Video Case Study - Diabetes Mellitus in the Pediatric Patient

Nurse Camden works on a pediatric Medical-Surgical unit and is caring for Tate, an 11-year-old who was recently admitted for new onset type 1 diabetes mellitus.

After settling Tate in his room, Nurse Camden goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Tate’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Camden recognizes important cues including temperature 97.3°F or 36.2°C, pulse 101 beats per minute, respirations 19 breaths per minute, oxygen saturation 98% on room air, and blood pressure 105/70 mmHg.

Tate’s mother is at the bedside and reports that lately, Tate’s been irritable, unusually hungry and thirsty, and he’s urinating frequently.

Next, Nurse Camden analyzes these cues. He reviews the electronic health record, or EHR, and notes that Tate’s blood glucose level is 240 mg/dl and his hemoglobin A1C level is 7.8 percent.

Nurse Camden also sees that Tate has lost four pounds in the past two months and that Tate’s urine is positive for glucose.

Nurse Camden realizes that the glucose from the food Tate eats can’t move from his blood into his cells, due to a lack of insulin.

Because of this, Tate isn’t able to convert the food he eats to energy, causing him to experience fatigue and increased hunger.

He also realizes that Tate’s kidneys can’t reabsorb the excess glucose, so it ends up in the urine, where it pulls water out along with it as it's eliminated, causing his other symptoms of frequent urination and increased thirst.

Nurse Camden recognizes that Tate needs effective management of his blood glucose. Now, using the information he’s gathered, along with Tate’s medical history, Nurse Camden chooses a priority hypothesis of unstable blood glucose.

Then, he generates solutions to address Tate’s unstable blood glucose using pharmacologic and nonpharmacologic solutions.

Nurse Camden establishes the expected outcome that after intervening, Tate’s blood glucose will begin to stabilize by the end of the shift.

Nurse Camden then takes action to implement these solutions. He notes an order for frequent monitoring of Tate’s blood glucose levels as well as the administration of subcutaneous insulin and continuous IV fluids to decrease his blood glucose.

Nurse Camden enters Tate’s room with the glucometer, IV fluids, and supplies to administer insulin. Nurse Camden: Hi Tate, I need to check your blood sugar level, I'm going to prick your finger with a very small needle.

Once I have a drop of blood, I'm going to put it on this strip and enter it into my machine. Then the machine will tell me what your blood sugar is.

Tate: Is it going to hurt? Nurse Camden: You'll feel a little sting, but it’ll be very quick.

I know it can still be scary, though, so do you want to hold your mom’s hand while we check it? Tate: Yeah.

Tate’s mother holds his hand while Nurse Camden obtains the blood sample and enters the strip into the glucometer. Nurse Camden: Your blood glucose is 205, which means I'll need to give you some insulin to bring your blood sugar back to normal.

I’m also going to give you some IV fluids to help keep you hydrated. Tate: Okay.

Nurse Camden then measures and administers Tate's insulin and IV fluids following the institution’s protocol and safe medication administration principles.

At the end of his shift, Nurse Camden re-enters Tate’s room to evaluate the outcome of his actions. He takes Tate’s vital signs which are blood pressure 110/75 mmHg, heart rate 85 beats per minute, and respirations 19 breaths per minute.

Nurse Camden also reassesses Tate’s blood glucose, which is 143 mg/dL. Alright, as a quick recap….

Nurse Camden recognized and analyzed cues related to Tate’s unstable blood glucose, prioritized hypotheses and generated solutions to address this problem.

Nurse Camden implemented measures to address Tate’s type 1 diabetes, and evaluated Tate’s outcomes, comparing them to the expected outcomes.

Since Tate’s blood glucose is starting to stabilize, Nurse Camden determined that the plan of care was successful.