Case Summary
The school RN sees an 8-year-old male coming into the nursing office by his Phys Ed teaching with complaints of profuse sweating and confusion. The patient is currently afebrile. |
Objectives. (More or less are possible)
1. Recognizing signs of hypoglycemia
2. Differentiate between hypo- and hyperglycemia 3. Initiates treatment plan for abnormal blood sugars 4. Evaluating effectiveness of treatment plan |
Description of Client
Age: | 8 years | Gender | male |
Medical diagnosis or chief concern | Abnormal blood sugars |
Care Setting (More than one are possible)
Emergency Department
Medical-Surgical Unit Pediatric Unit Maternity Unit Behavioral Health Unit Intensive care unit |
Post-anesthesia Care Unit
Skilled-care Facility Home Outpatient Clinic Other setting: school Others present: |
History of chief concern/current condition/problem
Symptom: sweating and confusion
Onset: 30 minutes ago Treatments tried (if applicable): drank water and sat down |
Other history as indicated
Allergies: NKA
Weight/BMI (If applicable): 23 kg Medical diagnosis/surgeries/psychosocial: Type I DM diagnosed 1 year ago, no further past medical history, no surgical history Medications: Novolog Diagnostic tests: blood glucose POC, vital signs |
Assessments
Important, abnormal, or relevant assessments | Normal or irrelevant assessments |
Confusion
Sweating Recent illness with “up and down” sugars PMHx DM Type I |
Afebrile
|
Solutions
Priority to address | Desired outcome |
Confusion
Sweating DM I history |
Alert and oriented x3
Normal blood sugars |
Actions/order indicated | Actions/order not indicated/contraindicated |
Obtain blood sugar
Obtain full set of vital signs |
Send back to gym class immediately
Increase insulin dose |
Information Sources
Phase Sheet
Nurses’ Notes History and Physical Admission Notes Vital Signs Medications Orders |
Intake and Output
Laboratory Report Flowsheet Progress Notes Diagnostic Report Other: |
- What is most concerning finding? (10 points)
- What factors best explain client’s symptoms? Use specific pathophysiology. (15 points)
- What condition would most likely be expected? (10 points)
- What will happen if this condition is not treated? (10 points)
- What actions should the nurse take? (15 points)
- Which actions are contraindicated? (10 points)
- How should the nurse provide the glucose and why? (10 points)
- When should the RN re-check the blood glucose? (10 points)
- ? (5 points)
- Who should the nurse notify? (5 points)
- The most concerning finding is the patient’s confusion, as it suggests potential neurological impairment, which can be serious.
- The client’s symptoms are best explained by hypoglycemia. In diabetes mellitus type 1, the body is unable to produce insulin, leading to high blood sugar levels. However, excessive insulin administration or inadequate carbohydrate intake can result in hypoglycemia. Profuse sweating and confusion are classic signs of hypoglycemia, as the brain is deprived of glucose, its primary energy source.
- The most likely condition expected is hypoglycemia, given the symptoms presented and the history of type 1 diabetes.
- If hypoglycemia is not treated promptly, it can progress to severe neuroglycopenia, causing seizures, loss of consciousness, coma, and even death.
- The nurse should take the following actions: a. Obtain a blood sugar reading to confirm hypoglycemia. b. Administer glucose orally or intravenously to raise blood sugar levels. c. Monitor vital signs regularly. d. Reassess the patient’s mental status and symptoms.
- Contraindicated actions include sending the patient back to gym class immediately without addressing the hypoglycemia and increasing the insulin dose, which would exacerbate the condition.
- The nurse should provide glucose orally if the patient is conscious and able to swallow safely. If the patient is unconscious or unable to swallow, intravenous glucose administration may be necessary for rapid correction of hypoglycemia.
- The RN should re-check the blood glucose within 15-30 minutes after administering glucose to ensure that it has normalized and to monitor for rebound hypoglycemia.
- EMS should be activated if the patient’s condition does not improve despite glucose administration or if there are signs of severe hypoglycemia such as seizures, loss of consciousness, or inability to swallow.
- The nurse should notify the school administration, the child’s parents or guardians, and the child’s primary care physician or endocrinologist about the episode of hypoglycemia and the treatment provided.