Nursing Essay: Pre-Operative Care in the Case of Hypoglycemia

Question

Task: You are required to submit a fully referenced academic nursing essay demonstrating your knowledge and application of best evidence-based nursing practice in relation to the following case scenario.

In accordance to academic writing, students are required to write in the third person.

Case Study Scenario:
It is 0800 hours and you are working in a Paediatric Unit in a large metropolitan hospital. You are caring for Shaun Cross, a 15 -year-old male, who has Type I Diabetes. Shaun has been admitted for an exploratory arthroscope on his right knee, from an injury incurred whilst playing soccer. Shaun has fasted from 0600 hours and continues to fast (Nil by Mouth) in preparation for the surgery which is booked for 1000hours. Shaun last administered insulin to himself at 2000 hours the previous evening. Medical history: Nil known allergies. Shaun was diagnosed with Type I Diabetes six (6) months ago. Shaun’s diabetes has been well controlled with Lantus 50 units BD (mane and nocte). His last HbA1c three (3) weeks ago was 6.4% / 48mmmol. Social History: Shaun lives with his family of four, Mother Leanne, Father Paul, and Sister Kelsey. Shaun is currently completing year 10 at secondary school and enjoys playing Basketball and Soccer.

The following data was assessed when Shaun was admitted to the ward:
Subjective data:
• Verbal pain rating 0/10
• Alert and talkative
Objective data:
• Blood pressure: 115/60 mm Hg
• Heart rate: 62 beats per minute
• Respiratory rate: 16/minute
• Temperature 36.2 tympanic
• SaO2: 100% Room air
• Random BGL 5.2mmol
• Weight: 61Kg

Shaun returns to the ward following his procedure at 1130 hours. He complains of severe nausea and is unable to tolerate any diet or oral fluids.

Answer

Introduction
As stated in this nursing essay, nursing practice plays a crucial role in post-operative care for patients of fifteen years with hypoglycemia. It is no different in the case of Shaun, a fifteen-year-old boy with Type I diabetes with the need for an operation to treat exploratory arthroscope on his right knee. Medical history of Shaun shows that he is a patient of Type I Diabetes; however, it is well controlled with Lantus 50 units BD (mane and nocte) along with 6.4% / 48 mmol HbA1c as per the report of three weeks back. At the same time, he has no allergies. In such a situation, the essay focuses on describing pre-operative care, management, prevention, and assessment of postoperative hypoglycemia along with education for sick day management. At the same time, it is also crucial for the nursing management team to educate Shaun and his family to manage diabetes.

Pre-operative care
Pre-operative care plays a vital role in managing hypoglycemia that affects health related safety and security of diabetic patients. However, to prevent adverse consequences in the post-operative phase it is essential for nursing staff to manage the entire procedure of work more efficiently. However, following aspects will be managed while treating and preparing Shaun for the operation.

Maintenance of normal blood glucose levels
Nursing and medical interventions need to include maintenance of normal blood glucose, recognition of altered blood glucose, and normal blood glucose levels. Primary reason for such a fact is that it is not possible for the nursing staff to work efficiently regarding managing blood glucose. Most importantly, medical nutrition therapy helps in preventing and managing existing diabetes to manage any complication (Vonderauet al. 2021). This therapy requires limiting glucose level in blood that is a reading between 7.8 mmol/L and 11.0 mmol/L. At the same time, CHO ratio regarding blood sugar is required to be maintained in the case of Shaun by administering insulin therapy through an equal number of rapid-acting insulin of the grams of carbohydrate.

Frequency of blood glucose monitoring
Shaun has been diagnosed as a patient of type I diabetes, and in such a circumstance it is essential to check the blood sugar level four to ten times a day. Most importantly, nutrition guidelines need to be taken care of Shaun for 7 to 14 days in general. At the same time, nursing staff can provide better support to Shaun regarding his health along with managing diabetes by testing blood sugar before snacks and meals along with after and before exercise. Most importantly, it is essential for the nursing staff to maintain the safety measurement related to the health of Shaun to manage the pre-operative care (Thapa et al. 2021). At the same time, pre-operative care plays a vital role in shaping up the success of the operation.

