Create an SBAR report for this patient.  What if the client with type 1 diabetes mellitus displaying symptoms of nervousness, confusion, pallor, diaphoresis, and tachycardia suddenly becomes unconscious with shallow breathing? What actions would you take and what is your rationale for those actions?  How would you include that in your SBAR?  What are interdisciplinary team follow up appointments you would recommend for this patient?

SBAR Report for a Patient with Type 1 Diabetes Mellitus Experiencing Unconsciousness with Shallow Breathing:

Situation:
The patient is a client with type 1 diabetes mellitus who is currently displaying symptoms of nervousness, confusion, pallor, diaphoresis, and tachycardia. Suddenly, the patient becomes unconscious with shallow breathing.

Background:
Type 1 diabetes mellitus is a chronic condition where the body does not produce enough insulin. This leads to an imbalance in blood sugar levels, resulting in various symptoms and potentially life-threatening complications. Nervousness, confusion, pallor, diaphoresis, and tachycardia are signs of hypoglycemia, which occurs when blood sugar levels drop too low. Unconsciousness with shallow breathing in this context suggests severe hypoglycemia that may progress to a diabetic coma.

Assessment:
Upon assessment, it is important to confirm the patient’s unconsciousness and shallow breathing. Assess the level of consciousness using the Glasgow Coma Scale and monitor the respiratory rate, effort, and oxygen saturation levels. Measure blood glucose levels immediately to determine the severity of hypoglycemia.

Recommendation:
Given the criticality of the situation and the potential for life-threatening consequences, immediate actions are necessary.

1. Activate the emergency response team:
Inform the relevant healthcare professionals, including the rapid response team or the emergency department, about the patient’s condition. Provide essential details such as the patient’s background (type 1 diabetes), symptoms, and the progression to unconsciousness with shallow breathing. Request prompt medical intervention and alert the team about the suspected severe hypoglycemia.

Rationale:
Activating the emergency response team is crucial to ensure skilled medical professionals with knowledge of emergency procedures promptly assess and manage the patient’s condition. In cases of severe hypoglycemia leading to unconsciousness, immediate intervention is necessary to prevent further deterioration.

2. Initiate first aid measures:
Administer 15 grams of rapidly absorbed carbohydrates, such as oral glucose gel or tablets, to increase the patient’s blood glucose levels. If the patient is unable to swallow, consider administering intramuscular or subcutaneous glucagon, which stimulates the release of stored glucose from the liver.

Rationale:
Providing rapidly absorbed carbohydrates or administering glucagon helps increase blood glucose levels, potentially reversing the severe hypoglycemia and restoring consciousness. These initial interventions can be lifesaving in cases of hypoglycemic emergencies.

3. Monitor vital signs and blood glucose levels:
Continuously monitor the patient’s vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation. Additionally, check the patient’s blood glucose levels at regular intervals to assess the response to initial interventions.

Rationale:
Ongoing monitoring is essential to evaluate the patient’s response to treatment and ensure stabilization. Monitoring vital signs helps detect any potential complications or changes in the patient’s condition, allowing for timely intervention.

4. Consider intravenous glucose administration:
If the patient does not respond to initial interventions or the hypoglycemia is severe, consider administering intravenous glucose to rapidly raise blood glucose levels.

Rationale:
Intravenous glucose administration provides a more direct and rapid method of increasing blood glucose, especially in cases of severe hypoglycemia where oral interventions may not be sufficient. This intervention may be necessary to stabilize the patient and prevent further complications.

SBAR Communication:
When communicating this situation through the SBAR framework, include the following:

Situation: Patient with type 1 diabetes experiencing symptoms of nervousness, confusion, pallor, diaphoresis, and tachycardia suddenly becomes unconscious with shallow breathing.

Background: Type 1 diabetes mellitus, chronic condition leading to insulin deficiency; symptoms indicate severe hypoglycemia; potential risk of developing a diabetic coma.

Assessment: Confirmation of unconsciousness and shallow breathing; Glasgow Coma Scale assessment; monitoring of respiratory rate, effort, oxygen saturation; immediate measurement of blood glucose.

Recommendation: Activate emergency response team for immediate medical intervention; initiate first aid measures (15g carbohydrates or glucagon); continuous monitoring of vital signs and blood glucose levels; consider intravenous glucose if no response to initial interventions or severe hypoglycemia persists.

Interdisciplinary Team Follow-up:
After the acute management of the aforementioned emergency, it is crucial to recommend appropriate interdisciplinary team follow-up appointments for the patient. These include:

1. Endocrinologist:
The endocrinologist, specializing in diabetes management, will conduct a comprehensive review of the patient’s diabetes management plan, evaluate the event that led to severe hypoglycemia, and make necessary adjustments to the insulin regimen or other diabetes medications.

2. Diabetes Educator:
A diabetes educator will provide additional education on managing hypoglycemia and offer strategies to prevent future episodes. They will review the patient’s blood glucose monitoring and insulin administration techniques, providing guidance for better glycemic control.

3. Dietitian:
A dietitian will assess the patient’s current dietary practices and recommend modifications to ensure optimal glucose control. They will educate the patient about the importance of proper nutrition in managing diabetes and provide meal planning guidance.

4. Mental Health Professional:
The mental health professional may be involved if the patient experiences emotional distress or anxiety related to diabetes management, as reflected by symptoms of nervousness and confusion. They can provide counseling and support to help the patient cope with the psychological impact of living with a chronic condition.

In conclusion, when a client with type 1 diabetes mellitus displays symptoms of severe hypoglycemia, resulting in unconsciousness with shallow breathing, immediate action is necessary. Activating the emergency response team, administering rapidly absorbed carbohydrates or glucagon, continuous monitoring, and considering intravenous glucose administration are crucial steps in managing this life-threatening emergency. Additionally, interdisciplinary team follow-up appointments will further address the patient’s long-term diabetes management and prevent future episodes of severe hypoglycemia.