NURSING 1 Assignment: Comprehensive Analysis of Type 1 Diabetes

This nursing assignment addresses a case study of a patient diagnosed with Type 1 Diabetes. The solution explores the underlying causes of the disease, focusing on the deficiency of insulin and its impact on glucose metabolism. It details the patient's symptoms, including high blood glucose levels, glucosuria, polyuria, polydipsia, and polyphagia, as well as weight loss and high blood ketone levels. The assignment then delves into the nursing implications of insulin administration, covering pre-, during-, and post-administration responsibilities, emphasizing patient assessment, medication safety, and patient education. Furthermore, the assignment examines the emotional and physical impact of Type 1 Diabetes on the patient and their family, highlighting anxiety, potential physical complications, and the need for holistic care. Finally, the solution emphasizes the importance of a holistic nursing model, advocating for patient-centered care, health literacy, cultural sensitivity, and the provision of support to both the patient and their family to effectively manage the illness and improve the patient's quality of life.

Running Head: Nursing
Nursing
Name of the Student
Name of the University
Author Note

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Answer to Question 1
Deficiency of insulin leads to type 1 diabetes. It is a chronic illness caused by the
autoimmune destruction of pancreatic beta cells producing insulin. This hormone is responsible
for regulating glucose metabolism and for getting energy from food. Insulin helps the glucose to
move in to the body tissues, where the cells can use it as fuel (Atkinson et al., 2014). Thus, the
absence of insulin, increases glucose production in the blood stream, cells starvation and poor
regulation of cellular functions. This was the underlying factor for high blood glucose level in
the patient (Chiang et al., 2014). Her blood glucose level was found to be 25.0 mmol/L. The
exact causative factor of type I diabetes is not known however, various reasons have been
suggested by the geneticists, microbiologists, and researchers in other domain.
According to Atkinson et al. (2014) development of antibodies against protein in the cow
milk is known to form antibodies against the pancreatic beta cells. The gene for type I diabetes
seems to run in families. The genetic basis of the disease is evident from the case study, which
highlights the family history of celiac disease. Robyn, mother of Briana suffered this
autoimmune disease. The other causative factors suggested for the disease are viral infection
(coxsackie and rubella viruses), where virus particles are activated against the beta cells. In
addition certain drugs and chemicals such as pyrinuron cause type I diabetes. The development
of type I diabetes, is also attributed to the lack of vitamin D in the first year of a child’s life.
The urine glucose in patient is indicative of renal glycosuria where the Kidney cells
release glucose in urine. Due to diabetes, glucosuria occurs in the body characterised by the
impaired resorption of the filtered glucose by the Kidney and release into the blood stream. Since
the blood sugar is abnormally high, excess amount of glucose ends up in urine. Therefore, due to

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high pressure on the Kidney cells glucose is not sent back into the blood stream, and is released
in the urine (Atkinson et al., 2014).
Polyuria is common in type I diabetes and is caused by osmotic diuresis. Increase in the
glucose level (hyperglycemia) causes it to pass in urine. Since water passively follows the
glucose concentration, it results in high urine output or increased urination in Briana that
caused bed wet for the past 2 nights (Chiang et al., 2014). During polyurea a patient passes large
volume of urine, more than the normal limit of urine output per day. With increased urination, in
type 1 diabetes, a patient feels excessive thirst and dehydration. This condition is called
polydipsia. With the accumulation of glucose, the body can no longer reabsorb it from the water
in the Kidney resulting in high osmotic pressure. This was the reason Briana was drinking lots of
water. Increased blood glucose pulls more fluid form the tissues. In this condition, even a toilet-
trained child may experience bed wetting (Pilek & Starkman, 2014).
Excessive hunger in type I diabetes patients, results due to hyperglycemia. As the body
cells do not receive glucose due to insulin deficiency, the body cannot convert the food eaten
into metabolic energy. The lack of energy in children’s organs and cells increases appetite due
to which Briana was eating more food and water (Skrivarhaug et al., 2014). However, with the
increased urination, dehydration, the patient experiences weight loss. The muscles do not
receive glucose due to insulin deficiency and the calories are lost from the sugar that is not used
as energy. Hence, it resulted in weight loss of 5 Kgs in Briana. Inspite of eating more due to
increased hunger, a rapid weight loss is observed in type 1 diabetes children (Atkinson et al.,
2014).

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The diagnostic tests of Briana revealed high level of blood ketone. Since, insulin cannot
fuel the body cells, liver fat metabolism increases to gain energy, which releases ketone bodies in
the blood stream as by-product. This process continues until the body receives sufficient insulin
and may lead to the dangerous condition called diabetic ketoacidosis (Peters et al., 2016).
However, Briana’s blood test confirmed no ketoacidosis and her blood ketone level was found to
be 1.5mmol/L.
Answer to Question 2
Prior to administration- The nursing implications prior to administration are-
Assessment of the patient and monitoring of fasting blood glucose and HbA1C. Prior to
the administration the nurse must assess the patient for the symptoms of hypoglycaemia (anxiety,
restlessness, cold sweats, nausea, nervousness) and hyperglycaemia (drowsiness, confusion,) to
prevent serious implications and adjust the dosage. These assessment will help to make deal with
hypoglycaemia. Prior to administration the nurse must be competent in drawing the correct dose
of insulin and use of the pen device, have knowledge of injection sites and know the patient
centred care. These precautions are required to prevent medication error and quick recovery from
treatment (Eiland et al., 2014). Prior to administration the nurse must explain the patient’s
family about the advantage of insulin therapy and disadvantages to enhance cooperatively and
eliminate anxiety which is obvious in families of ill patients (Pilek & Starkman, 2014).
During the administration- the nurse responsibility during the administration of insulin
ASPART is to ensure that it is given before 5-10 minutes before meal. Given before meal insulin
injection provides better glucose control. The insulin must be given immediately after mixing
properly with the NPH insulin to prevent contamination. The later is the long acting insulin and

