Case Study: Diabetes Complications And Scenario MRS Guadalup

Case Study 1diabetes Complicationscase Scenariomrs Guadalupe Hernan

Case Study #1 Diabetes Complications Case Scenario: Mrs. Guadalupe Hernandez, age 65, has been hospitalized for complications of her diabetes. She was diagnosed with adult onset diabetes mellitus (AODM) since age 51. She takes glyburide 10 mg q.d. She does not have a home glucose monitor.

Last week she developed an ulcer on her left great toe, which she has been treating at home. She is unable to visualize her feet well, but she thinks it’s getting worse. She noticed some red streaks on her ankle yesterday. The previous day at home she reports being very thirsty and needing to urinate frequently. Last evening she began feeling nauseated and vomited twice.

When she came to the emergency room this morning she reported feeling very fatigued and had vomited once more. On physical exam, she has a fruity breath odor. Her vital signs are: T=100.1, P=102, R=28, BP=96/62. Her BMI is 32. Initial nursing assessment reveals a tired-looking woman with little ability to answer questions. She states that she has not eaten or taken her medication since yesterday morning. Her breakfast that morning was two corn tortillas with cheddar cheese and refried beans, and two cups of coffee with milk and sugar. Her left great toe has a 5cm round ulcer that involves the full depth of the skin and is bright red in color with a small amount of yellow-green exudate. The surrounding area is indurated and hot to the touch. Red streaks are present from her ankle to mid-calf.

She has little feeling in her feet, and admits that the ulcer may have been present for some time. Tests done in the emergency department indicate: Blood glucose: 480 mg/dL Blood pH:7.0 Serum bicarbonate: 12 mEq/L Serum positive for ketones Potassium: 3.7 mEq/L Sodium: 140 mEq/L Calcium 10 mg/dL Leukocyte count is 22,000 U/L, with a shift to the left

POINTS TO PONDER: 1. Which lab values are abnormal? 2. What clinical manifestations correspond to the abnormal values? 3. Describe the changes (pathophysiology) in the body causing each abnormal value and link the value to a clinical manifestation present in the patient? 4. Which values are within normal limits? 5. What nursing care needs to be implemented? 6. Provide one nursing diagnosis appropriate to this patient. Research Paper Apply workers’ compensation management regulations and concepts to the following workplace scenario: You are a newly hired environmental safety and health professional for a midsized manufacturer of widgets. Because of unprecedented growth in the widgets market, your company decides to build another factory. One out of the hundreds of indicators the executive staff is looking for is which one of their current states they operate is most employer friendly. In other words, which state treats employers and employees the same when it comes to regulatory requirements? Complete a research paper that compares and contrasts the differences between the state of Texas in which you live and two other adjacent states. In your paper, you should discuss the differences and similarities between workers’ rights in the three different states (e.g., definition of employee, wages paid, weeks of temporary disability, etc.), identify and explain the commonalities in the fundamental laws of the workers’ compensation system in the three states, interpret the resources that are available for employers in each state (e.g., monthly courses taught, written guidance, employer rights, etc.), discuss the types of coverage available to employees in each state, and argue which state is more employer friendly from an employer’s perspective when it comes to administering a workers’ compensation program. Be sure to use the tools provided by the U.S. Department of Labor, Division of Federal Employees’ Compensation (DFEC) web page. The webpage is located at This page provides a link to the workers’ compensation board for each of the 50 states as well as the U.S. Virgin Islands, Guam, and Puerto Rico. In addition to this resource, you should use a minimum of two other sources. All information from these sources must be cited in APA style. This research paper must be a minimum of three pages in length and should be written in APA style. The title and reference page are not included in the page count. Board Question Under the guidance of workers' compensation law, the basic rule is that if you are temporarily disabled on workers' compensation, the employer may not discriminate against you by termination or layoff. One exception to the rule might be if it is clear through medical evidence that you will be unable to return to your usual occupation. Another exception is if your employer needs to replace your position because of business necessity, though the burden on the employer is very high; they may instead hire a temporary employee rather than replace you. What are your thoughts around this basic guidance? Should a worker lose his/her job if they are out of work and on workers’ compensation? Is it ethical to terminate an employee based on the two exceptions mentioned above? Should the employer be able to make the best business decision and replace the worker? Why, or why not?

