Patient Profile

Janine is a 21-year-old college student with Type I Diabetes Mellitus. She has been admitted to the hospital several times in the past when her diabetes was out of control. Janine has shared with several nurses that she eats foods that are not on her diet, goes to parties where she drinks beer, and corrects for these behaviors by giving herself extra units of regular insulin. She admits that sometimes she forgets to take her insulin and that she has not managed her diabetes very well. She hates having Diabetes and “being different.”

Approximately two days ago, she attended a party and drank 2 or 3 glasses of beer. She began to feel very intoxicated and asked for a ride home from two male party-goers. They gave her a ride home and sexually assaulted her when they arrived at her apartment. She did not report the sexual assault because she felt stupid that she must have drank a beer that was spiked with a drug. Instead, she went to work and school the next day. She stated she tried to forget the sexual assault by pushing it to the back of her mind and keeping herself busy. Last night, she attempted suicide with an overdose of Xanax (Alprazolam) and is currently hospitalized. Her friend found her and called 9-1-1. She was transported to the nearest ED and treated for the overdose. On admission to the ED, her blood sugar was 413mg/dL and the medical team decided to admit her to an inpatient medical unit to get her diabetes under control before she can be transferred to a mental-health unit. She has an insulin drip that is being titrated to her blood sugars.
Case Study

At 11 PM during the change of shift report, the 3-11 nurse tells the night nurse coming on duty that Janine, one of her assigned patients, is very attention seeking and noncompliant with her treatment regimen. About 2 hours into the shift, the night nurse hears Janine screaming. Janine says she has had a bad dream and does not think she can get back to sleep. She says she is very anxious and asks for a sleeping pill to help her go to sleep.




Discussion Questions

Please answer the following questions. Your answers should reflect a level of depth and understanding that incorporates theory and content from all your classes to date. Your answers need to be written in complete sentences and prepared in APA format.

1. How should you respond to a report that a patient is attention seeking and non-compliant?
2. How do you respond to this patient’s request for a sleeping pill?
3. You ask the patient if there is anything bothering her that might have caused the nightmare. She replies, “You wouldn’t understand. You have not experienced what I have.“ What do you say or do? Later the patient says, “I am going to tell you something that I haven’t told anyone. I want you to promise not to tell anyone else.” How should you respond?
4. The patient reveals to you that two men sexually assaulted her about 48 hours ago and she did not report it to the police. What do you say or do, if anything? Does she have the right not to report the sexual assault? What ethical issues are involved that might be troubling to you or the patient?
5. You recall there is a morning after pill (levonorgestrel) to prevent unwanted pregnancy. How does this pill work? How long after sexual intercourse is this pill effective? Does this pill present any potential ethical or legal issues?
6. What factors or variables increase an adult‘s vulnerability to drug-facilitated sexual assault? What are predator (date rape) drugs and what educational tips could you give this client on preventive measures to avoid being given such a drug?




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