Type 1 Diabetes Chelsea Warren Shadow health Transcript
Transcript
Started: Jan 27, 2021 | Total Time: 118 min
 |
Checked ID band
|
Exam Action |
|
Assessed vitals
|
Exam Action |
|
Checked ID band
|
Exam Action |
|
Hello, I am nurse xxx. What is your name? Type 1 Diabetes Chelsea Warren Shadow health Transcript
|
Question |
 |
Hiiiii.
|
|
|
What is your name?
|
Question |
|
Chelsea Warren.
|
|
|
Nice. Welcome to the clinic Chelsea
|
Empathize |
|
Thank you.
|
|
|
What brought you to the clinic today?
|
Question |
|
Duh. Diabetes.
|
|
|
Sorry about that
|
Empathize |
|
Thanks, I appreciate it.
|
|
|
How do you feel?
|
Question |
|
I feel way better now. I am super ready to go home.
|
|
|
Good to hear
|
Empathize |
|
Ummmm thanks.
|
|
|
Are you having pain right now?
|
Question |
|
No. No pain.
|
|
|
That is great Chelsea
|
Empathize |
|
Thank you.
|
|
|
Do you feel comfortable?
|
Question |
|
Yeah, I feel comfortable. I just wanna go home. I’m way better now.
|
|
|
Why were you admitted?
|
Question |
|
Like . . . two days ago I was at a riding lesson and I felt really bad all of a sudden. Me and Ms. Saint George thought I got too hot, but then I puked — er, threw up. I don’t remember the rest very well, but my dad brought me here, and then the doctors said I had DKA or whatever.
|
|
|
Sorry about that incident
|
Empathize |
|
Ummmm thanks.
|
|
|
What was the duration of the symptoms? (No matching questions found.)
|
Question |
|
how long did the symptoms last?
|
Question |
|
I guess I felt bad for like, 10 days before the DKA.
|
|
|
Have you been urinating more often?
|
Question |
|
I was going a lot before the DKA thing. But it seems back to normal now.
|
|
|
Were you almost more thirsty?
|
Question |
|
I’m not super thirsty very often, but for like 10 days before the diabetic key-do . . . the DKA thing, before that I was soooo thirsty. I could not drink enough water. I literally could not.
|
|
|
Have you been feeling more thirsty?
|
Question |
|
Well, before the DKA, I was super duper thirsty for like . . . 10 days. I didn’t know what was wrong, I just started drinking so much water. It felt like my mouth was always dry.
|
|
|
Excessive thirst is a symptom of DKA
|
Educate |
|
Oh, ok. I think I get it.
|
|
|
Are you fatigued?
|
Question |
|
I feel way better now, but before the DKA I was really tired. I didn’t wanna do anything. I felt like a slug. That happened for like . . . I dunno. Like 10 days before the DKA. It was super weird.
|
|
|
Are you always feeling fatigued?
|
Question |
|
I mean I’m not normally tired. I was super tired before the DKA, but I didn’t know that’s what was wrong with me.
|
|
|
Any appetite changes?
|
Question |
|
My appetite is fine now, but before the diabetic key . . . the DKA thing . . . I didn’t want to eat, like, anything. My mom thought maybe I was getting sick or hitting a growth spurt or something.
|
|
|
Am glad your appetite is back Chelsea.
|
Empathize |
|
Thanks, I appreciate it.
|
|
|
When did you start feeling sick?
|
Question |
|
I’ve been feeling pretty bad for a while. Since like ten days ago. I started feeling really bad right before dad took me to the hospital. That was two days ago.
|
|
|
What type of diabetes do you have?
|
Question |
|
Type 1. The kid kind.
|
|
|
That is correct.
|
Educate |
|
There’s so much to learn. I feel like my brain is full! But thanks for telling me.
|
|
|
What is your favorite diet? (No matching questions found.)
|
Question |
|
What is your typical diet?
|
Question |
|
My mom, Nora, is like, a total health nut. Breakfast is yogurt and fruit, lunch on the weekends is salad and chicken, and then she always does some kind of healthy grilled meat and veggies. Dad . . . well, he’s a little more chill about it. I mean, he’s a lot busier so he can’t cook as much.
|
|
|
Well, it is good to have high intake of fruits and vegetables
|
Educate |
|
This is a lot to take in, but I think I get it.
|
|
|
What is your usual breakfast?
|
Question |
|
When I’m staying with my mom, normally we eat yogurt and fruit for breakfast. When I stay with Dad, he likes to make pancakes or waffles sometimes.
|
|
|
What do you usually eat for lunch?
|
Question |
|
Well, I eat lunch at school. Shadow Academy has pretty good food, actually. When I’m staying with mom, on the weekends she’ll make a big salad with chicken. For lunch with my dad, we usually go out for a sandwich.
