Transcript
Chapter 32: Diabetic Crises
Critical Thinking Checkpoint Case Studies
Marcel M., 32 years old, is brought into the Emergency Department by his wife. She informs the nurse that her husband has been not been feeling well over the past few days with a gastrointestinal problem and his mental state has slowly shifted from being anxious and 'foggy-headed' to drowsy. About 1 hour prior to arrival at the ED, Marcel reportedly experienced a convulsion. His wife relates that her husband is a type 1 diabetic who has been on insulin most of his life. Over the past 3 days, he has been trying to eat but has been vomiting up his food. He had continued to administer his usual dosage of insulin until today. The nurse suspects that Marcel may be experiencing hypoglycemic coma.
This activity contains 5 questions.
1. Assuming that Marcel has developed hypoglycemic coma, what common symptoms would you anticipate finding during your assessment?
Answer: The nurse would likely find cold and clammy skin, tachycardia, hyperventilation, and diaphoresis. If Marcel were sufficiently awake, he might also complain of a headache, nervousness, tingling of his extremities, nausea and vomiting, and continuous hunger. The nurse might also observe changes in mentation and coordination, thickened speech, and other signs of brain function deterioration.
2. Briefly explain the pathophysiologic basis for the classic signs and symptoms of hypoglycemia.
Answer: The manifestations of hypoglycemia result from a combination of CNS effects and catecholamine effects. The CNS effects are related to the brain cells' rapid consumption of glucose for energy. When hypoglycemia develops, brain cells rapidly deplete their oxygen source and symptoms result. The catecholamine effects result from stimulation of stress hormones, particularly epinephrine, which then causes activation of the sympathetic nervous system response.
3. Marcel is now unconscious. What interventions are appropriate at this time?
Answer: A STAT blood glucose should be obtained to establish that hypoglycemia is the problem. The nurse can anticipate that typically, a 50 mL bolus of 50 percent glucose is administered intravenously. In the absence of available glucose, he could also be treated with 1-2 mg of glucagon. Following administration of one or the other drug, the nurse would closely monitor the patient for reversal of the hypoglycemic manifestations.
4. A STAT bedside glucometer reading cannot be obtained at this time. Should Marcel's drug therapy of either glucose or glucagon be held until his blood sugar level is confirmed? Why or why not?
Answer: No, therapy should not wait on obtaining a blood glucose level if the test cannot be performed immediately. It is recommended that treatment move forward to prevent possible complications of severe hypoglycemia. A blood glucose level should be obtained as quickly as possible.
5. After administration of IV 50% glucose, what assessments should the nurse complete?
Answer: Repeat blood glucose levels every 15 minutes until glucose levels normalize, then continue to periodically measure as ordered by provider or agency protocol.
Monitor level of consciousness and vital signs closely throughout interventional period.
Following correction of blood glucose levels, monitor closely for relapse of symptoms of hypoglycemia, keeping in mind that relapse may reoccur.