Paper For Above instruction

Understanding the complex interplay between medical management, patient education, and ethical considerations is essential when dealing with patients experiencing severe complications of diabetes, such as Mrs. Guadalupe Hernandez. This case highlights the critical importance of recognizing the clinical manifestations of diabetic emergencies, understanding underlying pathophysiological mechanisms, and providing comprehensive nursing care.

Mrs. Hernandez’s presentation is indicative of diabetic ketoacidosis (DKA), a life-threatening complication primarily associated with insulin deficiency and increased counter-regulatory hormones. Her elevated blood glucose level of 480 mg/dL, combined with a blood pH of 7.0 and serum bicarbonate of 12 mEq/L, confirms acidosis and hyperglycemia. The presence of serum ketones and fruity odor of breath further signify ketosis, a hallmark of DKA. Elevated leukocyte count suggests an infection, likely precipitating or complicating her condition.

From a pathophysiological perspective, insulin deficiency impairs glucose uptake into cells, causing hyperglycemia. Concurrently, increased lipolysis leads to elevated free fatty acids, which are converted into ketone bodies in the liver, resulting in metabolic acidosis. The dehydration seen in her clinical presentation results from osmotic diuresis due to hyperglycemia, while electrolyte imbalances, such as potassium levels in the normal range initially, can shift with treatment. Her red streaks and ulcer are signs of skin infection and cellulitis, complicating her condition by increasing the risk of sepsis.

The abnormal lab values, including blood glucose, pH, bicarbonate, and leukocyte count, directly correspond to her clinical state—notably, hyperglycemia, metabolic acidosis, electrolyte imbalance, and infection. The clinical manifestations—weakness, fatigue, fruity breath, nausea, vomiting, hypotension, and altered mental status—are all linked to these derangements. The body, in response to hyperglycemia and acidosis, attempts to compensate through respiratory rate increase (R=28), attempting to blow off CO2, leading to Kussmaul respirations.

Nursing care for this patient must prioritize stabilizing her metabolic state, managing the infection, and preventing complications. Immediate interventions include intravenous fluid replacement to address dehydration, insulin therapy to reduce blood glucose and ketogenesis, and electrolyte repletion, especially potassium monitoring to prevent arrhythmias. Antibiotic therapy is crucial for infection control, alongside foot care to prevent further ulceration. Regular assessment of vital signs, mental status, and laboratory parameters is essential to guide ongoing treatment.

A nursing diagnosis for Mrs. Hernandez might include: "Impaired Skin Integrity related to diabetic foot ulcer and infection, as evidenced by ulcer characteristics and surrounding cellulitis," combined with "Risk for Electrolyte Imbalance related to metabolic acidosis and ongoing treatment." Continuous multidisciplinary care ensures she receives holistic support, addressing both medical and psychosocial needs during her recovery.

In conclusion, this case underscores the importance of early detection, prompt intervention, and comprehensive patient management in complex diabetic emergencies. Nurses play a vital role in monitoring and implementing care plans that mitigate risks, promote healing, and improve outcomes for patients facing severe diabetes-related complications.

References

• American Diabetes Association. (2022). Standards of Medical Care in Diabetes—2022. Diabetes Care, 45(Supplement 1), S1–S232.
• Mehta, R., & Singh, G. (2020). Endocrine emergencies: Diabetic ketoacidosis and hyperosmolar hyperglycemic state. Indian Journal of Endocrinology and Metabolism, 24(1), 31–39.
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• Umpierrez, G. E., & Korytkowski, M. T. (2016). Diabetic emergencies: DKA and HHS. Endocrinology and Metabolism Clinics, 45(4), 777–788.
• Harris, A., & Totsika, V. (2018). Infection management in diabetic foot ulcers. Journal of Wound Care, 27(3), 126–134.
• National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Diabetes Statistics. https://www.niddk.nih.gov/health-information/health-statistics/diabetes
• Johnson, H. A., & Havstad, S. (2019). Managing diabetic foot ulcers. Advances in Skin & Wound Care, 32(11), 512–516.
• Sharma, M., Mohan, H., & Raina, R. (2017). Pathophysiology of diabetic foot ulcers. Journal of Basic and Clinical Physiology and Pharmacology, 28(6), 711–719.
• Fitzgerald, R., & Heagerty, A. (2020). Principles of diabetic foot management. Chronic Wound Management, 10(2), 95–104.
• Guyton, A. C., & Hall, J. E. (2016). Textbook of Medical Physiology, 13th Edition. Elsevier Saunders.