Admission Avoidance. Scenario 2 Hypoglycaemia

Transcription

1 Admission Avoidance Course Scenario 2 Hypoglycaemia Course lead Colette Chapman-Laws Faculty Course / Admission Avoidance Target Curriculum Delegates Scenario name Hypoglycaemia causing reduced GCS Group Size Community nurses, Residential carers, District nurses, GPs, Community based therapists, Diabetes specialist nurses 12 Patients Name: Patients Age: Major Problem Learning Goal Narrative Description Staffing Case Briefing Manikin preparation Jimmy Glover 79 years old Medical Suggested NTS / Technical ABCDE approach Calling for help Recognising hypoglycaemia SBAR Administering hypostop Admission Avoidance Factors Understanding the factors affecting diabetes and glucose control Early intervention & regular review Jimmy is a 79 year old man who suffers from diabetes and usually takes insulin. He has been a resident for one month now. He normally has very good control of his sugars. Last night, his sugar was a little low and he did not feel like eating much he only had half a slice of toast for supper. He still had his normal insulin dose. This morning, he is found unrousable by a residential carer who gets help. A district nurse is nearby who is able to check blood glucose and is able to administer hypostop. The patient then regains consciousness. Faculty Control Room: 1 x Sim man controls 1 x Pt voice (ACTOR) To All Candidates Jimmy is a 79 year old man who suffers from type 1 diabetes and usually takes insulin. He normally has very good control of his sugars. Last night, his sugar was a little low and he did not feel like eating much he only had half a slice of toast. He still had his normal insulin dose. Lying in bed in night clothes Initially drowsy, saying a few words Faculty Role Players: 1 x Plant Candidates: 2 x Care Assistants 1 x District Nurse Admission Avoidance - Scenario 2 Hypoglycaemia. Page 1 of 7

2 . Room set up Simulator operation Props needed Notes to faculty Location: Residents Room Bed, table Manikin initially drowsy groaning only After hypostop given, more responsive after 2-3 minutes although pupils slightly dilated Talking fully by the end of the scenario DN bag, BP, temp, stethoscope BM machine, Hypostop, Diabetic Chart The underlying cause of the problem is hypoglycaemia. The primary cause is insulin administration on top of low dietary intake but he is possibly dehydrated too. The care assistant should call for assistance from qualified personnel - informing them of a deterioration in the resident. The qualified personnel should recommend an assessment, blood glucose test and admin of hypostop. The Scenario will end with the DN making a referral for further assessment by diabetic team and GP review. Admission Avoidance - Scenario 2 Hypoglycaemia. Page 2 of 7

3 Observations: Initial PAR score HR 110/minute 1 BP 110/70 0 RR 12/minute 0 AVPU P 1 Total PAR Score 2 BM = 1.6 AMTS = N/A Pain score: N/A Around time hypostop given Par score HR 110/minute 1 BP 110/70 0 RR 12/ minute 0 AVPU P 1 Total Par Score 2 2 minutes after hypostop Par score HR 100/minute 0 BP 110/70 0 RR 14/ minute 0 AVPU V 0 Total Par Score 0 After further 5 minutes Par score HR 85/minute 0 BP 115/75 0 RR 20/ minute 0 AVPU A 0 Total Par Score 0 Admission Avoidance - Scenario 2 Hypoglycaemia. Page 3 of 7

4 Results of Investigations Bloods N/A Gases N/A Other N/A Glu Ket Pro Blood Leu Nit Admission Avoidance - Scenario 2 Hypoglycaemia. Page 4 of 7

5 Patient Role Manikin You are Jimmy a 79 year old man who suffers from diabetes and usually takes insulin. You have only recently moved to the care home a month ago. You normally have very good control of your sugars. Last night, your sugar was a little low and you did not feel like eating much and only had half a slice of toast. You took your normal dose of insulin. This morning you are initially drowsy, moaning and saying a few words only. When hypostop is given, you start responding after 2-3 minutes, gradually becoming more responsive over the next 5 minutes. Past medical history: Diabetes (usually well controlled) Drug history: Insulin Allergies: None Social history: Jimmy is a grandfather to 3 children from his sons and daughters marriages. They all live in Guildford, Surrey and he hasn t been to visit them since his dementia became a problem and he often forgot where he was when he stayed with them. He prefers to live in South London where he grew up and worked as a pub landlord. He retired 10 years ago but still likes to pop along for an afternoon although he is less active now and tends to stay within the grounds of the home. Instructions: If asked, this has happened once before around a year ago when you skipped dinner. Towards the end of the scenario you begin to feel much better. Admission Avoidance - Scenario 2 Hypoglycaemia. Page 5 of 7

6 Plant Role Carer (plant) You only enter the room as another carer if the participants require help. Past medical history: Diabetes (usually well controlled) Drug history: Insulin Allergies: None Social history: Jimmy is a grandfather to 3 children from his sons and daughters marriages. They all live in Guildford, Surrey and he hasn t been to visit them since his dementia became a problem and he often forgot where he was when he stayed with them. He prefers to live in South London where he grew up and worked as a pub landlord. He retired 10 years ago but still likes to pop along for an afternoon although he is less active now and tends to stay within the grounds of the home. Instructions: You can help remind them that he has diabetes or to call for help. If help is asked for, you call the nearest person who is a district nurse who has just finished seeing another resident. Admission Avoidance - Scenario 2 Hypoglycaemia. Page 6 of 7

7 Participant Briefing Care Assistant 1 You have been asked to check on Jimmy Glove, a 79 year old man. He has not come down to have breakfast and is usually one of the first up. You know he suffers from diabetes and takes insulin. He has no other medical problems. You go and check on him to make sure he is OK and if he wants something to eat. Participant Briefing Care Assistant 2 You are a care assistant at the care home. Participant Briefing District Nurse You are doing a visit to the centre to see another patient with a pressure sore. You are called by a residential carer to help with another patient. You do not know any further information. Admission Avoidance - Scenario 2 Hypoglycaemia. Page 7 of 7