Becky has been admitted to the paediatric ward from the emergency department after being brought to hospital by her parents due to becoming drowsy at home. Becky is being treated for diabetic ketoacidosis via intravenous insulin and fluids, blood glucose was 36 mmol/l and blood ketones were 3.2 mmol/l on admission. Currently, becky is withdrawn and has said she wants to go home, she says will be ok and that she doesn’t want the treatment. When speaking to mom and dad, they have stated that becky should not be told about the severity of her condition as she will worry too much. Patient Details Name: becky Smith Date of Birth: 13/08/2009 - Age 14 Address: Next Of Kin: Parents, James and Donna Religion: None Ethnic origin: White British Presenting Complaint or Reason for visit Diabetic ketoacidosis (DKA) secondary to recently diagnosed type 1 diabetes (T1DM) Past Medical History T1DM Autism Current Medication Lantus – 12 units - one per day in the evening Novorapid – for administration with each meal – approx. 1 unit per 10g carbohydrate Allergies NKDA Family and Social History · Lives with parents and 1 younger brother with autism / non-verbal / challenging behaviour · Attends mainstream secondary school, but refuses support from Autism Outreach as her friends will think she’s stupid · becky likes computer games – prefers to spend time in her room online gaming and talking to online friends as they understand her · Enjoys playing table tennis at school and with her dad when he has time · States smokes sometimes as her friends at school do it at the bus stop, she doesn’t drink alcohol · No direct familial history of diabetes · Struggles with big changes – causing anxiety & emotional outbursts · No significant other medical history Current observations and results Observations Results Blood Pressure 94/58 Heart Rate 118 beats per minute (bpm) Respiratory Rate 38 breaths per minute Oxygen Saturation (SaO2) 99% in air Temperature 36.9 AVPU Alert PEWS Score 4 Normal Range Blood Glucose 28mmol/l 4-7mmol/l Blood Ketones 2.6mmol/l < 1mmol/l Communication from other health care professionals GP note – Brought to surgery by mother as was refusing to take insulin, has been upset about diagnosis, afraid of needles and thinks her friends will laugh. Becky does not want to watch what she is eating, take injections nor monitor her activity. Becky has been having outbursts at home, throwing things and hiding in her room. During the consultation, despite encouragement, becky refused to engage nor make eye contact, all information was provided by mother. Advised both regarding consequences of non-compliance, eg hyper/hypo-glycaemia and hospitalisation, advised to return if problems persist. Legal – Discuss how law and legislation could impact on the nurse's decision making, when caring for the patient/service user.