HESI Case Study Diabetes Type 1 Clinical Medical Surgical 1

Diabetes Type 1: HESI CASE STUDY
Please read this case study located in your HESI case studies (It is available under
the Medical/Surgical section) complete the quiz, and answer the questions listed
below.
1. Identify 3 priority nursing diagnoses from the scenario overview; Identify

the 3 top nursing assessments for this patient; Identify the 3 top nursing
interventions for this patient; Identify 2 -3 priority orders for this patient.
Nursing Diagnoses:
- Deficient knowledge related to unfamiliarity with Type 1 diabetes as
evidenced by lack of disease awareness and concerning statements for
disease information and correlations.
- Risk for volume deficit related to dehydration from Type 1 diabetes as
evidenced by increased concentration of blood glucose and elevated lab
values and ketones in the patient’s urine
- Imbalanced nutrition related to insulin deficiency from Type 1 diabetes as
evidenced by polyuria, polyphagia, and polydipsia.
Nursing Assessments:
- Assess the patient’s airways
- Assess measures to correct the patient’s dehydration
- Obtain blood work for therapy management depending on lab values
Nursing Interventions:
- Assess the patient’s knowledge and have them to describe what is Type 1
diabetes
- Demonstrate and observe the patient’s return demonstration of their
administration techniques of insulin such as angle positioning and
rotations of injection sites
Priority Orders:
- Begin fluids (such as normal saline) to correct possible fluid imbalance
- Give patient’s insulin to restore blood glucose
2. Students treat the case study as your clinical patient for the day and answer the
following questions:
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a. What is the pathophysiology of the patient’s diagnosis & current
treatment recommendations?
Hubert and VanMeter (2018) explained that diabetes mellitus is caused by a
relative deficit of insulin secretion from beta cells in the islets of Langerhans or by
the absence of response in insulin resistance. In individuals with Type 1 diabetes
(like Lara), the insulin deficit stems from the destruction of pancreatic beta cells in
an autoimmune reaction, which results in an utter deficit of insulin in the body that
requires insulin replacement therapy. Complications of type 1 diabetes includes
hypoglycemia and ketoacidosis. Treatment recommendations that relates to the
patient’s diagnosis includes maintenance of optimal blood sugar and their body
weight and administer insulin at the proper scheduled time.
Reference:
Hubert, R. and VanMeter, K., 2018. Gould's Pathophysiology For The Health
Professions. St. Louis, Missouri: Elsevier, pp.405-406.
b. Address the pertinent labs, medications, treatments, etc. If these are

not explicitly outlined in the case study, identify expected labs for the
diagnosis.
 Labs:
- Hemoglobin
- Calcium
- Potassium
- Blood Urea Nitrogen
- LDL
 Medications:
- Humulin N/Humulin R 70/30
- Regular insulin (sliding scale dose)
3. Develop a teaching plan for the patient /patient’s family. Indicate why you
chose that topic and identify any obstacles they could face while implementing
the teaching plan.
Topic – Managing diabetes
Interventions
1. Schedule to take diabetic medications on time and right dose amount
2. Educate the patient to take their blood sugar before their meals and at
bedtime
a. Teach patient how to test their own blood sugar (if they are not aware
of how to do so)
b. Have supporters in the patient’s plan of care to help with checking
patient’s blood sugar
3. Talk with healthcare provider or professional of when the patient is approved
to exercise
4. Eat meals throughout the day to spread out calories and carbohydrate intake
5. Increase fluid intake to prevent dehydration
This topic was chosen because it is simple for a newly diagnosed individual
of diabetes to follow. It can also be modifiable towards the patient’s lifestyle
for their own maintenance.
Some obstacles that the patient may face include the patient may have to
take antibiotics to treat their infection due to diabetic ketoacidosis. It is
advised that the patient to finish their medication’s course of therapy. The
patient should be advised to not take extra insulin before performing any
exercise activity, because it can cause hypoglycemia
4. Find a scholarly (professional) journal article pertinent to the patient’s

condition or care and provide a 1-2 paragraph summary of the article in your
own words and cite the article in APA format.
In the article, “Psychosocial Care for People with Diabetes” discusses how
healthcare providers should include the psychosocial care within the plan of care
for a patient who has or can be in denial of being diagnosed with either Type 1 or 2
Diabetes. Young-Hyman et al, 2016, further explains that when a healthcare
provider or professionals pay more attention towards how their diabetic patients’
feelings of having and/or assess the patient’s understanding of diabetes. The patient
would understand and adapt to a treatment regimen to manage their diabetes as an
improvement on their medical outcomes and well-being. Initially, many patients
have poor maintenance of diabetes because they believe they have another illness
(since diabetes can mimic symptoms that is usually found in other conditions).
Another instance is with the diagnosis of the diabetes, many patients began to
experience conditions of distress (denial, anxiety, depression, fear relation to lack
of knowledge, treatment, or management upkeep) while adapting and/or modifying
their lifestyle with living this condition. The authors discuss that the majority of the
healthcare providers or professionals put more focus on their patients’ compliance
to the therapy and achieving medical outcomes, that they fail on assessing on if the
patient will need any behavior accommodations, any referral or assistance tools,
and/or cognitive and physical capabilities on how does the patient desires to self-
manage their symptoms or habits.
Young-Hyman et al, 2016, spend the next several sectional paragraphs and
tables by giving recommendations to providers how they can integrate patient-
centered psychosocial aspects in intertwined with treatment, goals, and
interventions depending on the particular situations. Few examples of situations
that were mentioned that depends on a mental health assessment or constant follow
up include if the patient has intentionally missed their insulin dose or abuse their
oral medications to lose weight, patient is not able to recognize symptoms and/or
knowledge of diabetes, or the patient showcase a range of difficulties for self-care.
Training skills and open-ended discussions was also mentioned as an
encouragement tactic to make sure the patient feels that they are able to manage
their diabetes – such as asking and assisting the patient on if they face any
difficulties (whether they could be mental, physical, about duration, personal,
and/or environmental) within their treatment. The article concluded that when the
health care providers get to the “root” as to why the patient would appear to have
poor management in their diabetes, then it will be a collaborative effort to make
sure that goals are being achieved.
Reference:
Young-Hyman, D et al(2016). Psychosocial Care for People With Diabetes: A
Position Statement of the American Diabetes Association. Diabetes
care, 39(12), 2126–2140. https://doi.org/10.2337/dc16-2053
5. Review clinical skills appropriate to your case study patient, consider

potential complications or accommodations that might need to be made for
this patient.
 Clinical Skills
- Taking the patient’s blood glucose
- Taking and obtain vital signs
- Starting the patient’s IV in order for them to receive the particular fluids
- Drawing up blood to help to obtain lab work (Hgb)
 Complications
- Protein in the urine
- Burning sensation
- Sores on her feet that may have trouble healing
 Accommodations
- Help the patient to modify treatment regimen to be flexible for her
collegiate lifestyle.
- Teach the patient to also let others know that she is a diabetic, so they
could accommodate their living arrangements to aid her when she has
episode
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Diabetes Type 1: HESI CASE STUDY

1. Identify 3 priority nursing diagnoses from the scenario overview; Identify

b. Address the pertinent labs, medications, treatments, etc. If these are

4. Find a scholarly (professional) journal article pertinent to the patient’s

5. Review clinical skills appropriate to your case study patient, consider

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