WEEK 2 SIM LAB – ENDOCRINE CHRONIC ILLNESS MANAGEMENT 2021/2022 EDITION

Week 2 : SimLab A – 2807NRS Chronic Illness Management Mr John Grant is a 64 year old man with a diagnosis of left knee osteoarthritis and a history of angina, hypertension (HTN), hyperlipidaemia, type 2 diabetes (T2DM), and depression. He also has mild reflux controlled by occasional doses of antacid and by moderating his alcohol intake. John underwent a right total knee replacement (TKR) 12 months ago. During hospitalisation, John reported angina symptoms after which he was prepared for coronary angiography and proceeded for coronary artery bypass graft (CABG) surgery. John has now returned to hospital to undergo a left total knee replacement (TKR). He reports that although his previous knee replacement was successful, he has been finding it difficult to manage his blood glucose lately as he is back at work at the café, experiencing quite a bit of stress, and not eating healthily as recommended by his cardiac rehabilitation team. He reports recent blood glucose levels (BGLs) between 3.8 and 22 mmol/L with little consistency throughout the day. He is scheduled for surgery tomorrow morning. The doctor has ordered enoxaparin sodium (100mg) and an insulin infusion to manage his diabetes while in hospital. His BGL is currently 13mmol/L.Skyler is an 18-year old male who was brought in by ambulance to the Emergency Department with diabetic ketoacidosis three days ago. He was experiencing fatigue and frequent urination beginning 2-3 weeks ago which progressively became worse. He has spent the last three days in the Intensive Care Unit receiving IV fluids and IV Insulin. His IV insulin has been discontinued. His electrolytes and blood glucose levels have stabilised and he has now been transferred to the medical ward. His urinary catheter was removed at 1930 hours yesterday. He has since consumed 1000 mL of water and is passing urine without difficulty. Urine output during the night was 700mL. He is alert and responsive. He has no significant past medical history and takes no medications. His immunisations are up to date. As far as his mother is aware he does not smoke or use illicit drugs but she does admit that in the last year he has come home drunk a couple of times. He lives with his parents and is a student. He is actively involved in sport. His mother has been with him since he was admitted and she is very worried for him.