Kaiden Watchell is a 65 year old single male who has a 20 year history of type 2 diabetes.

Kaiden Watchell is a 65 year old single male who has a 20 year history of type 2 diabetes. Both of his parents also had type 2 diabetes. He had a myocardial infarction at age 57 and states that he was told his cholesterol is high. He smokes 15 cigarettes per day for the past 40 years. WT 99.8 kg (220 lbs) HT 172 cm (5 feet 8 inches). 

 

He has been in hospital for three days due to diabetes complications and poorly controlled blood glucose levels. His blood glucose on admission was 40 mmol/L. He reported blurred vision, polyuria, and severe polydipsia. Skin was warm and dry and temperature was 38.3 C. He was very lethargic.

 

He reports numbness on the soles of both feet and a small, round, well-demarcated ulcer was noted on the ball of his left foot. He notes that he has not taken his anti-hypertensive medication or anti-diabetic medications for the past few days as he is recently unemployed and is trying to ration his medication and he has been sick in bed with a cold. 

 

Blood Work on Admission to Hospital

 

Lab test Findings Normal Findings Marks 

Random Blood glucose 40 mmol/L 5.0-10 mmol/L 2

Hematocrit (Hct) 0.50 0.37-0.47 1

Sodium (Na+ ) 150 135-145 mmol/L 1

Serum Osmolality  

Potassium (K+) 3.3 3.5-5.0 Meq/l 1

Creatinine 120 61.9-114.9 mmol/L 2                                         

Ketones (urine) Negative Negative 1

 

 

 

 

VS findings from his initial admission. 

 

 

 

 

T 38.3 C HR 135/bpm

BP 108/70 O2 sat 92% 

RR 30/min  

 

 

Assessment Findings this morning (Day 3).

 

Fasting blood glucose 9.9 mmol/L

Reports fatigue

Alert and oriented x 3

Skin is warm and dry

Urine is clear and concentrated with U/O 150 cc overnight

Urine tests negative for ketones

VS 37.5C-HR 90/min-RR-22/min  BP 150/80  O2 sat 93%

 

 

 

 

 

 

 

 

 

 

What are the risk factors for diabetes complications for this client? (6 marks)

 

 

 

 

 

 

 

 

Using the assessment data provided to support your answer, identify and explain whether he was experiencing DKA or HHNS on admission.  (5 marks)

 

 

 

 

 

 

What interventions are anticipated based on the identified problem above? (5 marks)

 

 

 

 

 

 

 

 

The client reports that he has never experienced angina and did not experience pain with his myocardial infarction. What patient teaching regarding diabetes and angina/MI pain is appropriate? (4 marks)

 

 

 

 

 

 

Based on the client’s history and presenting illness, he is now prescribed insulin. Explain the teaching required regarding:  

Symptom recognition (5 marks)

Insulin administration (5 marks)

Glucose monitoring (5 marks)

 

 

 Which members of the health care team should be involved in his care? (3 marks)

 

 

 

 

 

What are two priority nursing diagnoses for this client (excluding identified issues in questions 4 and 5 above). (2 marks)

 

 

care for one of these problems. (10 marks )

 

Nursing Diagnosis (Problem statement/related to):

 

Assessment Findings

 

(subjective/objective)

 

Planning

 

(Goals/objectives)

 

Interventions Evaluation

   

   

   

   

   

   

   

 

 

The End