Assignment
Case scenario
Rita is a 62-year-old woman who comes to the clinic for a routine physical examination.
She works as a banking executive and does little exercise. She says she is "just tired."
She has gained 8.2 kgs over the past year and eats a high-fat diet.
At the clinic her blood pressure is 162/98mmHg, her heart rate is 92 beats/min, and her respiration rate is 20 breaths /min. She complains of some weakness in her right foot that began about a month ago. She says it also feels a little numb.
A sensory examination reveals diminished sensations of light touch, proprioception, and vibration in both feet. She also complains of increased thirst and frequent nighttime urination. She denies any other weakness, numbness, or changes in vision.
A physical examination reveals an erythematous scaling rash in both inguinal areas and in axillae. She states the rash has been there on and off for several years and is worse in the warm weather.
Rita's diagnostic testing results come back from the lab. The doctor confirms a diagnosis of Type 2 diabetes mellitus.
Random glucose test: 14 mmol/l (253 mg/dL)
Hb A1c: 75mmol/mol or 9.1%
Urine: positive for glucose and negative for protein
Wet preparation of smear from rash: consistent with Candida albicans
ECG: evidence of early ventricular hypertrophy
Based on the type 2 diabetes mellitus diagnosis, Rita's doctor ordered metformin (Glucophage) 500 mg PO bd.
Task
I. What is metformin and its mechanism of action?
II. What should be included in the health teaching for Rita about her prescribed medication (metformin)?
III. What information should you include in Rita's health teaching about hyperglycaemia associated with type 2 diabetes and why?
IV. What are the long-term diabetes mellitus-related complications that Rita needs to be made aware of (at least 5)
Despite intense patient teaching, Rita presents to the Accident and Emergency (A & E) with the hyperglycaemic hyperosmolar syndrome (HHS). She has been ill with the flu and has not taken her metformin as prescribed.
V. Explain Rita's presentation with hyperglycaemic hyperosmolar syndrome (HHS).
VI. What is the medical management for Rita's presentation of hyperglycaemic hyperosmolar syndrome?
VII. What distinguishes hyperosmolar hyperglycemic syndrome (HHS) from Hyperglycaemic hyperosmolar non-ketotic (HONK)?
Rita's admitting blood glucose level is 46mmol/l. She is admitted to the ICU for IV hydration and insulin therapy.
VIII. What will be your priority nursing assessments and interventions for Rita?
IX. Rita is administered IV insulin therapy. Which clinical manifestations of hypoglycaemia will need to be monitored and assessed?
X. What is the risk of untreated hypoglycaemia?
XI. What are some of the causes associated with hypoglycaemia? (at least 4)
XII. Describe how hypoglycaemia be reversed or treated in an acute care setting?
XIII. Describe how hypoglycaemia be reversed or treated in a community setting?