Source for Case study #1: Winn

Source for Case study #1: Winningham, M.L. & Preusser, B.A.(1996). Critical thinking in medical-surgical settings, A casestudy approach. St. Louis, MO: Mosby

Case Study #1:


P.W. Is a 40-year old disabled man who recently lost his wife tometastatic breast cancer. His brother has taken him into his home.P.W. has a 22-year history of insulin-dependent diabetes mellitus(Type-1). Until recently, he has taken responsibility for themanagement of his disease and has been actively involved in thelocal chapter of the American Diabetic Association.

PMH includes 2 amputated toes on his R foot, retinopathy andvisual impairment in both eyes, and angina on exertion fromcoronary artery disease that severely restricts his activity. Sincehe began treatment with an Ace-inhibitor 2 years ago, his bloodpressure has gone from 182/128 to 126/78 mm Hg. Currently, he is71” tall and weighs 135 lb. P.W.’s sister-in-law, who is an LPNsays P.W. has lost about 12 lbs in the past 3 weeks. Over the pastfew years, P.W. has been administering a multidose (3 injections)regimen of regular Humulin insulin to himself before meals and atnight. Recently his BG levels have been increasingly inconsistentand labile, and he has been labeled “noncompliant.” It is Monday.You are the home care nurse assigned to visit P.W. 3 times per weekfor teaching and evaluation. P.W.’s brother and sister-in-lawexpress concern that P.W. seems to be indifferent about hisnutritional and pharmacologic regimens.

1. List the measures you normally would address in teaching forboth hypoglycemia and hyperglycemia (6 each).

· Hyperglycemia

· Hypoglycemia

Note: Current practice promotes tighter glucose management toprevent long-term complications of DM. In the past, patients’glucose often would be allowed to swing to 180 mg/dl or higher.

The American Diabetes Association criteria for screening anddiagnosis of diabetes is listed below. Also, more or less stringentglycemic goals may be appropriate for each individual.

As you start to review the above measures with P.W., you noticehe already seems aware of what he should do to control his bloodglucose. You are concerned that he seems too distracted and driftsoff in the middle of a discussion; his affect also appearsflat.


Hypoglycemia, also known as lowblood sugar, occurs when levels of glucose (sugar) in the blood aretoo low. Hypoglycemia is common in people with diabetes who takeinsulin and some (but not all) oral diabetes medications.Hyperglycemiais the technical term for high blood glucose(blood sugar). High blood sugar happens when thebody has too little insulin or when the body can’t use insulinproperly.

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