Reference to normal blood glucose levels
Level of glucose in a person’s blood needs to be controlled after going through operations. However, it can be done through proper nutrition support. It has been identified that metabolic needs for Shaun are essential here to control malnutrition. Dietary aspects of Shaun can only help in improving the level of blood. Along with that, it will help in controlling hypoglycemia by limiting high-sugar foods.

Recognition of altered blood glucose
Nursing staff have the opportunity to help Shaun as per the needs and requirements of his health. At the same time, it is also essential to consider factors such as increased thirst, frequent urination, and headaches. It is also essential for the nursing management team to identify other symptoms such as blurred vision, weakness, irritability, and fatigue in the case of Shaun. Blood glucose affects the procedure of operation in the case of patients with hypoglycemia rather than nondiabetic patients (Jemelet al. 2019). Most importantly, it is quite normal for responding to the diabetic patients regarding surgery compared to nondiabetic patients.

Assessment, prevention, and management of postoperative hypoglycemia Management of nausea and vomiting
Nausea and vomiting are quite normal in the case of hypoglycemia in postoperative cases that affect the procedure of responding to the operative situations for patients. However, this situation can be handled by trying to normalise the blood pressure and oxygenation of Shaun. Most importantly, it is essential for the nursing staff to provide any medicine and drug only after consulting the surgeon (Tommaso et al. 2019). Along with that, IV fluids can help in managing the dehydration of the patient. At the same time, it is crucial to manage any adverse situation and consequences by administering antiemetic to patients. However, it is essential to consider adverse drug reactions, anxiety, and volatility of anaesthetics. Opioids are other aspects that can affect the health of Shaun.

Re-introduction of diet and fluids
Reactive hypoglycemia can occur due to eating habits or dietary aspects of any patient after completion of any complex operations. In this case, it is crucial for the nursing management team to help the entire procedure of work by managing the entire situation by following strict guidelines of the surgeon to manage any deterioration in Shaun's health. Shaun is a boy of only fifteen, and it is the duty of the nursing staff to help him to get rid of any situation that can harm him. At the same time, fluids that can help him in managing hydration of the body need to be provided to time (Balasubramaniamet al. 2018). Along with that, diet can monitor and manage hypoglycemia of Shaun that can help him to manage the level of blood glucose. It has also been identified in the case of Shaun that medical conditions, medications, lifestyle choices, exercise, and diet can help him manage the entire situation.

Frequency of blood glucose monitoring
After completion of the operation and shifting Shaun to the bed it is essential to monitor his health regarding blood glucose ten times a day. At the same time, it is also essential to take care of every activity and responding nature of Shaun that can help him to stay healthy and safe even after having Type I diabetes and hypoglycemia (Fralicket al. 2021). It is worth noting that patients with Type I diabetes often face issues regarding hypoglycemia. However, this situation can be managed and controlled through better care and services to Shaun. It is only the caring approach and responsibilities of nurses that make them more mature to manage and monitor the present condition of a patient after going through an operation.

Recognition of signs and symptoms
Before treating any adverse consequences it is essential for the nursing staff to get a clear idea whether the patient is facing hypoglycemia or not. In order to do so, the nursing staff requires to see whether Shaun is becoming easily irritated, fast or pounding heartbeat and feeling trembling, or tingling lips. It is crucial for every nursing staff to strictly check every approach and movement of Sharyn to see whether he is feeling hungry shortly or he has any dizziness. At the same time, it is also essential for the nursing staff to identify whether Shaun is feeling tired or sweating that can affect his health. At the same time, there are a few more symptoms, including irritability, confusion, and inability to concentrate (Rieggeret al. 2021). Along with that, Shaun requires to know every aspect of his health that can affect his normal life even after managing the entire process of work. Brain is the most crucial organ that becomes affected due to hypoglycemia. Primary reasons for occurrence of such an issue include adrenal glands and pituitary glands stop working properly. At the same time, these glands start to produce hormones at a lower speed. Other critical diseases that create hypoglycemia in the case of postoperative patients include sepsis, cancer, heart failure, and chronic kidney disease. In such a condition, it is essential for Shaun to manage such a critical situation.

