Nursing Foundations: Case study Essay Example

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Nursing Foundations: Case study


Besides the administration of medication, the nursing process also includes various activities such as client teaching for the enhancement of the management of the illnesses of the respective clients. This is with special consideration to long-term illnesses such as diabetes. Thee client-teaching activity is tailored to the situation and circumstances of the client. This essay focuses on the scenario of 5-year-old Jaxson, a boy that was diagnosed with type-1 diabetes and is of school-going age. Type 1 diabetes is a result of the self-destructive process of the immune system where the immune system destroys the pancreatic beta cells responsible for the manufacture of insulin. The result is usually high blood sugar for the lack of the control of the blood glucose by the insulin.

Self-monitoring of blood glucose levels is one of the most essential self-management of the disease[ CITATION Sau17 l 1033 ]. This essay takes us through the diagnosis of the condition of Jaxson, the determination of the best way forward with self-care and the teaching process for the effective management of his blood glucose levels. The essay goes through the diagnosis, the determination of his learning needs in relation to self-management and the best approach to educate Jaxson and ingrain the pattern of self-check for blood glucose levels.


The various areas that affect the situation include the age of Jaxson (5 years old), the family background of Jaxson, his being a student, and his emotional and motor developmental stages. Other factors that may not be measurable and may come into play include the method of checking his blood glucose levels, his personality and the subsequent self-drive. His school environment and the possibility of monitoring are also possible determinants.

The expected learning outcomes include a clear understanding of the severity of dangerous blood glucose levels and an understanding of the importance of the monitoring of blood glucose levels. It is also expected that he learns how to determine that he has undesirable blood glucose levels, the actions to take, and the clear understanding of what diabetes type 1 is. Others include learning and internalizing personal routine checks that are unmonitored. An understanding of the symptoms of the high blood glucose levels is also essential for instances of emergencies around people that are not informed about his diabetic condition.

As a pupil, Jaxson must learn the basics of how to manage the diabetes which is why he must learn how to control his behaviour in relation to diet and test his own blood glucose. Diabetes requires the care and attention of the person who has the disease since the symptoms are only explained and easily monitored by the person. There are many factors to consider in relation to teaching him how to be independent. That involves caring for himself, self-drive, and self-control[ CITATION Sau17 l 1033 ].

His learning needs are determined with consideration to his level of physical, mental, and motor development. They include the fact that his vocabulary is limited, his autonomy is in its infancy and requires nurturing, and that his motor skills are still in development. It is highly likely that he knows little if anything about his condition and its management. It is essential to consider the extent of his awareness in relation to his condition and the reason why he gets the insulin medication he does. There is need for consideration of the diction and syntax used by adults in communication for modification to suit the age and level of understanding of Jaxson.

Being a child that is about to begin pre-school, the training about how to monitor his blood glucose levels and how to react the levels are dangerous should be done prior. That is because when he joins school life shall get busier and being a child in his preoperational stage of development he is not in a position to grasp and retain a lot of information at a go. The management of the type one diabetes requires a clear understanding of the risk associated with the lack of checking his blood glucose and the possible consequences[ CITATION Nur09 l 1033 ].

There is the reality of both cognitive and knowledge deficit where Jaxson is still adding onto his knowledge. Taking that into consideration, it is essential to feed him little information at a time and build upon that information after he shows an understanding of things previously taught. This is where the need for repetitiveness, motivation, and feeding little knowledge at a time comes into play[ CITATION Nur16 l 1033 ].

At his age, great effort must be put in his motivation for learning, especially since the learning required his understanding of various technical terms and advanced health implications. The use of graphics and examples familiar to his situation are essential for the encouragement of interest and the increase of the likelihood of a greater understanding. There is need to take the availability of learning resources that he can access within his environment. His environment includes the school and home environments which have different amounts of resources and monitoring personnel during his learning process in relation to the management of diabetes. Taking 5-year old Jaxson into consideration, he seems like a laid back child that is used to attention and closeness from his family. It is obvious that having been diagnosed with diabetes the level of care increased from all the members of his family.


The recommendation is to apply the Stress Management and Relaxation Techniques in education (the SMART method). This is a teaching program that is evidence-based. The maters that are most taken into consideration include the establishment of a balance between the cultivation of both emotional and mental intelligence. It also focuses on the improvement of the physical and mental health of the people involved and the reconnection of the professional and personal purposes of the individual.

The goals should to ensure that he checks for his blood glucose levels at least twice per day and records it within the first week of school. The other is to work towards his monitoring and recording his blood glucose levels at other random times and recording the same up to three random times within his three weeks of school. Additional goals include the alteration of the recording strategies by the end of the first month of school and the remembrance to record his readings without a reminder.

The other is the consideration of the best times to test his blood glucose levels. There are situations that expose one to the likelihood of hyperglycaemia and should be measured to prevent soaring and dangerous instances of the condition. It is also essential to consider the likelihood of the consumption of excessively sugary substances from other children which contributes to the increase of his blood glucose levels. For such, it is essential to consider the identification factors that require reporting to the teacher.

