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Understanding Quality Nursing Practice: Case Study of Sarah Assessment Answer

2.4.2 Case Study

Weight: Type of Collaboration

Aim of assessment The purpose of this assessment is to enable students to demonstrate. — An understanding of safe. appropriate and responsive quality nursing practice when administering pharmaco-logical interventions to people with type 1 diabetes — An understanding of the relationship between pharmacological interventions and the cause, pathophyology and clinical manifestations of type 1 diabetes — An understanding of the impact of type 1 diabetes on the individual, — An evaluation of relevant literature to support an understanding of the pharmacological and nursing management of a person with type 1 diabetes and express this in a clear and succinct writing style.

 Details: Case study

You sees Registered Nurse caring for Sarah Burns who is 5 years of age. Medical history Sarah's parents visited their local doctor after noticing that Sarah had increased appetite and excessive thirst She has been unusually tired lately, often falling asleep at school. She has lost 5 kilograms of weight over a two week period (22kg down to 17kg) and has been frequently urinating at night often wetting the bed The doctor suspected type 1 diabetes and tested her urine, which was positive for glucose and ketones, A random capillary blood glucose level was 25.0mmol/L and blood ketone level was 1.5rnmol/L. Sarah's parents were advised to attend the hospital emergency department immediately.

Social history

Sarah lives with her mother (Kathy - works full time as an accountant), father (Jake - works full time as an electrician) and 10 year old brother (Ben). She is in kindergarten at school and attends after school care three days a week. Sarah goes to swimming lessons on Saturday mornings and dance classes on Wednesday afternoons.

Emergency department review 

Two hours after review by the local doctor, Sarah's capillary blood glucose level (BGL) was 26 OmmoIlL and blood ketone level was 1.6mmol/L. Other vital signs were within normal limits. After review by the paediatric diabetes specialist doctor (end(crinologist), Sarah was given a provisional diagnosis of type 1 diabetes based on her symptoms and family history of autoimmune disease (Her mother has coeliac disease). Sarah's blood test confirmed that she did not have ketoacidosis.

Treatment plan 

Sarah was prescribed subcutaneous insulin; Aspart (NovoRapid) Flexpen 3 units TDS (three times per day) and Glargine (Lantus) Solostar 8 units nocte (at night). She was referred to the diabetes service for ongoing care.

Assessment instructions 

Using the marking criteria and supporting academic references address the following questions.
Question 1. (10 marks) Explain why Sarah has been prescribed insulin. Relate to the pathophysiology of type 1 diabetes and the mechanism of action of insulin. Support your answer with academic references 

Question 2. (5 marks) a) What is the onset. peak and duration of action for NovoRapid insulin according to Bullock. S.. & Manias. E. (2017). Fundamentals of pharmacology (8th ed, )? b) When should NovoRapid be administered in relation to food and why
Question 3. (10 marks) a) Define hypoglycaemia 5 b) What causes hypoglycaemia? c) What are the symptoms of hypoglycaemia? d) How is hypoglycaemia treated? Support your answer with academic references.
Question 4. (5 marks) a) What is the most appropriate insulin pen needle length for Sarah, b) Why is this length appropriate? Support your answer with academic references
Question 5. (10 marks) Why does Sarah ,use a blood glucose level (BGL) test prior to an insulin injection? Support your answer with academic references.
Question 6. (5 marks) a) What is an appropriate site on Sarah's body to inject the NovoRapid insulin? b) What injection angle is appropriate for Sarah? c) Why are these appropriate for Sarah? Support your answer with academic references.
Question 7. (5 marks) a) When would Sarah's BGL need to be tested after administration of NovoRapid? b) Why would a BGL be required at that time? Support your answer with academic references.
Question 8. (10 snake) Discuss the daily physical challenges of living with type 1 diabetes that Sarah may face. Support your enswer with academic references.
Question 9. (10 marks) Discuss potential emotional impacts of living with type 1 diabetes that Sarah may face. Support your answer with academic references.
Language Use (5 marks) 
Sentences are well constructed, expression and meaning is clear, basic written language rules are followed

Referencing and in-text citations (5 marks) The APA referencing style is used correctly for both in-text citations and reference list



Question 1:

Sarah needs to take insulin because her body cannot generate insulin due to her illness caused by type 1 diabetes. Insulin is mainly required in the right amount to keep the blood sugar in the appropriate range. According to Farrar et al. (2016), insulin is one of the hormones that is generated in the pancreas to help the body in using the glucose from the carbohydrates for generating energy. Therefore, insulin helps make the blood sugar level too low or too high. If the body became unable to produce enough quantity of insulin, then it can cause hyperglycaemia, which resulted in long-term complications on the human body. For reducing the impact, patients like Sarah need to take insulin through injection. This is because insulin lowers the BGL by binding the receptor of insulin for increasing glucose uptake.

