Video Case Study - Caring for Patients With Diabetes Mellitus

Nurse Charlotte works on a medical-surgical floor and is caring for José, a 53-year-old with a history of type 1 diabetes mellitus who was admitted for diverticulitis and just returned to the unit after a CT scan. In collaboration with the registered nurse, RN Luke, Nurse Charlotte goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about José’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking actions, and evaluating outcomes.

First, Nurse Charlotte recognizes important cues, including José’s vital signs which are temperature 98 F or 36.6 C, heart rate 87 beats per minute, respirations 18 breaths per minute, and oxygen saturation 95 percent on room air. She also notices that José’s hands are trembling slightly, and he’s diaphoretic.

Nurse Charlotte gathers more information from José.

Nurse Charlotte: Hi José, welcome back from your scan. How are you feeling this morning?

José: I’m okay I guess; I just feel a little weak and shaky. It started about ten minutes ago.

Nurse Charlotte: Have you had anything to eat today?

José: No, I haven’t eaten since last night because of that test I had this morning.

Next, Nurse Charlotte analyzes these cues. She reviews the electronic health record, or EHR, and notes that José received five units of insulin, for a blood glucose level of 121 mg/dL last evening. She also sees that José was ordered to be NPO after midnight for an abdominal CT scan that he underwent this morning.

Nurse Charlotte understands that type 1 diabetes mellitus is a condition caused by autoimmune destruction of the pancreatic beta cells, so they can’t produce and secrete insulin, and that treatment typically requires subcutaneous insulin administration. She also knows that hypoglycemia, or blood glucose below 70 mg/dL, is likely to occur if insulin is taken when a patient isn’t eating, like when a patient is NPO, leading to clinical findings such as weakness, diaphoresis, and tremors.

Nurse Charlotte then checks José’s blood glucose, which is 60 mg/dL. Based on this finding, she recognizes that José needs effective management of his hypoglycemia.

Next, using the information she has gathered, along with José’s medical history, Nurse Charlotte discusses her findings with RN Luke, and they choose a priority hypothesis of altered blood glucose.