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is used with the regular as Insulin aspart has short duration. The administration should be
subcutaneous (abdominal wall, thigh, or upper arm) and the injection site must be rotated. Use
of the insulin used should be the one refrigerated at 2°–8° C or stored at room temperature,
15°–30° C for up to 28 days, to prevent denaturation and contamination. The flex pen can be
however stored at room temperature as per the package instructions. Insulin should not be drawn
from prefilled pen and carefully check the expiry date to prevent accidents (Vallerand et al.,
2016).
Further, the nurse may assess for change the body weight as the change in weight may
indicate an adjustment in dosage of insulin. In order to determine effectiveness, the nurse must
monitor the glucose every 6 hours (Eiland et al., 2014).
After the administration- Nurse must withhold the drug to notify the patient if found to
be hypokalemic. Monitoring the patient is necessary as after the administration of insulin initial
hypoglycaemic response begins within 15 minutes and peaks 45–90 minutes. The symptoms of
hypoglycaemia in any is mainly due to toxicity and overdose (Malik & Taplin, 2014).
After the administration, the nurse must inform the patient and the child about the
adverse effects such as allergic reactions in the body, and other endocrine effects such as
hypoglycaemia or skin rashes. Patient education about warning signs will help in getting
immediate relief during emergency. Further, the family and the child must be educated about
keeping the area of injection, redness, swelling or itching free from the contact of sharp objects.
Nurse must inform them to seek immediate medical assistance if the symptoms of
hypoglycaemia develops (Higgs & Fernandez, 2015). Nurse must immediately notify the
physician in case of development of fever, diarrhea, infection, nausea, and vomiting. Sometimes

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cerebral edema is caused after insulin therapy requiring the adjustment of dosage (Vallerand et
al., 2016).
Answer to Question 3
The emotional impact- Briana’s father is highly anxious and overwhelmed with his
daughter’s condition. The other cause of nervousness and tension is the mild intellectual
disability he had. Since he cannot understand the medical terminology, he is unable to gain clear
insight on his daughter’s medical condition. Further cause of emotional concern in Briana may
be the loss of weight and energy which seems to hamper her school classes, sports, and dance
class. Briana has been referred to diabetes service for ongoing care. It means it will add financial
burden on the family. It may lead to anxiety and depression eventually (McDarbyc & Acerinie,
2014).
The physical impact- Briana has lost 5 Kg and must put on weight to gain back her
energy. She must suffer the pain on different injection sites. If untreated the long term effect
includes impairment of kidney, eyes, blood vessels, and other organs, Allergic reactions, skin
rashes, hypoglycaemia may be the other physical impact (Skrivarhaug et al., 2014).
Answer to Question 4
The nurse must use holistic model of health and illness. The nurse must consider the
biological, psychological and social factors as all of them play significant role in human
functioning (Bell, 2014). The nurse must provide patient centred care and identify the actual and
potential problems of Tom. The nurse must give health literacy to him and explain him the
meaning of different medical jargons. She can provide him with video, medical journals,

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pamphlets and magazines so that he can better understand the illness and related consequences.
She must be patient when he questions too much and use simple language, low tone of voice and
pitch. Further, the nurse must be culturally sensitive. The nurse should respect the patient’s
respect and dignity (Holland, 2017). It will help the family and Tom to cope up with the
implications of the illness and gain confidence in dealing with medications and treatment.

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References
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The
Lancet, 383(9911), 69-82.
Bell, L. (2014). Patient-centered care. American Journal of Critical Care, 23(4), 325-325.
Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L. (2014). Type 1 diabetes through the
life span: a position statement of the American Diabetes Association. Diabetes
care, 37(7), 2034-2054.
Eiland, L., Goldner, W., Drincic, A., & Desouza, C. (2014). Inpatient hypoglycemia: a challenge
that must be addressed. Current diabetes reports, 14(1), 445.
Higgs, M., & Fernandez, R. (2015). The effect of insulin therapy algorithms on blood glucose
levels in patients following cardiac surgery: a systematic review. JBI database of
systematic reviews and implementation reports, 13(5), 205-243.
Holland, K. (2017). Cultural awareness in nursing and health care: an introductory text. CRC
Press.
Malik, F. S., & Taplin, C. E. (2014). Insulin therapy in children and adolescents with type 1
diabetes. Pediatric Drugs, 16(2), 141-150.
McDarbyc, J. M., & Acerinie, C. L. (2014). Psychological care of children and adolescents with
type 1 diabetes. Pediatric diabetes, 15(20), 232-244.

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Peters, A. L., Henry, R. R., Thakkar, P., Tong, C., & Alba, M. (2016). Diabetic ketoacidosis with
canagliflozin, a sodium–glucose cotransporter 2 inhibitor, in patients with type 1
diabetes. Diabetes Care, 39(4), 532-538.
Pilek, N. L., & Starkman, H. S. (2014). Functional and Psychosocial Ramifications of Type 1
Diabetes Mellitus in Pediatric. Functional Symptoms in Pediatric Disease: A Clinical
Guide, 133.
Skrivarhaug, T., Stene, L. C., Drivvoll, A. K., Strøm, H., Joner, G., & Norwegian Childhood
Diabetes Study Group. (2014). Incidence of type 1 diabetes in Norway among children
aged 0–14 years between 1989 and 2012: has the incidence stopped rising? Results from
the Norwegian Childhood Diabetes Registry. Diabetologia, 57(1), 57-62.
Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2016). Davis's Canadian Drug Guide for
Nurses. FA Davis.