|
|
|
It is good to follow the recommended diet for people with diabetes
|
Educate |
|
Ok. Ok. I got it.
|
|
|
Do you exercise?
|
Question |
|
Yeah. I ride horses a few times a week, and there’s also gym class at school. Sometimes on the weekends Dad wants me to go running with him, but I hate it.
|
|
|
That is nice. Exercise is very important for your health
|
Educate |
|
There’s so much to learn. I feel like my brain is full! But thanks for telling me.
|
|
|
Don’t worry about that
|
Empathize |
|
Thank you.
|
|
|
D o you smoke tobacco?
|
Question |
|
No way! What would Sparkle think of me?
|
|
|
Yeah, smoking is bad for your health
|
Educate |
|
Ok. Ok. I got it.
|
|
|
Have you ever vaped or used an ecigarette?
|
Question |
|
Puff on a USB stick that turns your lungs into popcorn? I’ll pass.
|
|
|
Do you drink alcohol?
|
Question |
|
OMG I dunno. I’m 11! I’ve never tried it.
|
|
|
Yeah, alcohol is bad for your health
|
Educate |
|
This is a lot to take in, but I think I get it.
|
|
|
Do you have a headache?
|
Question |
|
Headaches? I don’t really get those.
|
|
|
Did your nausea improve?
|
Question |
|
Yup — I don’t feel nauseated anymore.
|
|
|
That is nice.
|
Empathize |
|
Ummmm thanks.
|
|
|
Are you feeling sick?
|
Question |
|
I feel way better now. I felt really bad two days ago, but I’m back to normal now.
|
|
|
Are you going to be sick?
|
Question |
|
I don’t feel like that anymore. I haven’t thrown up in two days.
|
|
|
Are you feeling constipated?
|
Question |
|
Nope. That’s normal, thanks.
|
|
|
How long have you been urinating more frequently?
|
Question |
|
I was peeing a lot more like . . . 10 days before I had the diabetic key . . . the DKA thing.
|
|
|
Do you feel dizzy?
|
Question |
|
Nuh uh.
|
|
|
Do you feel tingling anywhere?
|
Question |
|
No, nothing like that.
|
|
|
Do you have a wound?
|
Question |
|
Uh, I don’t think so. I don’t really get hurt that often, though.
|
|
|
What is your relationship to the patient?
|
Question |
 |
Chelsea is my daughter.
|
|
|
What is your daughter’s diagnosis?
|
Question |
|
She’s been diagnosed with type 1 diabetes.
|
|
|
WHEN WAS YOUR DAUGHTER DIAGNOSED WITH DIABETES?
|
Question |
|
Well, when I took Chelsea to the emergency room the doctors ran some tests and asked me about her symptoms. She was confused and disoriented. Honestly, I didn’t know what was going on with her until the doctors told us she has type 1 diabetes. Type 1 Diabetes Chelsea Warren Shadow health Transcript
|
|
|
Oooh, sorry about that
|
Empathize |
|
Uh, thanks.
|
|
|
When was your daughter hospitalized?
|
Question |
|
We came to the hospital two days ago. She had diabetic ketoacidosis when we came in, but I think she’s feeling a lot better now.
|
|
|
Did your daughter have complications with her diabetes?
|
Question |
|
We came to the hospital two days ago. She had diabetic ketoacidosis when we came in, but I think she’s feeling a lot better now.
|
|
|
How was your daughter feeling?
|
Question |
|
Chelsea was feeling pretty bad when we first got here. I thought maybe she had a stomach bug, because she was throwing up. She was also kind of confused — just not herself. She was pretty out of it. Type 1 Diabetes Chelsea Warren Shadow health Transcript
|
|
|
Sorry about that. Its hard seeing your child unwell
|
Empathize |
|
Thank you.
|
|
|
Has your daughter’s weight changed lately?
|
Question |
|
Well, her horseback riding lesson two days ago was the first time I’d seen her in two weeks. She was staying with her Mom. When I saw her at her riding lesson, I thought she looked a little thinner than normal.
|
|
|
How much weight has your daughter lost?
|
Question |
|
I think she lost around five pounds. It happened in the last two weeks, when she was staying with her mom. She’s not normally this thin.
|
|
|
Do you know anything about type 1 diabetes?
|
Question |
|
Just what I’ve learned here in the hospital. We’ve had a lot of different people come in and talk to us . . . and I’ve been reading a lot of articles on my phone. I’ve been reading about insulin, and uh, carb counting, but I don’t think it’s all sunk in.
|
|
|
It is good to have good knowledge about the disease so that you can manage your daughter’s condition effectively
|
Educate |
|
I see.