Making the case specific to 5-year-old Jaxson, the areas to focus on are the reduction of stress and burnout in the process of teaching him about diabetes and how to manage it. There is also need to focus on the reduction of the feeling of anxiety by taking the language used in communicating the information about the disease into consideration. Others include the improvement of attention, memory, mindfulness, and self-compassion. The method is most effective if applied in both the school and home environments.

Setting and Timing

It is also essential determine the setting and timing of the delivery of the nformation to Jaxson. The idea is to train Jaxson on how to monitor his blood glucose levels using the blood sugar meter and also consider the symptoms of diabetes to prompt his checking of the blood glucose levels. The plan should include the formulation of a schedule for memory purposes as opposed to random checking. As a child who is five years old, Jaxson is likely to get engaged in play and other activities and forget to randomly check his blood glucose levels. He is also likely to be oblivious of the symptoms in case of a complication[ CITATION Reb15 l 1033 ].

Materials needed by the teacher and resources needed by Jaxson

The fact that children exhibit magical thinking at this stage means that the strategies of teaching should be fascinating and attached to interesting reactions upon the lack of checking his glucose levels. Such are only made possible by the use of teaching materials that create interest and make the child eager to learn. Being that eager makes the child more willing to accommodate the information, maintain a longer attention span and accommodate more information by the use of objects for memory. However, the facts must be represented accurately since as he gets older, he shall build onto that information he gets at age five.

The teacher needs numerous toys, charts, timers, for practise and teaching purposes. They also need digital clocking records to record the instances when Jaxson remembers to read his blood glucose levels. Jaxson, on the other hand, needs a timer that sounds a comfortable reminder during meal times. The toys used for teaching could include word puzzles, question and answer gadgets to give answers related to the consequences that come as a result of negligence. The same also takes the developmental stages of Jaxson into consideration.

Teaching Methods

The choice of teaching method should vary based on the rate of the absorption and retention of information by Jaxson depending on his talents, abilities, and developmental stage. At this stage, it is essential to present the facts of his illness in simple terms that he can easily grasp. Being at a stage where he is still relatively egocentric, Jaxson needs to be presented with facts that show favour directed towards him. At this stage, feeding Jaxson bits of information helps so that he can build onto his schemas and eventually get a deep and clear understanding of his situation[ CITATION Hui97 l 1033 ].

The training that Jaxson requires involves self-control, self-consciousness, and an additional person that can assist in monitoring the behaviour and food consumption patterns of Jaxson. In order to assess the ability of Jaxson to accurately check his blood glucose levels, it is essential to check his glucose check table. The filling of the table must be an interesting activity and the monitoring encouraging and not one that is accompanied with harsh reprimand. Only then can Jaxson accurately report the number of times he checks his insulin levels. Although it is essential to set time intervals when he should check such as after meals, it is important to encourage more frequent checks, especially upon the detection of the obvious symptoms of hyperglycaemia such as severe thirst ad frequent urination.

Developmental, Social and Cultural Factors

The fact that children exhibit magical thinking at this stage means that the strategies of teaching should be fascinating and attached to interesting reactions upon the lack of checking his glucose levels. However, the facts must be represented accurately since as he gets older, he shall build onto that information he gets at age five.

Taking the theories of Piaget and Erickson into consideration, it is essential to make the teaching process interesting to Jason. It is even more important to make him feel worthy and let him express his autonomy for the development of genuine self-drive in relation to caring for his health and checking his glucose levels. If he is confident about his ideas and judgement, he is more likely to report when he feels his health is at stake because of the glucose levels to the teacher or to the other students. The need to build on his confidence for autonomous and self-driven behaviour is enhanced by Erickson’s theory of Autonomy vs Shame and Doubt.


Harsh reprimand and constant criticism directed towards the child when mistakes are done and the lack of approval result in the development of a sense of guilt and kill their morale and sense of initiative[ CITATION Mał09 l 1033 ]. At this stage, Jaxson looks up to his role models and identifies with the environment and the events within the environment. According to the explanation given by Tatala (2009), building up a bit of regular blood glucose checks is most likely to be adopted with consistency. As a result, the child does not quite develop in relation to the development of initiative. Based on that, it is essential to be careful on how the practice of the regular checking of the blood glucose by Jaxson when he is alone is enforced.

According to Erick Erickson’s psychosocial development theories, Jaxson is in the initiative vs guilt stage of psychosocial development[ CITATION Mał09 l 1033 ]. According to Tatala (2009), Jackson unconsciously seeks the approval of his parents and other caregivers. As a result, it is easy to rush his confidence if approached the wrong way. Although pointing out the mistake is essential for correction in the future, the nature of correction could either build Jaxson or demoralize him. It is important to make him understand that although it might be unintentional, frequent forgetfulness of checking his blood glucose levels is detrimental to his general health. It is also essential to ensure that he understands that imperfection is normal and it is all a matter of effort and practice.

