Case Study: Exploring Briana's Type 1 Diabetes and Nursing Care

This case study examines the case of Briana, a child diagnosed with Type 1 Diabetes. The assignment begins by outlining the symptoms Briana presented, including high blood glucose, glucose in urine, increased urination, thirst, appetite, ketones in urine, and weight loss, linking them to the underlying autoimmune mechanisms of the disease and the role of insulin. It then delves into the nursing responsibilities associated with managing Type 1 Diabetes, including pre-administration checks, the administration process itself, and post-administration monitoring, with a focus on insulin therapy and patient assessment. The case study also highlights the importance of emotional and physical support for both the child and the parents, providing guidance on maintaining a healthy lifestyle and managing the condition. Finally, it addresses the importance of clear communication with patients and their families, especially when intellectual disabilities are present. The assignment concludes with a list of relevant references.

CASE STUDY

Contents
QUESTION 1..................................................................................................................................1
1. High blood glucose level.........................................................................................................1
2. Glucose in the urine.................................................................................................................1
3. Increased urination...................................................................................................................2
4. Increased thirst.........................................................................................................................2
5. Increased appetite....................................................................................................................2
6. Ketones in urine.......................................................................................................................2
7. Weight loss..............................................................................................................................3
Question 2........................................................................................................................................3
1. Prior towards administration....................................................................................................3
2. During administration..............................................................................................................4
3. After administration.................................................................................................................4
Question 3........................................................................................................................................4
1. Emotional.................................................................................................................................4
2. Physical....................................................................................................................................4
Question 4........................................................................................................................................4
REFERENCES................................................................................................................................6

