Case Study No. 2 – Kimberly Peters Hospital Admission for Stable Hypoglycaemia at Griffith University Hospital Patient Profile
Name: Kimberly Peters Age: 36 Gender: Female
Medical History: Type 2 Diabetes Mellitus, hypertension, and hyperlipidaemia. Kimberly weighs 72.6kg, her height is 167 cm, and her waist circumference is 86 cm. Kimberly takes Metformin extended release for blood glucose control, Captopril for hypertension (target systolic < 120 mmHg), and a maximum daily dose of atorvastatin for hyperlipidaemia.
Social History: Kimberly is married and lives with her spouse and two young children in a suburban home, working full-time as a project manager in a local IT company. Kimberly and her family maintain a balanced diet and try to make healthy food choices. Kimberly tries to incorporate regular physical activity into her routine but has recently dropped off her exercise due to increasing work demands. Work pressures have also meant she not monitoring her blood glucose levels routinely.
Presenting Condition
Ms Kimberly Peters presented to Griffith University Hospital Emergency Department (ED) at 4 a.m. on November 1, 2023, with symptoms of hypoglycaemia stating she felt lethargic, following a recent viral illness, including 24 hours of vomiting and diarrhoea. Kimberly was administered IV antiemetic medication and IV Glucagon. The ED RMO inserted a peripheral intravenous cannula and ordered IV sodium chloride 0.9% with glucose 5% 1 Litre, delivered at 125 ml/hr. At 9 a.m. (same day), Kimberly was transferred to the medical ward for the continuance of IV fluid therapy and stabilisation of blood glucose.
ISOBAR Communication Approach
In Kimberly Peter’s case, the ISOBAR approach facilitated communication between the registered nurse (RN), Hamid, and the registered medical officer (RMO) covering the morning shift. Hamid introduced himself to Kimberly on transfer to the ward, gathered key patient information, and confirmed the patient’s identity in addition to Kimberly Peters’ current health issues, medications, and relevant history.
Introduction: During the morning medical round RN Hamid, introduced himself, and Kimberly Peters, a 36-year-old female, who was admitted with hypoglycaemia and dehydration due to a recent viral illness accompanied by vomiting and diarrhoea for 24hrs, before admission. No further vomiting or diarrhoea since presenting to the Emergency Department at 4 am.
Situation: Kimberly has a known history of Type 2 Diabetes Mellitus coexisting with hypertension and hyperlipidaemia. Current blood glucose level is within normal range (4-8mmol/L).
Observation: Upon admission to the medical ward, Kimberly’s baseline assessment was:
Vital Signs: Blood pressure 130/80 mm Hg (post oral dose of Captopril) HR 85 bpm RR 18 bpm SpO2 of 98% on room air Temperature, 36.8 degrees centigrade Neurological Status: GCS 15, mildly lethargic General Examination: pink and well perfused, capillary refill time < 2 seconds Blood Glucose Level: 4.1 and 4.8 mmol/L (finger prick) Other Lab Results: Normal serum creatinine and electrolyte levels (Case Study 2 – Adjunct Data Urea and Electrolytes) QADDS score: 0 (Case Study 2 – Adjunct Data QADDS #1)
Background: Kimberly has a 2-year history of Type 2 Diabetes Mellitus, hypertension, and hyperlipidaemia. Up until recently, Kimberly had consistently monitored blood glucose levels. Most recent documented HbA1c result was 7% (53mmol/mol).
Assessment: Kimberly is currently stable, with Blood Glucose Level within normal range.
Recommendations: Further evaluation revealed that Kimberly had been missing meals before the viral illness due to work pressure and an increased feeling of being overwhelmed and helplessness. Kimberly revealed she had also forgotten to regularly test her blood glucose levels and take Metformin. Referral to a Diabetic Educator to discuss recent difficulties in monitoring blood glucose levels was commenced and a planned visit by the social worker.
Approximately 2 hours later, Kimberley experienced a sudden deterioration. Kimberly reported feeling nauseated and dizzy before starting to slur speech. RN Hamid notified the medical officer to report the observations and assessment data gathered using a primary survey:
Airway: patent Breathing: borderline bradypnea (8 bpm), shallow breathing, SpO2 92-93% on room air (Case Study 2 – Adjunct Data Pulse Oximeter image) Circulation: Hypotensive – Blood pressure 100/60 mm Hg, bradycardic, 50 bpm (Case Study 2 – Adjunct Data ECG), severely diaphoretic and peripherally cool, with capillary refill time > 2 seconds. Disability: decreased level of consciousness, eyes = 2, Voice = 3, Motor = 5 GCS of 10/15, Blood Glucose Level = 1.776 mmol/L (venous sample) Exposure: Temperature 36.6 degrees centigrade QADDS score: E (Case Study 2 – Adjunct Data QADDS #2)
Task Descriptions to do:
scholarly literature:
1. Identify TWO (2) actual or potential priority problems related to failure to rescue described in the selected case study. For each problem, justify your choice as a priority (e.g., by referring to the patient’s assessment data in the selected case study and to appropriate literature)
2. For EACH priority problem, identify ONE (1) SMART goal for care of the selected patient (total 2 goals). Remember a SMART goal is specific, measurable, attainable, realistic, and timely
3. For EACH goal, describe TWO (2) evidence-based nursing interventions you would implement to meet the goal (total 4 interventions). For each nursing intervention, justify your choice by referring to appropriate literature.
4. For EACH goal, identify the expected outcomes and describe your evaluation approach (e.g., how, and when, would you evaluate whether your interventions have been effective or not?)
5. Analyse the impact of failure to rescue on the patient, their family, and the health care system.
Criterion One (12 Marks)
Identify two potential/actual priority problems related to failure to rescue and justify the selection
Criterion Two (12 Marks)
Identify and prioritise two goals (G) for care using SMART structure
Criterion Three (24 Marks)
Describe four relevant nursing interventions and provide an evidence-based rationale for nursing intervention
Criterion Four (12 Marks)
Discuss expected outcomes for interventions and provide description of how this outcome would be evaluated
Criterion Five (12 Marks)
Analyse the impact of failure to rescue on the patient, their family, and the health care system
Criterion Six (16 Marks)
Evidence and referencing