Bachelor of Nursing Case Study Analysis

This essay presents a comprehensive analysis of nursing care for Rohan, a nine-year-old with type 1 diabetes. It discusses the essential needs for managing his condition, including physical exercise, dietary adherence, and emotional support from family and healthcare providers. The essay outlines nursing care priorities, strategies for building trust with the patient, and a detailed care plan aimed at stabilizing blood glucose levels. The importance of family involvement and effective communication in the management of diabetes in children is emphasized, along with the need for continuous monitoring and support.

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BACHELOR OF NURSING
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Within this essay is an in-depth analysis of the case of Rohan, a nine-year-old child,
suffering from type 1 diabetes mellitus as illustrated in scenario one of the tasks. For Rohan to
keep a healthy and sound living as a type 1 diabetes patient, he has categorical needs that must
be met. These needs are among them cultural, social, and physical and psychological
expectations. Due to his tender age, he requires special attention when meeting these needs so as
to realize the intended sound and healthy life motive.
Diabetes is a disease whose cure has not been established yet and thus only requires
proper management and treatment. To grow healthier, Rohan needs to get plenty of physical
exercises. The exercise is important in managing his condition (Boyd 2012, p. 167). Through
physical exercise, his muscles and bones are strengthened hence reducing the risk of heart attack
and other cancer types. Exercise would also help him gain better endurance, coordination,
strength, and balance as well as increasing the levels of energy. Still, physical exercise is
important in assisting the activities of insulin and blood sugar levels (Bulechek 2013, p. 268).
Through exercise, Rohan will learn to manage any forms of stress and tension he could
be undergoing hence improving on his moods and encouraging relaxation. In the social, cultural
and psychological aspects, Rohan requires support from both the family members and his
teachers at school. The support should be in the form of companionship as well as such services
as food. The support helps in dealing with any complex situations that may arise (Hanas 2010, p.
369). Such support is important in the elimination of feelings of social isolation of the child by
the family members.

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Nursing care priorities for Rohan
Based on his health condition and the situation back at his home, the following would be
the priorities of nursing care;
Checking the blood sugar level: Rohan’s blood sugar level should be checked at least
three times a day to ascertain that stability is maintained. The times of check would be as guided
by the healthcare provider. Just before meals, the blood sugar level should range between 90 and
130 mg/dL while it should between 90 and 150 mg/dL when he is retiring to bed. Checks should
also be done for the presence of ketone in his urine or blood (Hyde 2011, p. 547). For the case of
Rohan, he has low blood sugar levels and in case the sugar levels go below 70 mg/dL then a
corrective measure should be adopted. The measures would include eating foods that are rich in
calories for example fruits and dairy products.
Following the meal plan of the child: Rohan had a diabetes diet plan from the clinician
which is rarely observed since his family is vegetarian. In the nursing care priorities in would be
fundamental in adhering to the meal plan as provided by the healthcare provider. The meal plan
is useful in keeping the blood sugar level of the child steady and therefore the nursing care would
ensure the child does not skip any meals. Taking insulin without eating may lead to the blood
sugar levels dropping too low. In following the meal plan as provided by the doctor it is
important to keep track of the dietary intake of starch and sugar foods, give him high-fiber foods
and low-sodium and low-fat foods. These foods keep in check the insulin levels (Boyd 2012, p.
201).

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Exercise: through exercise, his blood sugar level stabilizes hence it would be important to
encourage Rohan to exercise for at least one hour for the better part of the week. The physical
activities would strengthen his bones and muscles. Before and after the exercise his blood sugar
levels should be checked. This would help in determining the health progress and any significant
impacts of the exercise on his health. Physical exercise to a greater extent improves the health
and well-being of the patient both physically and mentally as it relieves tension and stress (Burns
2012, p. 455).
Strategies for developing a trusting relationship with Rohan
At his tender age, Rohan needs to be convinced that what the doctors and the nurses are
offering him are the best solutions to his problems. He may be having challenges understanding
his situation and thus it becomes quite difficult to convince him that his disease is not curable.
He is a school going boy and that translates aspirations of various achievements in his future life.
In order to develop a trusting relationship when engaging Rohan, these strategies can be
deployed:
Family involvement: Making the nursing care services more of family-centered has the
potential to develop a trusting relationship (Fitzpatrick 2011, p. 654). Rohan, just like any other
child, is more familiar with his family members and believes that whatever they do to him cannot
be with the intention of harming him. He would, therefore, be quick to adjust to the management
and care plans when offered from the family members. The family is central in offering social
support that is greatly required to manage type 1 diabetes mellitus in children. Through
informational, emotional and physical support that the family would offer, Rohan would find
value in him once again despite his medical condition (Colgrove 2014, p. 584).

