Type 1 Diabetes Chelsea Warren Shadow health Transcript

Transcript

Started: Jan 27, 2021 | Total Time: 118 min
Your avatar
 Checked ID band

Exam Action
01/27/21 5:21 PM PST

Your avatar
 Assessed vitals

Exam Action
01/27/21 5:21 PM PST

Your avatar
 Checked ID band

Exam Action
01/27/21 5:21 PM PST

Your avatar
Hello, I am nurse xxx. What is your name?

Question
01/27/21 5:32 PM PST

Chelsea Warren
Hiiiii.
Your avatar
What is your name?

Question
01/27/21 5:32 PM PST

Chelsea Warren
Chelsea Warren.
Your avatar
Nice. Welcome to the clinic Chelsea

Empathize
01/27/21 5:32 PM PST

Chelsea Warren
Thank you.
Your avatar
What brought you to the clinic today?

Question
01/27/21 5:33 PM PST

Chelsea Warren
Duh. Diabetes.
Your avatar
Sorry about that

Empathize
01/27/21 5:33 PM PST

Chelsea Warren
Thanks, I appreciate it.
Your avatar
How do you feel?

Question
01/27/21 5:34 PM PST

Chelsea Warren
I feel way better now. I am super ready to go home.
Your avatar
Good to hear

Empathize
01/27/21 5:34 PM PST

Chelsea Warren
Ummmm thanks.
Your avatar
Are you having pain right now?

Question
01/27/21 5:35 PM PST

Chelsea Warren
No. No pain.
Your avatar
That is great Chelsea

Empathize
01/27/21 5:36 PM PST

Chelsea Warren
Thank you.
Your avatar
Do you feel comfortable?

Question
01/27/21 5:38 PM PST

Chelsea Warren
Yeah, I feel comfortable. I just wanna go home. I’m way better now.
Your avatar
Why were you admitted?

Question
01/27/21 5:38 PM PST

Chelsea Warren
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.
Your avatar
Sorry about that incident

Empathize
01/27/21 5:39 PM PST

Chelsea Warren
Ummmm thanks.
Your avatar
What was the duration of the symptoms? (No matching questions found.)

Question
01/27/21 5:40 PM PST

Your avatar
how long did the symptoms last?

Question
01/27/21 5:40 PM PST

Chelsea Warren
I guess I felt bad for like, 10 days before the DKA.
Your avatar
Have you been urinating more often?

Question
01/27/21 5:41 PM PST

Chelsea Warren
I was going a lot before the DKA thing. But it seems back to normal now.
Your avatar
Were you almost more thirsty?

Question
01/27/21 5:42 PM PST

Chelsea Warren
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.
Your avatar
Have you been feeling more thirsty?

Question
01/27/21 5:42 PM PST

Chelsea Warren
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.
Your avatar
Excessive thirst is a symptom of DKA

Educate
01/27/21 5:43 PM PST

Chelsea Warren
Oh, ok. I think I get it.
Your avatar
Are you fatigued?

Question
01/27/21 5:43 PM PST

Chelsea Warren
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.
Your avatar
Are you always feeling fatigued?

Question
01/27/21 5:44 PM PST

Chelsea Warren
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.
Your avatar
Any appetite changes?

Question
01/27/21 5:44 PM PST

Chelsea Warren
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.
Your avatar
Am glad your appetite is back Chelsea.

Empathize
01/27/21 5:45 PM PST

Chelsea Warren
Thanks, I appreciate it.
Your avatar
When did you start feeling sick?

Question
01/27/21 5:45 PM PST

Chelsea Warren
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.
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What type of diabetes do you have?

Question
01/27/21 5:46 PM PST

Chelsea Warren
Type 1. The kid kind.
Your avatar
That is correct.

Educate
01/27/21 5:46 PM PST

Chelsea Warren
There’s so much to learn. I feel like my brain is full! But thanks for telling me.
Your avatar
What is your favorite diet? (No matching questions found.)

Question
01/27/21 5:47 PM PST

Your avatar
What is your typical diet?

Question
01/27/21 5:47 PM PST

Chelsea Warren
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.
Your avatar
Well, it is good to have high intake of fruits and vegetables

Educate
01/27/21 5:48 PM PST

Chelsea Warren
This is a lot to take in, but I think I get it.
Your avatar
What is your usual breakfast?

Question
01/27/21 5:48 PM PST

Chelsea Warren
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.
Your avatar
What do you usually eat for lunch?

Question
01/27/21 5:49 PM PST

Chelsea Warren
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.
Your avatar
It is good to follow the recommended diet for people with diabetes

Educate
01/27/21 5:50 PM PST

Chelsea Warren
Ok. Ok. I got it.
Your avatar
Do you exercise?

Question
01/27/21 5:50 PM PST

Chelsea Warren
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.
Your avatar
That is nice. Exercise is very important for your health

Educate
01/27/21 5:50 PM PST

Chelsea Warren
There’s so much to learn. I feel like my brain is full! But thanks for telling me.
Your avatar
Don’t worry about that

Empathize
01/27/21 5:51 PM PST

Chelsea Warren
Thank you.
Your avatar
D o you smoke tobacco?

Question
01/27/21 5:51 PM PST

Chelsea Warren
No way! What would Sparkle think of me?
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Yeah, smoking is bad for your health

Educate
01/27/21 5:52 PM PST

Chelsea Warren
Ok. Ok. I got it.
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Have you ever vaped or used an ecigarette?