|
|
|
What is your daughter’s typical diet? (Clarified to What is your daughter’s diet like?.)
|
Question |
|
It’s actually pretty normal, I suppose. Pancakes and fruit for breakfast are my speciality. I’ll either fix a sandwich and chips for lunch or she’ll get lunch at school. Dinner varies between take-out or my world famous chili. (Clarified to what my daughter’s diet is like.) Type 1 Diabetes Chelsea Warren Shadow health Transcript
|
|
|
It is recommended to avoid high intake of carbs and fatty foods. Please follow the appropriate debates diet.
|
Educate |
|
Okay.
|
|
|
How many carbohydrates does your daughter eat a day?
|
Question |
|
I . . . I don’t think she eats many carbs. I haven’t counted yet, but we stick to pretty healthy foods. We don’t eat a lot of sugar.
|
|
|
What medications does your daughter take for her diabetes? (No matching questions found.)
|
Question |
|
What medications does your daughter take? (No matching questions found.)
|
Question |
|
Any treatment? (No matching questions found.)
|
Question |
|
Are you married?
|
Question |
|
Chelsea’s mom, Nora, and I are divorced. We split custody 50/50, so Chelsea stays with me for two weeks at a time, and then stays with her mom for two weeks. We try to set a good example and, you know, do the civil co-parenting thing.
|
|
|
Okay, I know divorce is hard even for the kids. But it is good to see Chelsea has the love of both her parents even after the divorce
|
Empathize |
|
Mmmhmmm.
|
|
|
How is your daughter’s relationship with her mother? Type 1 Diabetes Chelsea Warren Shadow health Transcript
|
Question |
|
Chelsea and Nora are really close.
|
|
|
That is great
|
Empathize |
|
Uh, thanks.
|
|
|
Has your daughter been hospitalized before?
|
Question |
|
This is Chelsea’s first visit to a hospital. No surgeries . . . I mean, she hasn’t even broken a bone before.
|
|
|
Does any one in your family have diabetes?
|
Question |
|
Well, Mother has type 2 diabetes. She was diagnosed a little bit after Chelsea was born. Other than that, nothing else.
|
|
|
Do you take medications?
|
Empathize |
|
Thanks, I appreciate it.
|
|
|
Do you take medications?
|
Question |
|
Um, I mean, I guess I take insulin every day, if that’s what you mean.
|
|
|
Do you monitor your blood glucose levels? (Clarified to Do you check your blood sugar at home?.)
|
Question |
|
Other people have been checking it for me. I haven’t done it myself yet. (Clarified to if I check my blood sugar.)
|
|
|
Okay. It is good to closely monitor your glucose levels
|
Educate |
|
Oh, ok. I think I get it.
|
|
|
thanks for answering the questions Chelsea. Type 1 Diabetes Chelsea Warren Shadow health Transcript
|
Empathize |
|
Thank you.
|
|
|
Do you have a high heart beat?
|
Educate |
|
There’s so much to learn. I feel like my brain is full! But thanks for telling me.
|
|
|
Do you have a high heart beat? (Clarified to Does your heart race?.)
|
Question |
|
Nope, my heart feels fine. (Clarified to if my heart races.)
|
|
|
Do you have fever?
|
Question |
|
No, I don’t think I have a fever.
|
|
|
I will now perform a physical assessment
|
Educate |
|
Oh, ok. I think I get it.
|
|
|
Checked ID band
|
Exam Action |
|
Assessed vitals
|
Exam Action |
|
Do you feel any pain?
|
Question |
|
No. No pain.
|
|
|
Assessed growth
|
Exam Action |
|
Assessed growth
|
Exam Action |
|
Inspected IV site
|
Exam Action |
|
Assessed vitals
|
Exam Action |
|
Do you have any needs right now? (Clarified to Do you need anything?.)
|
Question |
|
I guess, uh . . . I guess I need to know more about this diabetes stuff. I find it all kinda confusing, but I want to know more. (Clarified to if I need anything.)
|
|
|
Diabetes is a metabolic disease. With the right diet, appropriate exercise and adherence to medication and close monitoring of the blood glucose levels, the condition can be managed very well.
|
Educate |
|
Ok. Ok. I got it.
|
|
|
Inspected IV site
|
Exam Action |
|
Educate Chelsea in the most therapeutic manner on what supplies she will need to administer insulin.
|
Exam Action |
|
Chelsea, before you administer insulin, you will need a new, packaged syringe, a vial of insulin, alcohol wipes, and access to a special container for storing your used syringe. Do you have any questions? Type 1 Diabetes Chelsea Warren Shadow health Transcript
|
Question |
|
Okay, got it.
|
|
|
Actually, what do you mean by a special container?
