Posted: March 10th, 2013

Case study

Case study
Mr Adam Jones is a 45 year old man who is admitted into your ward after being transferred from the emergency department. He has a week long history of fatigue, headache, poor appetite, thirst and increasing frequency in urination. Mr Jones also has a past medical history of hypertension in which he was diagnosed 5 years ago and manages with medication.

His weight is 105kg and his height is 165cm. Admission observations are:

• Temperature: 38.8˚ Celsius
• Heart Rate (HR): 125 bpm
• Respiration Rate (RR): 21 rpm
• Blood Pressure (BP): 158/85 mmHg
• Oxygen saturations (SaO2) 94% on room air

• A urine analysis (UA) was undertaken and shows a large amount of Glucose, a trace of Albumin, no
ketones and a specific gravity (SG) of 1.016
• Blood Glucose Levels (BGL) are 23.4mmol/L

The medical officer (MO) reviews Mr Jones, obtains bloods and inserts an Intravenous Cannula (IVC). The MO orders; Oxygen at 2 Litres/minute via nasal prongs, intravenous fluid of 0.9% Sodium Chloride in a 1 Litre bag with 30 mmoL potassium chloride (KCl) added and to be infused at 125mls per hour via a pumClick here to get more on this paper………..

The MO also requests that a mid-stream urine (MSU) and an electrocardiograph (ECG) be undertaken for Mr Jones. He is prescribed a stat dose of 10 units of Actrapid insulin via subcutaneous injection and commenced on oral Metformin 500mgs twice a day (bd).

Mr Jones is given a provisional diagnosis of Type 2 Diabetes Mellitus.

His blood results show: Blood Cultures
Not yet available
BGL (Blood Glucose Level) 23.4mmol/L
FBC (Full Blood Count) NAD (No Abnormalities Detected)
LFT’s (Liver Function Test) NAD (No Abnormalities Detected)
Ca & Mg NAD (No Abnormalities Detected)
PO4 NAD (No Abnormalities Detected)
EUC: Na 133 mmol/L
K 3.2 mmol/L
Cl 99 mmol/L
Urea 7 mmol/L
Creatinine 65 μmol/l
Applies the ABCD assessment framework to the case study in a logical, comprehensive manner.

Identifies and discusses 2 high priority nursing interventions and relevant nursing care with supporting rationales (i.e observations, fluid management, documentation and other specific needs relevant to the case study).

Identifies and applies patho-physiology/ physiology relevant to the case study and/or clinical symptoms.

Discusses and applies the relevant pharmacology to the case study.
Identifies nursing responsibilities associated with administration, action, dosage, side effects and evaluation that are relevant to the pharmacology in the case study.