Case Study #2

Patient Name: Jacob M.

Age: 17

Diagnosis: Type 1 Diabetes Mellitus (T1DM)

History: Diagnosed at age 10, uses insulin pump therapy, active in sports

Situation:

Jacob is brought to the emergency department by his coach after collapsing during basketball practice. He is unconscious, diaphoretic, and unresponsive to verbal stimuli. A bedside glucose check reveals a blood sugar of 28 mg/dL. VS are temp. 97 F, HR 112, RR 12, BP 104/48, 02 sat 96%.

The nurse prepares to administer 1 mg of glucagon IM as per the emergency protocol.
After administering glucagon, what is the nurse's next priority action?

Turn the patient on his side

Administer a second dose of glucagon

Prepare for intubation

Give a high-protein snack

Answer and Explanation

The Correct Answer is A

A. Turn the patient on his side: After administering glucagon to treat severe hypoglycemia, the nurse should turn the patient to their side to prevent aspiration if the patient vomits as they regain consciousness. This is a preventive measure to protect the airway until he wakes up.

B. Administer a second dose of glucagon: Glucagon is usually given once in emergency situations to treat severe hypoglycemia. A second dose is not needed unless the patient remains unresponsive after 15 minutes, but the priority action is to monitor the patient closely after the first dose.

C. Prepare for intubation: There is no immediate evidence suggesting the need for intubation. Jacob’s respiratory rate (12/min) and oxygen saturation (96%) are within reasonable limits. The priority is to monitor his response to glucagon and keep the airway clear.

D. Give a high-protein snack: A high-protein snack should only be given after the patient is awake and alert and able to swallow safely. The immediate priority is to ensure the patient’s safety and monitor their response to glucagon.

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Correct Answer is C

Explanation

A. Converts glycogen to glucose: The process of converting glycogento glucoseis known as glycogenolysis, and it occurs in the liver. This is actually stimulated by glucagon, not insulin. Insulinworks to lower blood sugar levels by facilitating glucose uptake.

B. Stimulates the breakdown of adipose tissue: Insulinactually preventsthe breakdown of adipose tissue. It promotes fat storageby inhibiting lipolysis (fat breakdown). It is glucagonand other hormones that stimulate fat breakdown during fasting states.

C. Stimulates active transport of glucose into muscle and adipose tissue cells: The primary function of insulinis to facilitate the uptake of glucoseinto muscleand adipose tissuecells by stimulating glucose transporterson the cell membrane. This helps lower blood glucose levels.

D. Increases the breakdown of protein into amino acids: Insulinhas an anaboliceffect on protein metabolism, meaning it promotes protein synthesisand inhibits the breakdown of proteins into amino acids. Glucagonis more involved in protein catabolismduring fasting states.

A. Characterized mainly by insulin resistance B. Characterized mainly by insulin deficiency C. Best managed through diet, exercise, and oral medication D. Can be prevented by proper nutrition and monitoring blood glucose levels

Correct Answer is B

Explanation

A. Characterized mainly by insulin resistance: Insulin resistance is more characteristic of type 2 diabetes, not type 1 diabetes. In type 1 diabetes, the body is unable to produce insulin due to the autoimmune destruction of pancreatic beta cells.

B. Characterized mainly by insulin deficiency: Type 1 diabetes is caused by insulin deficiency due to the body's inability to produce insulin, leading to high blood sugar levels. This is a life-long condition that requires insulin replacement for proper blood glucose control.

C. Best managed through diet, exercise, and oral medication: Type 1 diabetes cannot be managed with oral medication alone. It requires insulin injections or an insulin pump in addition to diet and exercise to control blood glucose levels.

D. Can be prevented by proper nutrition and monitoring blood glucose levels: Type 1 diabetes is an autoimmune disease and cannot be prevented through nutrition or blood glucose monitoring. Prevention strategies are more applicable to type 2 diabetes.

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Naxlex Comprehensive Predictor Exams

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