401209 Health Variations - Potential Assessment Answers

Part A 

2. As Ben's blood glucose level and his blood ketone level was high. Therefore, from Diagnostic tests, he was diagnosed with type 1 diabetes in an emergency department. Type 1 diabetes is a result of severe lack of insulin in the body caused by loss of beta cells( LeMone, Burke, Levett- Jones, Dwyer, Moxham, Reid-Searl & Raymond, 2017). Lack or lost of beta cells is related to various factors such as- environmental, immunity of body and susceptibility. Type 1 Diabetes is a slowly progressive disease that destroys beta cells in the pancreas.

In type 1 diabetes, the body produces very little or no insulin because insulin producing cells are destroyed by autoimmune reaction in the body. So, body needs Insulin replacement by insulin injections. Ben has been prescribed novorapid insulin because it facilitates glucose uptake into body cells which lower blood glucose levels. It Inhibits the metabolism rate of fats and protein and also inhibit the gluconeogenesis and stimulates glycogenesis as well (Atkinson, Eisenbarth & Michels, 2014). Insulin stimulates amino acid uptake, promote fat storage and protein synthesis.

3. The onset action of NovoRapid is between 0-15 minutes, the peak effect is 1-3 hours and the duration of this insulin is 3.5-5 hours (Bullock & Manias, 2017). NovoRapid should be administrated immediately before the meal because if the person does not eat shortly after administration of insulin they will experience hypoglycemia (low blood glucose <4.0mmol/L). This may be life-threatening and it could result in unconsciousness if not treated with carbohydrates.

4. It is extremely important to be aware medication or drug that is to give. Before the administration of medication, it is important to know about any known allergies. To ensure a patient's safety and safe nursing practice it is important to know about adverse effects, and route. To avoid any medication error it is extremely important that we have educated and knowledge about drug or type of medication we are giving to them (Ministry of Health NSW, 2013).

6. The five rights of medication administration are right patient, right drug, right dose, right route and right time( NSW Health, 2013). It is very important to reduce any medication error, for safe nursing practice and patient's safety (Craft et al., 2015). In the real world, medication error can be life-threatening so it is a way to follow the safe nursing practice to minimize medication errors.

7. As Ben has lost weight in the past two weeks the appropriate needle length for Ben would be 4-6mm (Australian Diabetes Educators Association, 2015). If a longer length needle is used, it might inject the insulin in the blood vessel rather than in the subcutaneous layer.

8. I would check Ben's blood glucose level and five rights of administration prior to give Novorapid insulin to patient (Craft et al., 2015). Furthermore, I would check the consistency and appearance of insulin, any known allergies, the site of injection, inspect for hypersensitivity and ipoatrophy (LeMone et al, 2017).

9. As Ben has lost further 10 kgs in the past 2 weeks. So, therefore, for his body type, recommended angle for injection is a 90-degree angle to prevent insulin from being injecting in skin layer as needle length is very tiny (Bullock & Manias, 2016). The ideal site for insulin injection would be abdomen because it is safe, insulin is absorbed fast and less painful. To avoid any infections injection site is to be changed every time, a site should be sterile, proper hand hygiene must be exercised and the same needle should not be reused (Australian Diabetes Educators Association, 2015)

10. Patient's BGL results should be documented in National subcutaneous insulin chart along with the time it has been taken in twenty-four hour time (ACQSHC, 2017). A diet that has been eaten by the patient in the diet section. After administering the medication, I will document the dose and time it was given. My initial and the second nurse's initial in top half section (Insulin chart quick start guide, 2017). It is essential to complete any necessary documentation like progress notes, fluid medication chart etc to avoid hyperglycemic or hypoglycemic state and quality nursing practice.

11. As a nurse, I would check Ben's Blood glucose level. Furthermore, I would check any symptoms of hypoglycemia or hyperglycemia (LeMone et al., 2017). Moreover, I will monitor any effect of Ben's diet on his Blood glucose level (Craft et al., 2015)

Part B 

Discuss the potential impact of type 1 diabetes on Ben.

