Ms Nancy Huang is a 29 year old university student undertaking her honours year in physics. Nancy was diagnosed as a type 1 diabetic three years ago. She normally manages her diabetes reasonably well since making a number of lifestyle changes combined with regular insulin. Nancy has been very stressed, as she has not been able to finish her thesis on time due to having to recently return to China unexpectedly to attend a family funeral. Since returning a few days ago, she has seen her GP, as she was unwell, and was diagnosed with a viral chest infection that was managed conservatively. She subsequently fell further behind in her studies. Nancy decided to pull a few ‘all-nighters’ to get her thesis finished and decided to consume excessive amounts of coffee and soft drinks in order to stay awake to finish her thesis. The next day her husband noticed Nancy was particularly irritable and becoming emotional as she could not concentrate on finishing her thesis. Nancy was insisting on being driven to the university to speak to her lecturer. On the drive in, they had to stop 4 times for Nancy to use the bathroom. She became even more irritable and her husband decided to call an ambulance once they arrived at the university, who then transported her to hospital. The time is now 1400 and Nancy has just been admitted into the emergency bay. You are the first RN to assess her. She is awaiting medical review.
Review:

See available patient information via MyLO. Little documentation available at this point as newly admitted.

Gather new information (patient assessment):
Upon undertaking a further assessment of Ms Huang you obtain the following new information:

Log book
Her husband provides you with a logbook that was provided to Nancy by her endocrinologist. It shows that Nancy has been diligently recording her BGL levels and insulin regime for some months. You note there are no entries for the last few days.

Vital signs
BP: 90/50
HR: 120 beats per minute
Sp02: 94%
RR: 20, coarse air entry, moist productive cough.
Temp: 37.9 degrees.

Other information
Patient irritable and agitated. Speaking in a confused mixture of English and Mandarin. Husband in attendance.
GCS 13 (confused)
BGL 24
Poor skin turgor.
Frequent urination
Urinalysis positive for glycosuria, specific gravity 1.030. No ketones present.
Soft abdomen, no rebound tenderness. Bowel sounds present.
Recall:
Recall and apply your existing knowledge to the above situation to ensure you have a broad understanding of what is/may be occurring before proceeding with the rest of the cycle (self-directed)
Interpret:
List the data that you consider to be normal/abnormal below (not included in word count)
Normal Abnormal

Relate& Infer:
• Relate the two most significant abnormal findings to the underlying physiology/pathophysiology to justify why it is considered abnormal in this context.
• Based on your interpretation of all the information/cues presented, form an overall opinion on what may be happening and justify your answer (400 words).

Predict:
What may happen to your patient if you take NO action and why? (100 words)

List in order of priority at least three key nursing problems (not included in word count)

From the above (identify problems), use the top 2 nursing problems identified and for each of these establish one goal and thenlist related actions you would undertake, including detailing any relevant nursing considerations (350 words)
Problem 1 Goal Related actions Rationale

Problem 2 Goal Related actions Rationale

Briefly describe how you would evaluate the effectiveness of the care provided (i.e. what do you want to happen?) and reflect on how this encounter has informed your nursing practice if you were to encounter a similar situation in the future (150 words).


 

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