Online Case Studies Learning Activity #1: Diabetes Management
Assignment Outline
This assignment will give you the opportunity to apply your knowledge related to respiratory illness and related medications. You will be asked to complete preparation work prior to reviewing the case study and complete the ensuing knowledge application questions. To complete this activity, please download this worksheet and complete the fillable spaces. Please submit your completed document to Dropbox by midnight Friday January 27th. You will be evaluated based on your responses on the worksheet. This assignment is worth 5% of your overall theory mark.
Case Study Preparatory Work- Mini Drug Cards (3 marks)
| Metformin (Glucophage) | Classification: Anti-diabetics |
| Indication: treat high blood sugar caused type 2 diabetes | |
| Assessment required: confusion, tachycardia, HPT, nausea, vominting, Hypoglycemia. | |
| Contraindication: chronic heart failure, metabolic acidoci, severe renal disease, septicemia, myocardial infarction | |
| Insulin Aspart
(NovoRapid insulin) |
Classification: fast-acting insulin |
| Indication: Improve blood sugar control in people with diabetes mellitus | |
| Assessment required: redness, swelling and itching, skin thickening or depression, constipation | |
| Contraindication: hypersensitivity, hypoglycemia | |
| Insulin glargine
(Lantus Insulin) |
Classification: long acting insulin |
| Indication: used to treat type 1 diabetes | |
| Assessment required: test blood sugar levels | |
| Contraindication: hypersensitivity to insulin |
Case Information
Lorenzo is a 55-year-old male patient who is seeing his family physician today. The patient’s wife, who is a nurse, believes Lorenzo has type 2 diabetes. At a health care clinic, the physician questions the patient about his symptoms. The patient reports that his wife commented on how much water he was drinking and that he had to urinate frequently. He has had an 8-lb (3.6 kg) weight loss as well. Lorenzo’s wife performed finger stick blood glucose levels on him, and the results were 9 mmol/L and 10 mmol/L on separate days. Today his blood sugar is 9.8 mmol/L. The physician prescribes metformin (Glucophage).
Learning Resources
Please review the following resources to assist you in completing the assignment:
- Sealock, K., Seneviratne, C. (2020). Lilley’s pharmacology for Canadian health care practice (4th edition). Elsevier. Chapter 33.
- Canadian Diabetes Association. (2020). Clinical Practice Guidelines Quick Reference Guide. CPG Quick Reference Guide.
- Insulin Pen Use:
- o Sobhy, T., Wylie, E. [UHN Patient Education]. (2017, November 13). A guide to using your insulin pen. [Video] Streaming service. https://www.youtube.com/watch?v=g8DffwTyn0k
You are encouraged to procure any additional resources that you find useful for completing the worksheet.
Assignment Questions (21 marks)
- Lorenzo asks for information about how metformin works and how long he will need to take it for. As the nurse caring for Lorenzo, what would you include in your response? (2 marks)
Metformin reduces the amount of sugar released by the liver to the blood, and depending on the body response to the medication, it can be a longterm use.
- Given the symptoms that Lorenzo presents with, are there any additional tests that you would anticipate being ordered by the physician? (1 mark)
A weekly weight check record can be requested to monitor weight loss concern that were mentioned, as well as a fluid intake and output chart to monitor overall fluid balance.
The physician orders more bloodwork for Lorenzo- specifically his hemoglobin A1C (HgbA1C). Lorenzo’s HgbA1C comes back 7.3%.
- a) What does the HgbA1C tell us and why is this important? (1 mark)
HgbA1c tells us the average blood sugar lebel and it is important because it can help diagnose diabetes or monitor how well a diabetes tratement plan is going.
- b) Comment on Lorenzo’s HgbA1C result. What is a normal HgbA1C result? (1 marks)
Lorenzo HgbA1c result is higher than normal which could indicate that he has type 2 diabetes. A normal level is below 5.7%.
- c) What should Lorenzo’s target HgbA1C be now that he has been diagnosed with, and is being treated for, diabetes? (1mark)
Lorenzo’s target should be between 7-8%
- One important aspect of diabetes management is patient-focused goal setting. What might be an appropriate goal for Lorenzo to set at this time and why? (1 mark)
An apptopriate goal for Lorenzo at this time could be setting up a diet plan to manage his blood sugar levels
- What additional health teaching is important to provide Lorenzo with at this time? (2 marks)
Keeping track of carbohydrates intake
Eating healthy and exercising
6 months later, Lorenzo returns for a follow up appointment. Lorenzo’s HgbA1C is 7.5% and his fasting blood glucose (FBG) was 10.1 mmol/L this morning. He is feeling fatigued, and continues to experience increased thirst, nocturia and weight loss. Lorenzo has been attending his follow-up appointments regularly and states that he has been following his medication regime. Lorenzo expresses frustration with the challenges in managing his blood glucose levels. The physician decides to start Lorenzo on insulin to better manage his blood sugar levels. Lorenzo has been prescribed the following:
- Glargine insulin (Lantus) 10 units subcut QHS
- NovoRapid insulin subcut TID with meals as per the following sliding scale:
| ac meal blood glucose level | Units of NovoRapid to administer |
| ≤8.0 mmol/L | 0 units |
| 8.1 – 10.0 mmol/L | 2 units |
| 10.1 – 14.0 mmol/L | 4 units |
| 14.1 – 18.0 mmol/L | 6 units |
| ≥18.1 mmol/L | 8 units |
- a) Using the sliding scale and the glucose level recorded, how much insulin should Lorenzo receive this morning? (1 mark)
4 units
- b) What are three (3) relevant nursing considerations for administration of NovoRapid to Lorenzo this morning? (3 marks)
ensuring patient is aware of what is taking and why
Looking for adverse reactions
Momitor medication effectiveness
- Lorenzo asks why he needs two different types of insulin, and why he would take one at bedtime if he is just going to sleep. What information will you provide to Lorenzo about each time of insulin that he has been prescribed? (ie. Compare each type of insulin that he has been ordered) (4 marks)
The information I would provide is that Novorapid is a type of fast acting insulin that lowers blood sugar levels while lantus is a type of long acting insulin that assist in stabilizing the blood sugar while the patient is sleeping.
- Lorenzo requires teaching for insulin administration and insulin pen use. What would you include in your teaching regarding insulin pen use? (4 marks)
How to follow the sliding scale
Which medication to use and at what time
Where to inject the medication in the body
How the pen works
How to select the right dosage using the pen
Reflection and Application of Learning (3 marks)
- Did the mini drug card preparation assist you in critically thinking through diabetes management for this patient? Why or why not? If not, how could you better prepare yourself for medication administration and teaching? (1 mark)
Yes, they helped. They reinforced what was taught during class, acting as a refresher. They also helped when having to answer questions about the case study.
- What are two pieces of learning that you will take away from this case study? (2 marks)
- The information in the drug cards that way I am able to know and inform patients the difference between these medication when admistering or answer questions regarding the medications.
- The importance of HgBA1c and what it can tell me to help a patient who may be living with diabetes
Total /27 marks