Nursing Care of Patient hypoglycemia in diabetes type 2: Case Study of 2 Cases.

Abstract

     This study is a comparative case study of patients with type 2 diabetes who experience hypoglycemia, involving two cases treated at Nong Nakham Hospital. The objective is to study illness data, risk factors, pathophysiological symptoms and signs, treatment, and nursing. The data collection tools include information from emergency medical records, outpatient diabetes clinic records, observations, interviews with patients and relatives, and data analysis using nursing record forms based on Gordon's functional health patterns framework. This approach aims to identify patient problems and needs, which will then be used to plan nursing care for patients with type 2 diabetes who have hypoglycemia, establish nursing diagnoses, provide nursing care, and evaluate nursing outcomes.
     Results: Case Study 1: A 67-year-old Thai male with a 22-year history of diabetes was unable to control his blood sugar levels. He also had comorbidities including hypertension and chronic kidney disease stage 3B - 4. One hour before arriving at the hospital, he was unresponsive.. A DTX measurement was 37 mg%. The doctor planned to administer a slow IV push of 50% glucose (50 ml). After treatment, the patient regained consciousness and was able to communicate. Blood samples were sent for lab tests including CBC, BUN, creatinine, and electrolytes, while holding diabetes medications. He was placed on IV 10% D/N/2 (1000 ml) with a drip rate of 60 ml/hr. A repeat DTX measurement 15 minutes later showed 136 mg%. After 6 hours, DTX was checked every hour, revealing blood sugar levels between 136 and 180 mg%, which were within the treatment target range. The patient also presented with hypokalemia, for which he received Elixir KCL (30 ml orally every 3 hours for 3 doses). He was discharged home with a follow-up appointment for the next morning to repeat electrolytes and fasting blood sugar (FBS).
     Case Study 2: A 65-year-old Thai female patient was diagnosed with diabetes and hypertension 11 years ago. She regularly received medication from Nong Nakham Hospital and had no issues with medication adherence. One hour before arriving at the hospital, her condition worsened; she became lethargic and non-verbal. After waking up in the morning, her relatives found her unresponsive, not eating, and not urinating since the previous night, prompting them to take her to Nong Nakham Hospital. Initial testing revealed a blood glucose level of 34 mg%. Treatment included an IV push of 50% glucose (50 cc) and a 10% dextrose solution (1000 ml at 60 ml/hr). A repeat blood glucose test 15 minutes later showed a level of 210 mg%. The patient regained consciousness but remained lethargic and minimally verbal, exhibiting signs of fatigue and being largely dependent on assistance. She also presented with anemia (Hct = 24.6 vol%). After one hour, a repeat glucose test showed high levels, prompting treatment with insulin (10 units SC). Additionally, she exhibited hyperkalemia due to end-stage chronic kidney disease, for which she received treatment with insulin (10 units), 50% glucose (50 ml IV slowly), 10% calcium gluconate (1 amp IV push), and 7.5% sodium bicarbonate (1 amp IV push), along with 30 gm of Kali mate mixed with 50 ml of water orally.While in the ER at Nong Nakham Hospital, the patient declined renal replacement therapy (RRT) and was subsequently referred to Phu Wiang Hospital. At Phu Wiang Hospital, she agreed to undergo dialysis and was further referred to Chum Phae Hospital for RRT.