QUESTION 1
1. High blood glucose level
Autoimmune disease are developed when immune system that are helpful to defends
body from healthy cells. When they decide that the healthy cells are foreign and this results for
the immune system to attack healthy cells (Dabelea, Mayer-Davis and Liese, 2014). This type of
disease can affect one or many types of body tissue. This depends upon the type and it has the
potential to cause abnormal organ growth and also changes the functions of organ. There are
about 80 types of autoimmune diseases. As per the given case of Briana, she is facing this type of
disease as there are changes seen in the functions of her organs. Further, some of the common
triggers includes systemic lupus erythematosus, psoriasis, Graves’ disease, scleroderma, etc.
Possible disease trigger to Briana may be scleroderma as there are symptom of Type 1 diabetes.
Pancreas develop insulin in order to maintain the level of glucose in blood. When the rate of
insulin gets reduced, then it causes Type 1 diabetes (Hovorka, Allen and De Palma, 2010).
Insulin is helpful enough to move sugar from bloodstream to cells so that body gets enough
energy. Due to Autoimmune disease, insulin gets attacked and this produces beta cells that are
only found in pancreas. Hyperglycemia is formed when beta cells get damaged. Further, when
beta cells are destroyed, then body becomes no longer to develop insulin and this causes health
related complication similar to one which Briana is facing.
2. Glucose in the urine
Diabetes chances are there if urine has presence of high glucose-levels than 0.8 mmol/L.
Presence of glucoseGlucose presence's in urine is also known as Glycosuria. The extremely high
glucose-levels are among the responsible entitiescauses for its occurrence (Parikka, Näntö-
Salonen and Simell, 2012). AgainAgain, this tends to an outcome of type-1 diabetes. To filter the
blood there are ample of nephrons. Blood usually starts to flow towards glomerulus from the
arteriole as peraccording to it. Bowman's capsule surrounds every glomerulus that collects the
filter solution having wastage material mixed in it. Moving further, this gets passed through the
renal tubules which are there within kidney. As per the case, it was identified that from the urine
test that was conducted Type 1 diabetes was found.
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3. Increased urination
The medical term that is used for this issue is polydipsia. The process of osmotic diuresis
is generally caused by type-1 diabetes. As per this, the glucose levels become extremely high as
a result of which major part of it gets excreted within urine. In order to produce urine when
kidney filters blood, absorption of sugar is there when shifting towards the blood-flow
(Bluestone, Herold and Eisenbarth, 2010). The extremely high glucose levels makesmake it
difficult to absorb all the glucose from blood. So, it gets diffused into urine. As a result, the
urine's volume rises. This was the case due to which the last two nights parents of Briana were
finding her bed wet.
4. Increased thirst
Within the bloodstream, the level of glucose gets hyper concentrated. This can be
determined to be the reason due to which failure of pulling over glucose from water through
kidney. It is a type of function that increases the pressure of osmotic (Patterson, Gyürüs and
Bingley, 2012). When these levels becomes high, then consumption of water becomes high.
5. Increased appetite
Polyphagia is the medical term that is used in the case of increased or excessive hunger.
And this is determined to be the 3 main signs of diabetes (Bergenstal, Tamborlane and Willi,
2010). This is also known as hyperphagia and this was the case with Briana that her parents
noticed that she was drinking so much water.
6. Ketones in urine
Ketones in urine are formed due to lack of insulin. There is huge amount of energy that is
developed in the body and it is present in the form of sugar but when there is not insulin present,
then glucose can not get into the cells in order to provide energy (Atkinson, Eisenbarth and
Michels, 2014). Ketones are acid that remains in the body when it burns fat. When the rate of
insulin is low which is generally seen in the patients with Type 1 diabetes like what Briana has,
then ketones are formed in the blood. Further, when the rate of insulin is too low, then it can
cause dangerous condition like ketoacidosis.
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7. Weight loss
Due to lack of insulin in the body this prevents them to get proper glucose for the blood
that can be used as energy. In this type of condition the body burn out muscles and fat in order to
get energy and this causes the reason for reduction in weight.
Question 2
There are different type of nursing responsibilities that has to be considered with the help
of which proper care can be delivered to patients.
1. Prior towards administration
It is important to check the medication order is valid. In this process, it is important that
proper information to be provided to parents and patients as per the type of policy that are being
followed (Murri, Leiva and Queipo-Ortuño, 2013). Further, patient’s safety should also be
determined so that potential risk can be eliminated.
Nurses should be comprehensive knowledge of the medication. In this process, they need
to be able to indicate other about the medication that is to be conducted. Further, it includes the
mode of action that they should be taking. It requires the nurses to have proper information about
the amount of dose that need to be given. Contraindication is the type of situation which nurses
should be aware of in which a particular procedure or drug should not be given that could harm
the patient. There are conditions in which adverse reactions are faced and those should also be
identified by nurses and proper steps should be taken for Briana. In addition to this, storage
should be done and the type of route that should be taken need to be appropriate so that the
health related issue can be solved.
There are five rights of medication administration which are right to patient, drug, dose,
route and time. Further, as a part of treatment for type 1 diabetes, Briana should be given insulin
so that blood sugar level can be maintained. Moreover, it includes injection aids like I-Port and
Insuflon. In addition to this, it includes insulin pens like Autopen, NonoPen PernMate, etc.
Patient should be properly assessed in which the glucose level should be determined and
accordingly dose should be given. As per the case the glucose level that was identified of Briana
was 26.Ommol/L.
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2. During administration
Stomach will be the proper place where insulin can be injected as it will be proper to
make the child relax and to inject it. It should be injected by keeping it in 90 degree.
3. After administration
Information should include the results of all the test that are considered and the
medication that are given to be patient. Adverse effects include pain, headache, swelling, itching,
etc. In order to overcome such issues, proper monitoring should be done for 15 to 20 minutes and
patient should be asked for any type of discomfort (Dabelea, Mayer-Davis and Liese, 2014).
After two hours, the injection is given, the blood pressure of patient should be checked and two
days later again it should be checked.
Question 3
1. Emotional
In such type of situation, it is important for the parents to be strong. A child of 7 years old
develop their attitude or behaviour that are shown by their parents. When parents show support,
then it will have positive impact over the child. In the case, Briana will get the strength with her
parents overcome the pain that they feel for their child. Emotionally parents will face difficulty
but they have to stay strong.
2. Physical
Early morning blood sugar should be checked and Briana should have healthy breakfast.
This this, parents should provide vegetables and fruits which contains fats and protein. Then
medication that are given by the doctor should be taken (Hovorka, Allen and De Palma, 2010).
Then mid-morning snake should be taken by Briana. Then blood again to be checked and them
afternoon healthy lunch should be taken. Further, proper time should be given for exercise that
also about 30 to 60 minutes. Then at dinner healthy food should be consumed and one should
take up to 9 hours of sleep.
Question 4
As a nurse it my responsibility to make sure that proper information is being delivered to
parents. In the case Tom has intellectual disability and in order to overcome this issues, it is
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essential for me to make use of simple language that will be properly understood. Eye contact
will be maintained so that Tom may not get carried away. Further, visual presentation will be
done for diabetes so that Tom will be able to understand more and the issue that are faced by
Briana.
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REFERENCES
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The
Lancet. 383(9911). 69-82.
Bergenstal, R. M., Tamborlane, W. V., & Willi, S. M. (2010). Effectiveness of sensor-
augmented insulin-pump therapy in type 1 diabetes. New England Journal of
Medicine. 363(4). 311-320.
Bluestone, J. A., Herold, K., & Eisenbarth, G. (2010). Genetics, pathogenesis and clinical
interventions in type 1 diabetes. Nature. 464(7293). 1293.
Dabelea, D., Mayer-Davis, E. J., & Liese, A. D. (2014). Prevalence of type 1 and type 2 diabetes
among children and adolescents from 2001 to 2009. Jama. 311(17). 1778-1786.
Hovorka, R., Allen, J. M., & De Palma, A. (2010). Manual closed-loop insulin delivery in
children and adolescents with type 1 diabetes: a phase 2 randomised crossover trial. The
Lancet. 375(9716). 743-751.
Murri, M., Leiva, I., & Queipo-Ortuño, M. I. (2013). Gut microbiota in children with type 1
diabetes differs from that in healthy children: a case-control study. BMC medicine. 11(1).
46.
Parikka, V., Näntö-Salonen, K., & Simell, O. (2012). Early seroconversion and rapidly
increasing autoantibody concentrations predict prepubertal manifestation of type 1
diabetes in children at genetic risk. Diabetologia. 55(7). 1926-1936.
Patterson, C. C., Gyürüs, E., & Bingley, P. J. (2012). Trends in childhood type 1 diabetes
incidence in Europe during 1989–2008: evidence of non-uniformity over time in rates of
increase. Diabetologia. 55(8). 2142-2147.
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