Bachelor of Nursing Diabetes Management

This report discusses the management of type 1 diabetes in a pediatric patient, focusing on the role of nursing in medication administration, patient assessment, and emotional support. It highlights the physiological impacts of diabetes, the importance of proper insulin administration, and the need for continuous monitoring and education for both patients and their families. The report emphasizes the critical role of nurses in ensuring patient safety and effective diabetes management.

Bachelor of nursing
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Q1.
High blood glucose level: Autoimmune destruction of the β cells of the pancreas is prominently
responsible for the occurrence of type 1 diabetes. β cells perform function of synthesis of insulin
which is helpful in the metabolism of carbohydrates. Insulin is responsible for the reduction in
the blood glucose level. Insulin performs this function in different ways. In first way, insulin
facilitates transport of glucose from the blood to the muscle cells. In the second way, insulin
stimulates glycogenesis. Glycogenesis is the process in which there is conversion of glucose to
glycogen. Insulin also plays role in the glycogenolysis and gluconeogenesis. In glycogenolysis,
there is inhibition of liberation of stored glucose form the liver. In gluconeogenesis, there is
production of glucose form breaking down of protein and fat. Briana is having type 1 diabetes
and her blood glucose level raised above 200 mg/dL due to insulin deficiency. Raised levels of
glucose generally occur due to deficiency of insulin which leads to increases in glucose
production and decrease in uptake of circulating glucose (Pugliese, 2016).
Glucose in the urine: In type 1 diabetes patient like Briana, kidney would not be able to reabsorb
surplus glucose and it would lead to presence of glucose in urine (Creutzfeldt and Lefebvre,
2012).
Increased urination : Filtration and reabsorption is responsible for amount of urine output. In
filtration process, there is transport of glucose, amino acids and other small molecules form
plasma into the Bowman’s capsule. In reabsorption process, there is check on loss of these
substances from the body. During reabsorption process, epithelial transport system is used by
cell lining the kidney tubules to send back these substances to the extracellular fluid. There
would be more filtration of glucose form plasma to the Bowman’s capsule as compared to the
reabsorption. This results in the more urine output in patients with type diabetes which is called
as polyurea. Due to this increase in the urine, there would be more glucose level in patient with
type 1 diabetes (Duck and Hageman, 2015; Atkinson, 2012).
Increased thirst : In cases of increase in the glucose level above 200 mg/dl, kidney would not be
able to reuptake water. There may be increase in the osmotic pressure, due to inability of the
kidney to pull glucose from the water. As a result of increase in the osmotic pressure, there may
be hindrance for the absorption of water back into the bloodstream. It may lead to water
deficiency and increased thirst in patients with type 1 diabetes (Campbell-Thompson, 2016).
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Increased appetite: In patients with type 1 diabetes, glucose would not be able to enter into the
cells from the blood due to insulin deficiency and insulin resistance. Due to deficiency of glucose
in the cells, body cannot utilize glucose as energy source. Due to loss of energy source, patients
with type 1 diabetes may feel more appetite. Increase in the consumption of food in response to
the appetite may not be helpful in getting rid of appetite sensation. On the other hand, this
increase in the food consumption may lead to the augmented blood glucose level. This raised
blood glucose level increase appetite feeling (Reinehr, 2013).
Ketones in the urine and blood : There would be increase in the early morning levels of ketone
bodies in patients with type 1 diabetes which results in the ketoacidosis. Ketone bodies mainly
formed due to deficiency of energy because body burns its own fat. Ketone is the remaining acid
after the burning of the fat. Liver has role in the formation of ketones from the fatty acids. After
releasing ketone bodies in the blood, it is used as source of energy. Patients with type 1 diabetes
generally does not respond to the consumed food. Hence, there may be more ketone bodies
formation in patients with type 1 diabetes (Simmons and Michels, 2015).
Weight loss : Ketone production mainly occurs due to breakdown of protein and fat and it would
lead to weight loss. This would result in the body mass wasting in children with type 1 diabetes.
Q2.
Validate the medication order: Prior to administration, nurse should validate the insulin by
checking brand name, storage condition and expiry date.
Have comprehensive knowledge of the medication : Nurse should have comprehensive
knowledge of the medication in terms of storage condition, dose, route of administration,
evaluation of the effectiveness of medication and adverse effects of medication.
Prepare the medication safely: Nurse should take safety precaution during preparation of dose
like cleaning of hands and rubber stopper of FlexPen with alcohol. Nurse should record body
weight of Briana on regular basis because nurse need to adjust dose of insulin according to body
weight.
Assess the patient: Nurse should asses the Briana for allergic reactions because Aspart has the
potential to cause systemic allergic reactions. Allergy to insulin also should be assessed in
Briana. As Aspart has potential to develop hyperthyroidism, Briana should be assessed for
thyroid function. Hypokalemia may develop with the use of Aspart, hence Briana should be
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assessed for potassium levels. Nurse should enquire from Briana’s parents about diarrhea and
vomiting in her because in these conditions requirement of dose of insulin may be less.
Administer the medication safely : Nurse should not inject insulin in areas with redness, swelling
and itching. Nurse should make arrangement of food containing sugar like orange juice, candy,
glucose gel and honey. These foods should be administered, if hypoglycemia observed in Briana.
Nurse should take precaution that there is no concomitant administration of other hypoglycemic
agents in Briana along with Aspart. There is possibility of air entrapment in the cartridge of
FlexPen, hence nurse should take precaution that there is no air injection in Briana. Nurse should
keep needle beneath the skin for a minimum of six seconds. In the event of appearance of blood
at the injection site, nurse should press tightly and should not rub on it (Levich, 2011; Marelli et
al., 2015).
