Pharmacology in Health & Illness (University of North Carolina at Charlotte) NURS 3205 Pharmacology in Health and Illness Diabetes Case Study. With All the Answers...

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Pharmacology in Health & Illness (University of North Carolina at Charlotte) NURS 3205 Pharmacology in Health and Illness Diabetes Case Study Case Scenario The nurse in a diabetes mellitus (DM) ... treatment center located in a large teaching hospital meets the first patient of the day. K.W. is a 25-year-old female, who was just discharged from the hospital 2 days ago after being diagnosed with type I DM. Prior to admission, K.W. had a 1-month history of frequent urination, thirst, severe fatigue, blurred vision, and some burning and tingling in her feet. She attributed those symptoms to working long hours at the computer. On admission to the hospital, her labs were as follows: • Fasting glucose 335 mg/dL • HbA1C 8.8% • Cholesterol 310 mg/dL • Triglycerides 300 mg/dL • HDL 25 mg/dL • LDL 160 mg/dL • Creatinine 0.9 mg/d • Body mass index 37.6 • Her BP was 160/96 mm Hg. Create a chart comparing and contrasting type 1 and type 2 DM. Include pathophysiology, diagnostic tests, signs/symptoms, and major complications. Continuation of Case Study K.W. was admitted to the hospital for control of her glucose levels and initiation of insulin therapy with carbohydrate (CHO) counting. After discharge, K.W. was referred to the clinic for comprehensive education. K.W. was started on sliding scale lispro insulin four times daily and glargine insulin 30 units at bedtime. What is the most significant difference between these two types of insulin? What is the peak time and duration for lispro insulin? Based on this information, what should the nurse teach K.W.? K.W. states that she knows people who take NPH and regular insulin and wants to know why she can't take them. Explain the advantages of using glargine and lispro insulin. What specific points are important for the nurse to include in a teaching plan for K.W. regarding managing insulin therapy? (Select all that apply.) a. Two injections will be needed to administer lispro insulin and glargine insulin. The current vial of lispro insulin can be kept at room temperature for 1 month. b. Ideally, the glargine insulin should be administered at bedtime. c. The insulin can still be used if it is yellowed but not expired. d. Unused insulin needs to be kept in the freezer. e. Administer the lispro insulin within 15 minutes of eating. Discuss the rationales for each answer option as to why you selected it or did not select it. A. You want to rotate injection sites otherwise it can create a pit or lump in the skin from where the insulin is being injected repeatedly (Williams, 2004). B. The action of insulins can be changed when mixed in the same vial. Instead of a long- acting glargine insulin you may end up with some short-acting/long-acting mix and it will not regulate insulin levels properly (Williams, 2004). C. Most insulin is stored in the refrigerator until used because bacteria can begin to grow otherwise. It is acceptable to keep it at room temperature for a month because of the preservatives in the insulin that keep bacteria from growing. Eventually the preservatives will stop working which is why it’s important to store in the fridge until use and not keep it out for more than a month (Williams, 2004). Continuation of Case Study K.W. states that her diet is mostly fast foods, and the foods cooked at home are high in starch and fat. She also states that because of her work schedule, mealtimes often vary from day to day. What is carbohydrate (CHO) counting, and why would this method work well for K.W.? K.W. states that she currently does not exercise at all. What benefits will K.W. receive from participating in an exercise program? What is it important for the nurse to teach K.W. regarding exercise precautions for clients with DM? What are the best evaluative parameters the nurse can use to determine whether teaching with K.W. was effective? Reference list: Comerford, K.C. ed. (2017). Nursing 2017 drug handbook. Philadelphia. Baltimore. New York. London. Buenos Aires. Hong Kong. Sydney. Tokyo: Wolters Kluwer. Franz, M. J., & Warshaw, H. (2014) Carbohydrate counting & diabetes what is carbohydrate counting? National Institute of Diabetes and Digestive Kidney Diseases (NIDDK) Lilley, L. L., Collins, S. R. & Snyder, J. S. (2017). Pharmacology and the nursing process (8th ed.). St Louis, MO: Elsevier ISBN: 978-0-323-35828-6 Mayo Clinic. (2014, Aug 02). Type 1 Diabetes. Retrieved from http://www.mayoclinic.org/diseases-conditions/type-1-diabetes/basics/tests- diagnosis/con-20019573 Mayo Clinic. (2016, Jan 13). Type 2 Diabetes. Retrieved from http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis- treatment/treatment/txc-20169988 Neithercott, T. (2010, April). A User's Guide to Insulin: Diabetes Forecast. Retrieved from http://www.diabetesforecast.org/2010/apr/a-user-s-guide-to-insulin.html Noble, S.L., Johnston, E., & Walton, B. (1998) Insulin lispro: a fast-acting insulin analog. Journal of American Family Physician, 57(2):279-286. Williams, A. S. (2004). Insulin Basics: The Reasons Behind the Recommendations. Retrieved from https://nfb.org/images/nfb/publications/vod/vodsum0401.htm [Show More]

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