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Case Study-The Pediatric Client with Diabetes
Patient assignment for today is Miguel Ortiz, a 14-year-old Hispanic student who has been newly diagnosed with Type I Diabetes Mellitus. Miguel was admitted with a blood glucose level of 745 mg/dL. At that time, he displayed typical symptoms of diabetic coma. After treatment with IV insulin, Miguel is feeling much better and is in the process of learning to manage his diabetes to prepare for discharge to home.
Physician orders
Monitor blood glucose QID (ac and hs)
Up ad lib / encourage activity
1800 cal diabetic diet
Diabetic teaching
Humulin N 22u / Humulin R 7u in am
Humulin N 16u / Humulin R 5u in pm
Preclinical preparation
As prepare for the clinical day to take care of this young man who has just been diagnosed with Type I diabetes explain the pathophysiology at the cellular level so that will understand how this type of diabetes works will be prepared to answer questions for this client. Discuss the pathophysiology of Type II diabetes as well as compare the two types of diabetes. Because this young man is of Hispanic descent will also need to research how the care of a Hispanic child could vary from a Caucasian child. As research Hispanic beliefs in disease and illness it will be important to understand who makes the decisions in the family regarding healthcare, who will need to be educated regarding his diabetes, and what type of healers do some Hispanic persons utilize other than the medical profession. What are the risk factors associated with diabetes and why is the Hispanic population more at risk for diabetes? (Type responses to all the questions in this paragraph here) (6 points)
Assessment
Enter the room to check the blood glucose before breakfast. As perform initial assessment, look for signs and symptoms of DKA (diabetic ketoacidosis). As progress through the case study and answer the questions please support response with appropriate rationale or support for response. Some of the questions will be a response to the patient so write response to those questions as if were addressing this young patient.
What signs and symptoms are looking for regarding diabetic ketoacidosis? (.5 points)
Miguel asks what normal fasting blood glucose would be, what is the response? (.5 points)
Discuss the onset of Miguel’s illness with him. Miguel describes his symptoms and note they were typical symptoms of most people during the onset of diabetes.
What symptoms would expect patient to describe regarding the onset of Type I Diabetes? How do these symptoms differ from what the symptoms of Type II Diabetes might be? (1 point)
Explain to Miguel that these symptoms were caused by the blood glucose level being higher than normal, and that if his blood glucose level is not controlled, he will experience these symptoms again.
Miguel asks what can cause his blood glucose level to become uncontrolled. What is the response? (1point)
Miguel asks why the body needs insulin. What is your response? (1 point)
Insulin Administration
You prepare to administer Miguel’s morning dose of insulin. Explain everything asprep are the insulin, so Miguel will learn to properly administer his insulin at home.
Miguel asks why are rolling the insulin instead of just shaking it. What is reply? (.5 points)
Explain the process of preparing a mixed dose of insulin. Which insulin do draw up first? Make sure to answer this question as though were providing patient education to this patient. (1point)
When have drawn up both the N and R, how many units of insulin will be in the syringe? (.5 points)
Miguel asks why the insulin is now being given by injection when before it was given IV. How do respond? (1 point)
Miguel asks why the physician has prescribed two types of insulin for him. How do respond? (1 point)
Discuss the differences between the various types of insulin including rapid acting, short acting, intermediate acting, long acting, mixed insulin (example 70/30). Are there any other treatment options for Miguel? (2 points)
Diabetic teaching
When Miguel’s breakfast tray arrives, he looks at the food and says, “I think I’ll just drink the milk and juice. I’ve never been a breakfast eater at least not this kind of food.”
What is best response? (1 point)
Miguel asks what will happen if the CHO intake is less than what is needed to balance the insulin. What is reply? (1 point)
Miguel ponders reply and then asks, “How will I know if this is a problem?” Know that Miguel needs to know the symptoms of hypoglycemia and this is a good opportunity to review this information with him.
What will tell him? (1point)
After breakfast, Miguel takes a shower and takes a long walk around the hospital. When he returns he states, “I feel so nervous, shaky, and weak. My vision is a little blurry.” Note that Miguel’s skin is pale and moist.
What action should you take? (1 point)
After explain the relationship of exercise to the blood glucose level, Miguel states, “I play football, basketball, and baseball at school. I suppose I won’t be able to do that anymore.”
What is the best response? (1point)
When deliver Miguel’s lunch tray, he states, “I’ve been wondering why the doctor won’t just let me take the insulin pills like my uncle does. He’s diabetic and gets by just fine on the pills. I suppose it’s a difference in the doctor’s ideas of treatment.”
How will respond? (1point)
Discuss the action that each of the following antidiabetic agents utilizes and give an example of each; Alpha-glucosidase inhibitors, Biguanide, Insulin Stimulators, and Insulin Enhancing Agents (Thiazolidinediones or Insulin Sensitizers). (2points)
In the early afternoon, sit down with Miguel to discuss the long-term complications which have an increased incidence in those with diabetes.
What complications will discuss? (1 point)
Miguel asks, “How can I avoid these complications?” What information will give him? 1 point)
Miguel sighs and looks unhappy. “What did I do to get this disease?” Now must keep in mind that the Hispanic culture may have different views about disease and illness so keeping those in mind how will you answer his questions?
What information can give Miguel regarding the cause of type I diabetes? (1point)
What other resources can suggest for Miguel’s support once he has been discharged? (1.5 points)
Miguel know that you will be leaving soon. Miguel thanks for all the information have given him today, and has no further needs at this time. Proceed to document the items on which the nurse have done patient teaching.
List those topics (1 point)
Besides working with Miguel to understand his diabetes and all the elements that impact his care who else needs to be involved in his care? Explain how you would facilitate this involvement. Again, you must keep in mind his ethnic background and realize that there are key people that must be integrated into his care if he is to be successful with management of his diabetes. (1.5 points)
This client is 14 based on that what tasks are age appropriate for him regarding his diabetes care? (1point)
Based on other ages in the pediatric group please describe how this scenario would be different if the child were a toddler, preschooler, and elementary aged child. How would your care and education be different and what tasks are appropriate for each age group regarding diabetes care? (3 points)

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