Jaxson must have the liberty to record the monitoring readings in his own style to encourage autonomy. Such autonomy gives one a sense of control of his environment, something that children in the initiative vs guilt stages require[ CITATION Mał09 l 1033 ]. The mode of reminder, guidance, and the mode of correction matter in the way that the child reacts to such instances in future. It also affects the ability to internalize the practice. With the sense of control over his environment, it is easier for Jaxson to even develop something that suits his interests and even end up monitoring his blood glucose levels for fun. The focus should be directed towards the importance of recording his blood glucose levels whenever he checks them and be sure to check the glucose levels every time after meals as routine.

There is the additional dependency of his health on his honesty and responsibility. The fact that he is still developing his motor skills and schemas is of importance consideration in the determination of how the information about the condition and how to approach it when teaching it to Jaxson. It is found that making the monitoring and recording process fun in addition to monitoring the instances in which he monitors himself helps him develop a schedule. Repetition also plays an essential role in ingraining the culture of the frequent check of his blood glucose levels [ CITATION Eno10 l 1033 ].

Jaxson is five years old, a stage where he starts to initiate himself and exercise a reasonable level of control over his life as recorded by McLeod (2017). The control extends to his environment where a child begins to make personal decisions and try to control the environment in an attempt to do things his way. In this stage, it is upon the caregiver to give the morale and encouragement required to develop confidence in themselves and their decisions[ CITATION Mał09 l 1033 ].

In such an instance, scolding and punishing him are not options if the parents hope to build a sustainable sense of responsibility within him. Only through the self-set goals and reminders can Jaxson develop sustainable behaviour and develop a sense of purpose out of the lessons he gets in the process in relation to the condition [ CITATION Mał09 l 1033 ].

Taking into account the fact that Jaxson is in the pre-operational stage according to the developmental stages as presented by Jean Piaget, he is at the point where he can think symbolically and develop a memory of things. It is not easy for Jaxson to easily grasp complex facts[ CITATION Kay14 l 1033 m Web171 m Fer14].

The case of the frequent monitoring of his blood glucose levels could be initiated by the formulation of a schedule as laid out in the plan. According to the plan it is essential to check blood glucose levels after meals. However, they are most likely to be a little higher than normal after meals. It is for that reason that there is the option of giving Jaxson insulin pump therapy to save him the frequent insulin injections and only leave him the work of monitoring his blood glucose levels. That ensures that he receives the right insulin in his system throughout the day.

As a child in his preoperational stage, there is need for repetitiveness to get used to the pattern and practice of the procedure of checking for his blood glucose levels. Motivation in the form of recording the reading each time he checks against a time table is essential. It is also essential to avoid instances of punishment upon forgetting to record or check and record his blood glucose levels. That is because such behaviour may result in lying just to please the parents. In order to take initiative, letting Jason prepare his own monitoring timetable and select his method of filling it in with guidance is essential. People tend to take ownership of things in which they are involved.


Regular monitoring ensures that the patient does not experience cases of hyperglycaemia or hypoglycaemia. That is especially the case if the patient is using insulin pump therapy[CITATION NHS01 l 1033 ]. The frequent reminders are essential in helping with the developing and building up on the schemas of [ CITATION Bob08 l 1033 ]. The monitoring is essential in the evaluation of the change of diet and environment as a result of the commencement of school. The frequent monitoring ensures that he does not reach dangerous blood glucose levels because of the immediate action of doing a bolus if the hike is a result of meals.

The process of introducing the self- monitoring practice in Jaxson is one that must be fun, easy-to-remember and not rigid. Although checking his blood levels is essential, accuracy is more essential. It is for that reason that he must be allowed to drive the process.

A record of the blood glucose levels that is done during play times and meal times means that he is more likely to check the levels when paying or talking with his friends just to show off. It is a good sign since he is more likely to ingest items with high glucose levels when with his friends during play time than under normal school hours. That is further enforced by the possibility of a regular pattern in relation to the times that he records the levels on his book. If the checks are irregular, it is essential to check and see if he checks at the most crucial times, after meals. If it does not happen, it should be encouraged for the purposes of the adjustment of his blood insulin levels.


A 5-year child with diabetes type one is a delicate case because of the tender age and the developmental stage. That is because the monitoring of blood glucose levels among people with type 1 diabetes is essential for the maintenance of good health. However, it is risky when the most essential times of checking the glucose levels are ignored and frequent checks left out upon a change of schedules. The scenario described above is the delicate case of a child who is yet to grasp the idea of diabetes and the risk involved in the lack of the monitoring of his blood glucose levels when away from his family. It is more risky based on his former environment where he is cared for and the transition to school where there are several students and he must develop a sense of self drive. The family background as told is one that most likely helped him successfully go through the trust vs mistrust stage and one that autonomy is likely to be challenged but not shamed. That gives the likelihood of successful development through the second psychosexual stage, autonomy vs shame and doubt, as well.


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