Registered Nurse working in the emergency department

Details: Case studyYou are a Registered Nurse working in the emergency department caring for Zach Forbes who is 15 years of age.Medical historyZach visited his local doctor after experiencing increased appetite and excessive thirst. He has been unusually tiredwhen playing cricket and hasn’t been able to perform at his best. He has lost 10 kilograms of weight over a two weekperiod and has been frequently urinating at night. The doctor suspected type 1 diabetes and tested his urine, whichwas positive for glucose and ketones. A random capillary blood glucose level was 25.0mmol/L and blood ketone levelwas 1.5mmol/L. Zach was advised to attend the hospital emergency department immediately.Social historyZach lives with his mother (Susan), father (John) and 10 year old brother (Jacob). He is in year 10 at high schooland works at McDonalds on a casual basis. Zach plays cricket on the weekends and trains two days during the week.Emergency department reviewTwo hours after review by the local doctor, Zach’s capillary blood glucose level (BGL) was 26.0mmol/L and bloodketone level was 1.6mmol/L. Other vital signs were within normal limits. After review by the endocrinologist, Zachwas given a provisional diagnosis of type 1 diabetes based on his symptoms and family history of autoimmune disease(His mother has hyperthyroidism, Graves’ disease). His blood test confirmed that he did not have ketoacidosis.Treatment planZach was prescribed subcutaneous insulin; Aspart (NovoRapid) Flexpen 8 units TDS and Glargine (Lantus) Solostar24 units nocte. He was referred to the diabetes service for inpatient review and ongoing care.Assessment instructionsUsing the marking criteria and supporting academic references address the following questions

Assessment QuestionsQuestion 1. (10 marks)Explain why Zach has been prescribed insulin. Relate to the pathophysiology of type 1 diabetes and insulin mechanismof action. Support your answer with academic references.Question 2. (5 marks)Discuss the appropriate timing of Zach’s NovoRapid insulin administration in relation to food. Relate to the insulinaction profile of NovoRapid, hyperglycaemia and hypoglycaemia. Support your answer with academic references.Question 3. (5 marks)Discuss the rationale for testing Zach’s blood glucose level (BGL) before and after his first NovoRapid insulin injectionin the hospital setting. Support your answer with academic references.Question 4. (10 marks)Discuss the daily physical challenges and potential emotional impacts of living with type 1 diabetes that Zach mayexperience once he is discharged from hospital. Support your answer with academic references.Language Use (5 marks)Sentences are well constructed, expression and meaning is clear, basic written language rules are followed.Referencing and in-text citations (5 marks)The APA (7th Edition) referencing style is used correctly for both in-text citations and reference list.– Academic references include journal articles, textbooks and reports from professional nursing associationssuch as The Australian Diabetes Educators Association.– The Diabetes Australia website and patient information sheets are examples of consumer (general public)resources and are not considered academic references. Official reports published by Diabetes Australia forhealth professionals are considered academic references.– High quality academic references are current (within 5 years) and specifically relevant to type 1 diabetes orinsulin administration.

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