication
whenever accountability and responsibility for a patient’s care is transferred”. This can be related
to the study, as there has been a clinical handover while the patient was transferred from the
emergency department (ED) to the HHHS ward 1. Standard 9 states “Recognizing and
Responding to Clinical Deterioration in Acute Health Care”. According to this “the systems and
processes to be implemented by health service organizations to respond effectively to patients
when their clinical condition deteriorates”. Lastly the standard 4 which is “Medication Safety”,
states that “the systems and strategies to ensure clinicians safely prescribe, dispense and
administer appropriate medicines to informed patients”. In terms of clinical handover, it is the
duty of the clinical leaders and the senior managers involved in a healthcare organization to
implement the systems of documentation to ensure an effective clinical handover that is
structured (Cryer 2014). A timely handover needs to be ensured. In terms of recognition and
response if clinical deterioration in the acute health care, it is the sty of the healthcare
organizations to establish and maintain system that is enable the recognition and the response to
deterioration. The clinicians along with the various members included workforce use the system
of recognitions and response (International Hypoglycaemia Study Group 2015). There is a need
for the health care organizations to implement the system of medication standards in order to

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reduce the occurrence of incidents of medication, along with improvement of the quality of
medical use.
Conclusion
From the above discussion, it can be concluded that conditions like critical diabetes along
with multi-trauma, requires an inter-professional care model approach. The multidisciplinary
care team makes elevates the quality of the care that is provided to the patients and reduces
distress in them. The inter-professional care tea enables the patients to easily access all the
medical professionals from various backgrounds and disciplines. From this study the standards
provided by the national safety and quality health service can also be analyzed in the light of the
health needs of the patient presented in the study. This highlights the importance of clinical
handover along with the need of recognition and response to quality health care. Along with this
the standards of medical safety is also presented which ensures the reduction of incidents of
medicinal administration.

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Appendices
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56 ml/hr

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