Phlebotomy Essentials
6th Edition
ISBN: 9781451194524
Author: Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher: JONES+BARTLETT PUBLISHERS, INC.
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Becky has been admitted to the paediatric ward from the emergency department after being brought to hospital by her parents due to becoming drowsy at home. Becky is being treated for diabetic ketoacidosis via intravenous insulin and fluids, blood glucose was 36 mmol/l and blood ketones were 3.2 mmol/l on admission. Currently, becky is withdrawn and has said she wants to go home, she says will be ok and that she doesn’t want the treatment. When speaking to mom and dad, they have stated that becky should not be told about the severity of her condition as she will worry too much.
Patient Details
Name: becky Smith
Date of Birth: 13/08/2009 - Age 14
Address:
Next Of Kin: Parents, James and Donna
Religion: None
Ethnic origin: White British
Presenting Complaint or Reason for visit
Diabetic ketoacidosis (DKA) secondary to recently diagnosed type 1 diabetes (T1DM)
Past Medical History
T1DM
Autism
Current Medication
Lantus – 12 units - one per day in the evening
Novorapid – for administration with each meal – approx. 1 unit per 10g carbohydrate
Allergies
NKDA
Family and Social History
· Lives with parents and 1 younger brother with autism / non-verbal / challenging behaviour
· Attends mainstream secondary school, but refuses support from Autism Outreach as her friends will think she’s stupid
· becky likes computer games – prefers to spend time in her room online gaming and talking to online friends as they understand her
· Enjoys playing table tennis at school and with her dad when he has time
· States smokes sometimes as her friends at school do it at the bus stop, she doesn’t drink alcohol
· No direct familial history of diabetes
· Struggles with big changes – causing anxiety & emotional outbursts
· No significant other medical history
Current observations and results
Observations
Results
Blood Pressure
94/58
Heart Rate
118 beats per minute (bpm)
Respiratory Rate
38 breaths per minute
Oxygen Saturation (SaO2)
99% in air
Temperature
36.9
AVPU
Alert
PEWS Score
4 Normal Range
Blood Glucose
28mmol/l
4-7mmol/l
Blood Ketones
2.6mmol/l
< 1mmol/l
Communication from other health care professionals
GP note –
Brought to surgery by mother as was refusing to take insulin, has been upset about diagnosis, afraid of needles and thinks her friends will laugh.
Becky does not want to watch what she is eating, take injections nor monitor her activity. Becky has been having outbursts at home, throwing things and hiding in her room.
During the consultation, despite encouragement, becky refused to engage nor make eye contact, all information was provided by mother.
Advised both regarding consequences of non-compliance, eg hyper/hypo-glycaemia and hospitalisation, advised to return if problems persist.
Health Promotion – Explain how the nurse will try and promote the patients’ health in relation to one
or more of the above factors
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