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The family unit and interactions play a role in determining the long term outcomes
including functional, physiological and psychosocial outcomes. This is because the
communication and interaction patterns in the family are able to promote somatization in
children. The parents and the other family members are as well supposed to be trained so as to be
able to offer technical know-how support such as recording the blood sugar levels (Funnell 2015,
p. 198). In this light, the family members will be able to have control of the medical condition of
their son. All these family injections would build trust and confidence in Rohan regarding the
quality of medical care he is receiving.
Communication: Communication helps in building a connection between the nurse and
the patient. Investing small time to build the rapport with the patient influences the level of
compliance and thus leading to positive care management (Guthrie 2014, p. 378). In most cases,
patients who do feel connected with their nurses never trust the services they are yet to receive.
And therefore may not follow their instructions. Through communication, Rohan would feel that
he is understood and that the services he is receiving are to the best of his interest. To improve
the impact of the communication it would be important to include the family members as well
thereby founding a relationship which is based on respect and trust.
Through communication, the nurse would be able to get more information about the
patient including his hobbies, or any other interests thereby putting him at less anxiety and easing
his visit to the nurse. Rohan would treat the nurse as a friend and a helper who understand his life
from this collaborative approach. When dispensing the care or treatment plans, the patient should
be carefully listened to and his comments responded to accordingly in a way that ensures he is
convinced and the confidence levels maintained high (Brook 2011, p. 530).

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Care Plan
The nursing care plan for would be the risk for unstable levels of blood glucose. Unstable
variations in the blood sugar levels may greatly compromise the quality of health of the patient.
Among the risk factors for this care include;
 Failure to observe the diabetes management plan
 Stress
 Inadequate monitoring of blood glucose level
 Limited knowledge of management of type 1 diabetes mellitus
 Rejection of diagnosis
The risk may be evidenced by the blood glucose levels being lower than the normal levels as the
case of Rohan.
The care plan aims at:
 Maintaining the blood sugar levels at normal levels
 Identification the factors that may cause the low and unstable levels of blood glucose
 Make verbal a comprehension of energy needs and balancing the body
 Verbalizing plans in the modification of the risk factors which would, in turn, prevent
shifts in the levels of glucose
The nursing intervention would be to evaluate the risks factors to unstable levels of glucose
as well as assist the patient in coming up with mechanisms for preventing unstable blood sugar
levels (Hyde 2011, p. 666). In evaluating the risks that contribute to unstable blood sugar levels,
factors that may lead to the unstable levels in the patient would be determined. These factors

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may include such risk factors as any history of poor control of glucose, family history of
diabetes, poor eating habits and lack of exercise/ poor exercise habits.
The cultural and religious influence of Rohan on his diet would as well be important in
determining the risk factors. How much responsible the patient is to his own health care will
assist in the development of the healthcare plan. The plan would take into account his dietary
practices in line with his religious and cultural practices (Hanas 2010, p. 690).
In assisting the patient with preventive strategies against unstable blood glucose levels,
finding out whether the patient can use the glucose monitoring device is important. The
monitoring device is used in determining the levels of glucose and when properly used it helps in
detecting when the levels of glucose become unstable (Kuiper 2016, p. 715). The patient would
also be educated on the need to balance physical exercise and intake of food which help in
inhibiting sudden rise or fall in blood sugar levels. A review of the intake of carbohydrates helps
in stabilizing the blood sugar levels. The effectiveness of the nursing care plan is dependent on
the outcome regarding the health of the patient. The plan would thus be effective if the desired
outcomes are realized and the patient life improves.

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References
Boyd, MA 2012, Psychiatric Nursing: Contemporary Practice, 4th edn, Lippincott Williams &
Wilkins, New York.
Brook, CGD 2011, Brook's Clinical Pediatric Endocrinology, 6th edn, John Wiley & Sons,
London.
Brown, JE 2013, Nutrition Through the Life Cycle, 5th edn, Cengage Learning, Chicago.
Bulechek, GM 2013, Nursing Interventions Classification (NIC)6: Nursing Interventions
Classification (NIC), 3rd edn, Elsevier Health Sciences, New York.
Burns, CE 2012, Pediatric Primary Care - E-Book, 5th edn, Elsevier Health Sciences,
Cambridge.
Colgrove, KC 2014, Prioritization, Delegation, & Management of Care for the NCLEX-RN®
Exam, 9th edn, F.A. Davis, New Delhi.
Fitzpatrick, JJ 2011, Encyclopedia of Nursing Research, Third Edition, 2nd edn, Springer
Publishing Company, Salt Lake.
Funnell, R 2015, Tabbner's Nursing Care: Theory and Practice, 7th edn, Elsevier Australia,
Manchester.
Hanas, R 2010, Type 1 Diabetes in Children, Adolescents, and Young Adults: How to Become an
Expert on Your Own Diabetes, 5th edn, Class Publishing Ltd, New York.
Hyde, V 2011, Community Nursing and Health Care: Insights and Innovations, 3rd edn, CRC
Press, Oxford.

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Kuiper, R 2016, Clinical Reasoning and Care Coordination in Advanced Practice Nursing, 4th
edn, Springer Publishing Company, Manchester.
MD, DRG 2014, Management of Diabetes Mellitus: A Guide to the Pattern Approach, Sixth
Edition, 6th edn, Springer Publishing Company, London.