|
|
|
It is called a sharps container. Before you go home, we will make sure that each of your parents gets one, and that you know where to find one at school.
|
Question |
|
Okay, thanks.
|
|
|
Educate in the most therapeutic manner on how to prepare a syringe for injection.
|
Exam Action |
|
Ned, take the syringe out of its packaging, and pull the cap off of the needle on the syringe. Pull the plunger of the syringe back until it is level with the correct dose. The numbers are printed on the side of the syringe.
|
Question |
|
Understood. This is how I will prep Chelsea’s syringe when I am going to administer Chelsea’s insulin.
|
|
|
Hey, I thought I was going to be doing that.
|
|
|
You have not selected the most therapeutic way to deliver this information. The incorrect response you selected has been removed. Try again with the remaining responses.
|
Exam Action |
|
Educate in the most therapeutic manner on how to prepare a syringe for injection.
|
Exam Action |
|
Chelsea, take the syringe out of its packaging, and pull the cap off of the needle on the syringe. Pull the plunger of the syringe back until it is level with the correct dose. The numbers are printed on the side of the syringe.
|
Question |
|
Take the syringe out of the package, get the cap off the needle, pull the plunger back to my correct dose. Roger, dodger.
|
|
|
Educate Chelsea on the first steps in filling the syringe with insulin.
|
Exam Action |
|
Put the bottle of insulin on a flat surface, and hold it steady with one hand. With your other hand, push the needle straight into the insulin bottle and slowly push the plunger down. This will inject the air in the syringe into the bottle. Don’t pull the syringe out yet. Any questions?
|
Question |
|
No questions. So far, so good.
|
|
|
Educate Chelsea on completing the process of filling the syringe with insulin.
|
Exam Action |
|
With the needle still in the insulin vial, turn both upside down, so that the bottom of the vial is pointing at the ceiling. Slowly draw the plunger down so that insulin fills the syringe. Keep the tip of the needle in the insulin, and make sure you don’t bend the needle. Do you have any questions? Type 1 Diabetes Chelsea Warren Shadow health Transcript
|
Question |
|
I still get it.
|
|
|
Educate Chelsea on how to evacuate air bubbles from the syringe.
|
Exam Action |
|
The needle is still in the bottle at this point. Tap the side of the syringe with your finger to make any bubbles rise to the top. Then, you can push the plunger just enough to force the air out through the needle.
|
Question |
|
Makes sense to me.
|
|
|
Now that I think about it, what’s wrong with air?
|
|
|
Injecting yourself with insulin is safe, but if there are bubbles in the syringe, they will take up space, and you won’t inject enough insulin.
|
Question |
|
Understood.
|
|
|
Educate Chelsea on prepping the insulin injection site.
|
Exam Action |
|
After removing the needle from the vial, use an alcohol pad to clean the injection site. Let the site dry, otherwise it might sting a little. Pinch approximately 1 inch of skin, not too hard. Insert the needle into the pinched skin at the proper angle and slowly push the plunger in until it is empty. Leave the needle in your skin for five seconds. Any questions?
|
Question |
|
Huh, okay.
|
|
|
Educate Chelsea on how to complete the injection process.
|
Exam Action |
|
Once you take the needle out, keep an eye on the area you injected. If you see any bleeding, use a tissue to clean it up. If you see any insulin leak out, check back with your provider to go over the injection process again.
|
Question |
|
Watch out for leaks, and clean up the blood. I got it.
|
|
|
Now it’s time for Chelsea to demonstrate what she’s learned.
|
Exam Action |
|
Ok, Chelsea, do you feel ready to practice injecting insulin? We’re going to use sterile saline to practice, since you don’t need a dose of insulin right now.
|
Question |
|
Yep! Let’s do this.
|
|
|
Are you sure you’re ready for this, sweetie?
|
|
|
I got it, Dad. Don’t worry.
|
|
|
Chelsea demonstrates the proper technique for how to prep and fill a syringe. Type 1 Diabetes Chelsea Warren Shadow health Transcript
|
Exam Action |
|
Next.
|
Question |
|
Chelsea demonstrates the proper technique for giving herself an injection.
|
Exam Action |
|
Next.
|
Question |
|
You complete education with Chelsea on how to effectively manage her diabetes, having successfully covered areas such as glucose monitoring using a glucometer, how to manage risk factors such as hypoglycemia and hyperglycemia, how her diet impacts her diabetes, what to do on sick days, and how to create an action plan at her school. Chelsea and Ned both verbalize that they feel ready to manage Chelseas new chronic illness. Ned says he feels confident that he and his ex-wife will be able to manage Chelsea’s diabetes for the next few days, until their appointment with an endocrinologist. Type 1 Diabetes Chelsea Warren Shadow health Transcript
|