Education for sick day management
It is essential for Shaun and his family to understand the need of staying alert regarding proper management of diabetes along with “sick days.” For example, nursing staff need to maintain the frequency of blood glucose monitoring by four to ten times a day. It is also essential to modify the aspect of Insulin administration dosage as per the requirements. At the same time, CHO dietary intake can only help Shaun to manage body fluid. Medical attention is another essential aspect of the management system of post-operative care. Educational resources regarding such a critical situation include journals and cases on hypoglycemia among teenagers.

Education for exercise
Frequency of monitoring blood glucose along with managing procedures of checking blood glucose should be four times a day before and after exercise. At the same time, Shaun and his family need to understand the importance of CHO dietary intake that can help him to stay healthy and make him avoid any consequences (Vlahuet al. 2018). Recognition of hypoglycaemia can be done through symptoms such as dizziness, fatigue, hunger, and blurriness in eyesight. Shaun also requires to know about Emergency CHO supply and first aid such as medicines and IV fluids that can help him prevent vomiting and dehydration.

Conclusion
Thus, it is crucial for nursing staff to take care of Shaun in both the phases such as pre-operative and post-operative situations that can affect his entire health. Most importantly, the entire management team requires proper training regarding essential drugs and medicines along with implementing knowledge on the procedure of managing patients with type I diabetes when it comes to managing post and pre-operative situations. In this case, the essay has highlighted the procedure of recognising hypoglycemia that can affect the health of Shaun after operation.

Reference List
Balasubramaniam, U., Kiran, U., Hasija, S., &Devagourou, V. (2018). Randomized Study Comparing Pre-Operative Glycemic Profile in Pediatric Cardiac Surgical Patients Administered Oral Carbohydrate Solution Preoperatively versus Those Kept Fasting. World Journal of Cardiovascular Diseases, 8(06), 298.https://www.scirp.org/html/3-1910764_85281.htm

de Tommaso, A. M. A., Hessel, G., Riccetto, A. G., de Oliveira Semenzati, G., &Gusmão, R. J. (2019).

PRE AND POST-OPERATIVE OTORHINOLARYNGOLOGY SURGERY CARE IN PATIENTS WITH GLYCOGEN STORAGE DISEASE TYPE 1. RevistaPaulista de Pediatria, 37(4), 516.https://www.scielo.br/pdf/rpp/2019nahead/0103-0582-rpp-2019-37-4-00005.pdf

Fralick, M., Dai, D., Pou?Prom, C., Verma, A. A., & Mamdani, M. (2021). Using Machine Learning to Predict Severe Hypoglycemia in Hospital. Diabetes, Obesity and Metabolism.https://dom-pubs.onlinelibrary.wiley.com/doi/abs/10.1111/dom.14472

Jemel, M., Kandara, H., Adel, M., El, G. D., Jemni, H., &Kammoun, I. (2019, May). Insulinoma: a case series of a tertiary care center. In Endocrine Abstracts (Vol. 63). Bioscientifica.https://www.endocrine-abstracts.org/ea/0063/ea0063P425

Riegger, L. Q., Leis, A. M., Golmirzaie, K. H., & Malviya, S. (2021). Risk factors for intraoperative hypoglycemia in children: a multicenter retrospective cohort study. Nursing essayAnesthesia & Analgesia, 132(4), 1075-1083.https://journals.lww.com/anesthesia-analgesia/Abstract/2021/04000/Risk_Factors_for_Intraoperative_Hypoglycemia_in.19.aspx

Thapa, A. S., Yadav, R. K., Basnet, R., Pradhan, B., Maharjan, R., & Chaudhary, S. (2021). Pre-operative Hypoglycemia in Patients Presenting for Surgery: A Hospital Based Cross-sectional Study. Journal of Lumbini Medical College, 9(1), 4-pages.https://jlmc.edu.np/index.php/JLMC/article/download/373/321 Vlahu, T., Mancil, E., Amin, V., Menich, B., & Forsythe, S. M. (2018). Comparison of Post-Operative Cardiac Surgery Blood Glucose

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