SBAR Report – Diabetes Mellitus

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SBAR Report – Diabetes Mellitus

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 Patient with Type 1 Diabetes Mellitus

Situation:

The patient, a 76-year-old male with type 1 diabetes mellitus, is exhibiting acute symptoms of nervousness, confusion, pallor, diaphoresis, and tachycardia. He suddenly becomes unconscious and presents with shallow breathing.

Background:

The patient has a known history of type 1 diabetes mellitus requiring insulin therapy. He has previously experienced episodes of hypoglycemia but has been able to manage them with dietary adjustments and family support. Recent lab results indicated fluctuating blood glucose levels, necessitating ongoing monitoring and management.

Assessment:

  • Neurological: Patient is unconscious and previously demonstrated confusion and nervousness.
  • Vital Signs: Tachycardia noted; shallow breathing observed; blood pressure requires monitoring.
  • Skin Assessment: Pallor and diaphoresis indicative of possible hypoglycemia.
  • Respiratory: Shallow breathing, requiring immediate intervention.

Recommendation:

  1. Immediate Actions:
    • Administer 15-20 grams of fast-acting carbohydrates if the patient is conscious and able to swallow (e.g., glucose tablets, juice).
    • If unconscious, initiate intravenous dextrose or glucagon administration as per protocols.
    • Activate emergency medical services for rapid transport to the hospital if the patient does not regain consciousness.
    • Continuous monitoring of vital signs and perform a blood glucose check immediately.
  2. Interdisciplinary Team Follow-Up Appointments:
    • Endocrinologist: To reassess and adjust the diabetes management plan.
    • Registered Dietitian: For dietary guidance to help prevent future hypoglycemic episodes.
    • Certified Diabetes Educator: To provide education on self-management and recognizing hypoglycemic symptoms.
    • Primary Care Physician: For overall care coordination and management of any comorbid conditions.

Rationale for Actions Taken

  • Immediate Administration of Carbohydrates: The symptoms suggest the possibility of hypoglycemia. Prompt treatment is necessary to prevent further neurological damage and stabilize the patient.
  • Glucagon/Dextrose Administration: In cases of unconsciousness, administering glucagon or dextrose intravenously offers immediate access to glucose, which is crucial for regaining consciousness and stabilizing vital functions.
  • Monitoring and Emergency Services: Continuous monitoring is vital, and activating emergency services ensures that the patient receives advanced care swiftly if he does not improve.
  • Interdisciplinary Follow-Up: Collaboration with specialists, such as an endocrinologist, dietitian, and diabetes educator, will ensure comprehensive management of the patient’s diabetes and help mitigate the risk of future complications.

Including the Information in SBAR

In the SBAR report, the actions taken can be incorporated into the Recommendation section, formatted as follows:

Recommendation:

  • Administer fast-acting carbohydrates if conscious; if unconscious, initiate IV dextrose or glucagon.
  • Activate emergency medical services if the patient does not regain consciousness.
  • Schedule follow-up appointments with the endocrinologist, registered dietitian, certified diabetes educator, and primary care physician for comprehensive diabetes management and support.

This ensures that the healthcare team is aware of the acute interventions performed and the planned follow-up care, facilitating effective management of the patient’s diabetes and health status.

 

References

American Diabetes Association. (2023). Standards of Medical Care in Diabetes—2023. Diabetes Care, 46(Supplement 1), S1–S2. https://doi.org/10.2337/dc23-SINT

Frier, B. M., & Fisher, M. (2016). Hypoglycemia and Diabetes: A Summary of the Evidence. Diabetes Spectrum, 29(2), 103–108. https://doi.org/10.2337/diaspect.29.2.103

Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet, 383(9922), 1068-1083. https://doi.org/10.1016/S0140-6736(13)62154-6

American Association of Clinical Endocrinologists. (2021). AACE/ACE Comprehensive Diabetes Management Algorithm 2021. Endocrine Practice, 27(6), 510-512. https://doi.org/10.4158/EP-2021-0192

McNay, E. C., & Coyle, J. (2016). Glucose Regulation and Behavior: A Role for the Brain in Diabetes Management. Endocrine Reviews, 37(3), 271-303. https://doi.org/10.1210/er.2015-1106

 
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