Debriefing Guide for Medical Scenario 5 Skyler Hansen

Debriefing Guide for Medical Scenario 5: Skyler Hansen Review – Diabetes Mellitus lecture and textbook readings. 1. Document your focused assessment for Skyler Hansen, including blood glucose levels. Patient came into the ED and was hypoglycemic: blood sugar of 31mg/dL. He had not eaten anything for 5 hours. He felt lightheaded and his friends brought him to the ED. He is drowsy, only wakes with stimulus, has slurred speech, is diaphoretic, and was acting irrationally according to his friends. Vitals signs: Respirations=19 chest moving slowly and equally bilaterally Temp= 99 degrees F BP= 130/78 Blood sugar= 31 mg/dL (very low) Post IV meds= 170 mg/dL ECG: Sinus rhythm 2. What management options would have been appropriate if Skyler Hansen had been alert and could swallow? I would have given him carbs and juice PO instead of giving him IV meds. 3. What is the rationale for including carbohydrates and proteins in the treatment of hypoglycemia? Because his blood sugar was so low, we needed to give our patient carbs and protein because it has a high sugar content which would ultimately raise his blood sugar. Eating protein before you eat carbohydrates would lead to lower glucose and insulin levels with patients with diabetes. Carbs would ultimately lift glucose levels and proteins would slow the release of glucose into the blood stream. If the patient just had carbs alone it might spike the release of glucose in the blood stream to a dangerous level. 4. If Skyler Hansen’s acute hypoglycemic episode had not been treated immediately, what could have happened? As we saw in the Vsim a patient can go unconscious and their oxygen saturation levels can drop. If this would have gone untreated he could have stopped breathing, had a seizure, and unfortunately, death could occur. 5. Compare and contrast the signs and symptoms of hypo- and hyperglycemia and recognize which of these conditions poses a higher risk for the patient. Hypoglycemia s&s are nervousness, sweating, dizziness, shaking, weakness, confusion. This type is seen are more threatening than hyperglycemia. Hyperglycemia s&s are blurred vision, increased thirst, headaches, fatigue, and hyperuricemia. 6. What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format. S: Skyler Hansen is an 18-year-old male diagnosed with type 1 diabetes 6 months ago. He was brought to the Emergency Department by his friends. The friends report that he started acting “weird” while they were playing basketball. He had not eaten anything for 5 hours. Skyler told them that he felt lightheaded. They decided to bring him into the Emergency Department. Patient status - ECG: Sinus rhythm. Heart rate: 83. Pulse: Present. Blood pressure: 126/75 mm Hg. Respiration: 12. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C) B:. The patient was drowsy, only would wake with stimulus, had slurred speech, was diaphoretic, and was acting irrationally. While doing vital signs today he became unconscious. The doctor ordered: -Nasal oxygen cannula to maintain about 92 sat. levels -Vitals every 5min -50 mL of dextrose 50% in water, slow push (right-hand IV access) -Telemetry monitoring -Order a Basic Metabolic panel, sent to the lab, results are not back yet. -The patient was given carbs PO -Education on diabetes management A: Following all of these orders the patient’s vitals improved: Res: 12 breaths per minute. The chest is moving normally on both sides. Pulse: 90 BP: 128/76 Temp: 99 Blood sugar: 170mg/dL Alert and oriented times 4 I called the provider to let him know of all of these new changes in the patient and stated to continue with the current orders R: I would continue to monitor the patient and follow orders. I would recommend Carbs and protein for meals and snacks, and due to the patient's L.O.C changes, and especially if the physician orders more medication via IV, I would make him stand by assist. 7. Identify two key nursing diagnoses for Skyler Hansen, including two nursing interventions for each diagnosis. Diagnoses 1: Risk for unstable glucose levels as evidenced by defiance in knowledge for diabetes type 1 management. Intervention 1: Educate patients on how to regulate glucose levels with a well-balanced diabeticfriendly diet. Diagnoses 2: Low glucose levels r/t inadequate knowledge of diabetes management aeb hypoglycemic crisis, blood glucose levels of 31, and exercising and not eating anything for 5 hours. Intervention 2: Educate patients on the appropriate times/ frequency to check blood sugar as well as normal ranges for blood sugar levels. 8. What would you do differently if you were to repeat this scenario? How would your patient care change? So I had to repeat this senior plenty of times because I couldn't figure out where things were or how to work things, so I believe in a clinical setting I would know how to use the o2 cannula. However, on my last attempt, the only thing I missed was sitting the patient up to give him his food. Which I believe was just an oversight on my part because this was virtual.