Document nursing care : In medication chart, nurse should mention all the information like name
of patient, date of admission, brand name of insulin, dose of insulin, route of administration,
indication, schedule for insulin administration, next timing for administration and frequency of
administration.
Ensure patient safety : Nurse should discard needle used for the administration of insulin because
it may spread infection form one patient to the another (Lavin et al., 2015).
Monitor the patient :There should be monitoring of blood glucose level every six hours in Brian
to assess effectiveness of insulin. There should be more frequent assessment of blood glucose
level in Briana, if ketoacidosis occurs in Briana. Nurse should perform kidney and liver function
tests in Briana. Fever and hyperthyroidism should be monitored in Briana after administration of
Aspart. Hypoglycemia may occur at 15 minutes and peak between 45 to 90 minutes, Hence,
nurse should monitor hypoglycemia in Briana at these time points. Nurse should stop
administration of Aspart in Briana, if hypoglycemia or hypokalemia occurs in her. Symptoms of
hypoglycemia include anxiety, agitation, tingling in hands, feet, lips, or tongue, chills, cold
sweats, confused state, pale skin, loss of concentration, lethargy, difficulty in sleeping, extreme
appetite, headache, nausea, uneasiness, tachycardia, shiver, faintness, and shaky gait. HbA1C
levels should be monitored in Briana every 3 to 6 months to assess effectiveness on insulin (Beth
et al., 2016).
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Q3.
Emotional : Acceptance of Briana’s diabetic condition would not be easy for her parents. They
may feel guilty and angry on themselves and it may replicate on Briana. In such event, her
parents should make her understand that these emotions are not due her, however these are
situational. Due to her diabetic condition, there may be negative impact on the eating habits and
lifestyle of the whole family. In the age of Briana, children generally compare themselves with
their peers. Her age is growing age and due to affected food habit, there may be negative impact
on her physical growth and development. As a result, there may be development of inferiority
complex and social isolation in Briana.
Physical : There should be consumption of nutritious food for proper growth and development in
Briana. It is evident that Briana is having inclination towards playing and dancing, however due
to diabetic condition she could not fulfill this. It may have negative impact on her physical
development (Skyler, 2012).
Q4.
Parent’s should play prominent role in offering medical treatment to children because children
might not have enough knowledge and understanding about the significance of treatment.
Adherence to the mediation consumption in case of children is completely dependent on parents.
Tom, Briana’s father is not in position and state to understand medical terminologies and to pass
on it to Briana. Hence, he should be kept away from her medications and treatment because there
may be possibility of wrong communication. Robyn should take responsibility of Briana’s
treatment and nurse should provide her proper training. This training should comprise of
handling Flexpen for insulin administration and glucose strips for glucose monitoring. Nurse
should convince Robyn that it is not safe to give responsibility of Brian’s treatment to Tom and
Briana is not eligible to take care of herself. Nurse should make sure that Robyn to discontinue
her job to give full attention for Briana’s care (Barnard and Lloyd, 2012).
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References:
Atkinson, M. A. (2012). The Pathogenesis and Natural History of Type 1 Diabetes. Cold Spring
Harbor Perspectives in Medicine, 2(11): a007641. doi: 10.1101/cshperspect.a007641.
Barnard, K. D., and Lloyd, C. E. (2012). Psychology and Diabetes Care: A Practical Guide.
Springer Science & Business Media.
Beth, M. M., Sun, N. M., Zhiyuan, M.S., Bena, J. F. et al. (2016). Does an Insulin Double-
Checking Procedure Improve Patient Safety?. Journal of Nursing Administration, 46(3),
154–160.
Campbell-Thompson., M., Fu, A., Kaddis, J.S. et al. (2016). Insulitis and beta-cell mass in the
natural history of type 1 diabetes. Diabetes, 65, 719–731.
Creutzfeldt, W., and Lefebvre, P. J. (2012). Diabetes Mellitus: Pathophysiology and Therapy.
Springer Science & Business Media.
Duck, S. C., and Hageman, J. R. (2015). Pediatric Diabetic Ketoacidosis: Risk Factors and
Pathophysiology, Management Strategies and Outcomes. Nova Science Publishers
Lavin, M., Harper, E., and Barr, N. (2015). Health Information Technology, Patient Safety, and
Professional Nursing Care Documentation in Acute Care Settings. OJIN: The Online
Journal of Issues in Nursing, 20(2). DOI: 10.3912/OJIN.Vol20No02PPT04.
Levich, B. R. (2011). Diabetes management: optimizing roles for nurses in insulin initiation.
Journal of Multidisciplinary Healthcare, 4, 15–24.
Marelli, G., Avanzini, F., Iacuitti, G., Planca, E., Frigerio, I., Busi, G., et al. (2015).
Effectiveness of a nurse-managed protocol to prevent hypoglycemia in hospitalized
patients with diabetes. Journal of Diabetes Research, DOI: 10.1155/2015/173956.
Pugliese, A. (2016). Insulitis in the pathogenesis of type 1 diabetes. Pediatric Diabetes, 17(S22),
31–36.
Reinehr, T. (2013). Type 2 diabetes mellitus in children and adolescents. World Journal of
Diabetes, 4(6), 270–281.
Simmons, K. M., and Michels, A. W. (2015). Type 1 diabetes: A predictable disease. World
Journal of Diabetes, 6(3), 380–390.
Skyler, J. (2012). Atlas of Diabetes. Springer Science & Business Media.
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