1. Ben may face daily physical changes as a diabetic he may need to visit hospital or doctor after a few days for the checkup. He may find hard to check blood sugar level on a daily basis as he is not used to it. Ben is a teenager, now he needs to be aware of the diet he consumes which can affect his health (National Diabetes Services Scheme, 2016). Ben regularly plays sport but now he has to be careful because blood sugar levels change frequently with physical activities.

2. Diabetic Care requires a lot of attention and precautions related to diet and daily physical activities. Ben may feel helpless or angry about his condition at a young age. He may feel embarrassed to use flex pen in front of others. Ongoing treatment and test may affect his studies as he may unable to concentrate. He may develop a negative perspective and thoughts about his poor health (Diabetes SA, 2018). Over time, checking and testing BGL, restricted diet, unable to play sports, lost interest in studies can cause him stress.

Reference list

Atkinson, M. A., Eisenbarth, G. S., &amp; Michels, A. W. (2014). Type 1 Diabetes. The Lancet, 383(9911), 69 – 82. Retrieved from https://doi.org/10.1016/S0140-6736(13)60591-7.

Australian Commission for Safety and Quality in Health Care. (2017). User Guide to National Subcutaneous Insulin Chart: Acute Facilities. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2018/01/User-guide-to-the-national-subcutaneous-insulin-chart-Acute-facilities-October-2017.pdf

Australian Diabetes Educators Association. (2015). Clinical Guiding Principles for Subcutaneous Injection Technique. Retrieved from https://www.adea.com.au/wp-content/uploads/2015/11/Injection-Technique-Final-digital-version2.pdf

Bullock, S., & Manias, E. (2017). Medicines and the Pancreas. Fundamentals of Pharmacology (7^th Australian ed) (pp. 750-767). Retrieved from https://vuws.westernsydney.edu.au/bbcswebdav/pid-3539100-dt-content-rid-27066823_1/courses/401209_2018_spr/Bullock%2C%20S.%2C%20%26%20Manias%2C%20E.%20Fundamentals%20of%20pharmacology%20Chapter%2061%281%29.pdf

Craft, J., Gordon, C., Tiziani, A., Heuther, S., McCance K., Brashers, V., & Rote, N. (2015). Understanding pathophysiology (2^nd ed.). Chatswood, NSW: Elsevier Australia. P. 253-254 Chapter 11

Diabetes SA. (2018). Diabetes and Emotional Well-Being. Retrieved from https://www.diabetessa.com.au/about-diabetes/diabetes-and-emotional-well-being.html.

Insulin chart quick start guide. (2017). Retrieved from: https://vuws.westernsydney.edu.au/bbcswebdav/pid-3539100-dt-content-rid-27038022_1/courses/401209_2018_spr/Insulin-chart-quick-start-guide-2017-Handout%281%29.pdf

LeMone, P., Burke, K., Levett-Jones, T., Dwyer, T., Moxham, L., Reid-Searl, K., & Raymond, D. (2017). Nursing Care of People with Diabetes Mellitus. In A. Parrish, T (Eds), Medical-Surgical nursing: Critical Thinking for Person-centred care (3^rd Australian ed) (pp. 560-596). Retrieved from https://vuws.westernsydney.edu.au/bbcswebdav/pid-3539100-dt-content-rid-27066825_1/courses/401209_2018_spr/Medical-surgical%20nursing-%20Critical%20thinking%20for%20person-centred%20care%20Chapter%2019%20Diabetes.pdf.

Ministry of Health New South Wales. (2013). Medication Handling in NSW Public Health Facilities. Retrieved from https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_043.pdf

National Diabetes Services Scheme. (2016). Living with Diabetes: For Young People. Retrieved from https://www.diabetesaustralia.com.au/for-young-people

NSW Health. (2013). Medication Handling in NSW Public Health

Facilities.Retrieved from: https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_043.pdf