Question 2:

a) The onset action of the NovoRapid is 10 to 20 minutes after the injection. The peak effect of NovoRapid is between 1 to 3 hours. On the other hand, the duration of the impact of NovoRapid is between 3 to 5 hours.

b) NovoRapid needs to be administered after a meal. This is because, if it can be administered before a meal, then it can cause hypoglycaemia among patients who can even cause death on a patient (Bullock & Manias, 2017). Therefore, insulin such as NovoRapid should not be given before breakfasts or any meal.

Question 3:

a) Hypoglycaemia is the condition of the body that is caused by the lower level of glucose (blood sugar).

b) Hypoglycaemia can be formed among people with or without diabetes. Without diabetes, hypoglycaemia is frequent among people. In that case, the possible causes are critical illnesses, excessive consumption of the alcohol, overproduction of insulin, deficiencies in hormones and medications (Adamkin, 2019). When people have diabetes, then they take insulin for treatment. Accepting too much insulin reduces the blood sugar level, which causes hypoglycaemia. 

c) Hypoglycaemia has different symptoms and causes that are shakiness, anxiety, fatigue, irregular rhythm of heart, irritability, sweating, tingling sensation in mouth and hunger (Cryer & Arbeláez, 2017). If hypoglycaemia has become worsen, then the symptoms, include seizures, confusions, or visual disturbances.

d) Early signs of hypoglycaemia can be treated with the help of the consumption of fast-acting carbohydrates. Continuous nutrition therapy is necessary in that case.

Question 4:

a) Needles of insulin pen come in different sizes of the syringe. The sizes of syringe come in 12mm to 4mm size (Bergenstal et al. 2015). The thickness of the skin of kids is very less. Therefore, it would be better in using shorter 6mm syringe size.

b) Injecting insulin to a child is one of the biggest challenges for the parents. Thisisbecause; most of the children become frightened while taking insulin. Therefore, for injecting insulin to a child, it would be better to use the syringes that are small in size and less thick (Bergenstal et al. 2015). Moreover, the skin of children is thin. Therefore, it would be better in using 6mm syringe for children.

Question 5:

Before injecting insulin, it is highly essential in testing the blood glucose level. This is because, for the patient with type 1 diabetes, ketone as well as blood glucose level continually changes. Before taking food and after taking food, blood glucose level differs (Iyer, Jeyalatha & Sumbaly, 2015).  Therefore, for identifying the appropriate quantityof insulin as per the present blood glucose level, it is highly essential to test the BGL before injecting insulin to the patients.

Question 6:

a) the most appropriate place on the body of Sarah to inject the NovoRapid insulin is the lower abdomen.

b) It would be better to inject the injection in the 45-degree angle.

c) The injection needs to inject in the angle because it is the appropriate angel for kids. The injection needs to inject in the lower abdomen because it is the most common place to inject insulin (Iyer, Jeyalatha&Sumbaly, 2015).

Question 7:

a) After injecting the NovoRapid, the doctors or parents of Sarah need to check her BGL after 1 hour.

b) It is necessary to check the BGL after 1 hour. Though NovoRapid has a rapid-acting impact which generally starts working after 10 to 20 minutes sometimes, it takes 1 to 3 hours after taking the NovoRapid. For this reason, 1 hour time would be appropriate for Sarah in taking the insulin. The effect of NovoRapid lasts up to 3 to 5 hours (Iyer, Jeyalatha & Sumbaly, 2015). 

Question 8:

In type 1 diabetes, children like Sarah face a lot of problem in their daily life. In type 1 diabetes, she needs to pee a lot. This is because, for flushing out extra glucose, kidney have to work more, which creates more urine.  As a type 1 diabetes patient Sarah might feel tired very often, which could create difficulties for her in performing her regular tasks such as study, playing and other works. The main reason behind it is body cannot use the glucose to generate energy for the body (Alicic, Rooney & Tuttle, 2017). For the disease, Sarah might lose her weight. In type 1 diabetes, the body breaks the muscle, which reduces weight. As a type1 diabetes patient, Sarah needs to drink a lot of water that can create difficulties for Sarah during the time of schooling. Type 1 diabetes patient loses so much fluid so that they become thirst too often. Due to this reason, they have to drink a lot of water.

Type 1 diabetes causes some long-term complications that mainly include stroke, heart diseases, kidney damages, and impairment in vision (Alicic, Rooney & Tuttle, 2017). Type 1 diabetes also causes some issues in other parts of the body such as nerves, blood vessels as well as gums.

Question 9:

A child like Sarah, who has type 1 diabetes, requires maintaining a unique diet chart. This fact creates difficulties for her in attending different social events such as birthday parties of friends or summer camps. This fact makes them feel deprived, which creates a depression among them. In some school, children with diabetes are teased and bullied that creates a harmful impact on their mind. Therefore, in those schools, children like Sarah might face a higher level of mental stress (Sturt et al. 2015). Type 1 diabetes causes a feeling of isolation among children, which creates emotional problems such as an extreme level of frustration to lead a different life. At last, it can be said that the presence of type 1 diabetes in a kid's life can develop the chances of distress as well as stress. 

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