Details: Case study
You are a Registered Nurse working in the emergency department caring for Zach Forbes who is 15 years of age.
Zach visited his local doctor after experiencing increased appetite and excessive thirst. He has been unusually tired
when playing cricket and hasn’t been able to perform at his best. He has lost 10 kilograms of weight over a two week
period and has been frequently urinating at night. The doctor suspected type 1 diabetes and tested his urine, which
was positive for glucose and ketones. A random capillary blood glucose level was 25.0mmol/L and blood ketone level
was 1.5mmol/L. Zach was advised to attend the hospital emergency department immediately.
Zach lives with his mother (Susan), father (John) and 10 year old brother (Jacob). He is in year 10 at high school
and works at McDonalds on a casual basis. Zach plays cricket on the weekends and trains two days during the week.
Emergency department review
Two hours after review by the local doctor, Zach’s capillary blood glucose level (BGL) was 26.0mmol/L and blood
ketone level was 1.6mmol/L. Other vital signs were within normal limits. After review by the endocrinologist, Zach
was given a provisional diagnosis of type 1 diabetes based on his symptoms and family history of autoimmune disease
(His mother has hyperthyroidism, Graves’ disease). His blood test confirmed that he did not have ketoacidosis.
Zach was prescribed subcutaneous insulin; Aspart (NovoRapid) Flexpen 8 units TDS and Glargine (Lantus) Solostar
24 units nocte. He was referred to the diabetes service for inpatient review and ongoing care.
Using the marking criteria and supporting academic references address the following questions
Question 1. (10 marks)
Explain why Zach has been prescribed insulin. Relate to the pathophysiology of type 1 diabetes and insulin mechanism
of action. Support your answer with academic references.
Question 2. (5 marks)
Discuss the appropriate timing of Zach’s NovoRapid insulin administration in relation to food. Relate to the insulin
action profile of NovoRapid, hyperglycaemia and hypoglycaemia. Support your answer with academic references.
Question 3. (5 marks)
Discuss the rationale for testing Zach’s blood glucose level (BGL) before and after his first NovoRapid insulin injection
in the hospital setting. Support your answer with academic references.
Question 4. (10 marks)
Discuss the daily physical challenges and potential emotional impacts of living with type 1 diabetes that Zach may
experience once he is discharged from hospital. Support your answer with academic references.
Language Use (5 marks)
Sentences are well constructed, expression and meaning is clear, basic written language rules are followed.
Referencing and in-text citations (5 marks)
The APA (7th Edition) referencing style is used correctly for both in-text citations and reference list.
– Academic references include journal articles, textbooks and reports from professional nursing associations
such as The Australian Diabetes Educators Association.
– The Diabetes Australia website and patient information sheets are examples of consumer (general public)
resources and are not considered academic references. Official reports published by Diabetes Australia for
health professionals are considered academic references.
– High quality academic references are current (within 5 years) and specifically relevant to type 1 diabetes or
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