Question
01/27/21 5:52 PM PST

Chelsea Warren
Puff on a USB stick that turns your lungs into popcorn? I’ll pass.
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Do you drink alcohol?

Question
01/27/21 5:53 PM PST

Chelsea Warren
OMG I dunno. I’m 11! I’ve never tried it.
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Yeah, alcohol is bad for your health

Educate
01/27/21 5:53 PM PST

Chelsea Warren
This is a lot to take in, but I think I get it.
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Do you have a headache?

Question
01/27/21 5:54 PM PST

Chelsea Warren
Headaches? I don’t really get those.
Your avatar
Did your nausea improve?

Question
01/27/21 5:54 PM PST

Chelsea Warren
Yup — I don’t feel nauseated anymore.
Your avatar
That is nice.

Empathize
01/27/21 5:56 PM PST

Chelsea Warren
Ummmm thanks.
Your avatar
Are you feeling sick?

Question
01/27/21 5:56 PM PST

Chelsea Warren
I feel way better now. I felt really bad two days ago, but I’m back to normal now.
Your avatar
Are you going to be sick?

Question
01/27/21 5:56 PM PST

Chelsea Warren
I don’t feel like that anymore. I haven’t thrown up in two days.
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Are you feeling constipated?

Question
01/27/21 5:57 PM PST

Chelsea Warren
Nope. That’s normal, thanks.
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How long have you been urinating more frequently?

Question
01/27/21 5:58 PM PST

Chelsea Warren
I was peeing a lot more like . . . 10 days before I had the diabetic key . . . the DKA thing.
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Do you feel dizzy?

Question
01/27/21 5:58 PM PST

Chelsea Warren
Nuh uh.
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Do you feel tingling anywhere?

Question
01/27/21 5:58 PM PST

Chelsea Warren
No, nothing like that.
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Do you have a wound?

Question
01/27/21 5:58 PM PST

Chelsea Warren
Uh, I don’t think so. I don’t really get hurt that often, though.
Your avatar
What is your relationship to the patient?

Question
01/27/21 5:59 PM PST

Ned Warren
Chelsea is my daughter.
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What is your daughter’s diagnosis?

Question
01/27/21 6:00 PM PST

Ned Warren
She’s been diagnosed with type 1 diabetes.
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WHEN WAS YOUR DAUGHTER DIAGNOSED WITH DIABETES?

Question
01/27/21 6:00 PM PST

Ned Warren
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.
Your avatar
Oooh, sorry about that

Empathize
01/27/21 6:00 PM PST

Ned Warren
Uh, thanks.
Your avatar
When was your daughter hospitalized?

Question
01/27/21 6:01 PM PST

Ned Warren
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.
Your avatar
Did your daughter have complications with her diabetes?

Question
01/27/21 6:01 PM PST

Ned Warren
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.
Your avatar
How was your daughter feeling?

Question
01/27/21 6:02 PM PST

Ned Warren
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.
Your avatar
Sorry about that. Its hard seeing your child unwell

Empathize
01/27/21 6:02 PM PST

Ned Warren
Thank you.
Your avatar
Has your daughter’s weight changed lately?

Question
01/27/21 6:03 PM PST

Ned Warren
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.
Your avatar
How much weight has your daughter lost?

Question
01/27/21 6:04 PM PST

Ned Warren
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.
Your avatar
Do you know anything about type 1 diabetes?

Question
01/27/21 6:05 PM PST

Ned Warren
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.
Your avatar
It is good to have good knowledge about the disease so that you can manage your daughter’s condition effectively

Educate
01/27/21 6:05 PM PST

Ned Warren
I see.
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What is your daughter’s typical diet? (Clarified to What is your daughter’s diet like?.)

Question
01/27/21 6:06 PM PST

Ned Warren
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.)
Your avatar
It is recommended to avoid high intake of carbs and fatty foods. Please follow the appropriate debates diet.

Educate
01/27/21 6:07 PM PST

Ned Warren
Okay.
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How many carbohydrates does your daughter eat a day?

Question
01/27/21 6:08 PM PST

Ned Warren
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.
Your avatar
What medications does your daughter take for her diabetes? (No matching questions found.)

Question
01/27/21 6:09 PM PST

Your avatar
What medications does your daughter take? (No matching questions found.)

Question
01/27/21 6:09 PM PST

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Any treatment? (No matching questions found.)

Question
01/27/21 6:10 PM PST

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Are you married?

Question
01/27/21 6:10 PM PST

Ned Warren
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.
Your avatar
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
01/27/21 6:11 PM PST

Ned Warren
Mmmhmmm.
Your avatar
How is your daughter’s relationship with her mother?

Question
01/27/21 6:12 PM PST

Ned Warren
Chelsea and Nora are really close.
Your avatar
That is great

Empathize
01/27/21 6:13 PM PST

Ned Warren
Uh, thanks.
Your avatar
Has your daughter been hospitalized before?

Question
01/27/21 6:13 PM PST

Ned Warren
This is Chelsea’s first visit to a hospital. No surgeries . . . I mean, she hasn’t even broken a bone before.
Your avatar
Does any one in your family have diabetes?

Question
01/27/21 6:14 PM PST

Ned Warren
Well, Mother has type 2 diabetes. She was diagnosed a little bit after Chelsea was born. Other than that, nothing else.
Your avatar
Do you take medications?

Empathize
01/27/21 6:14 PM PST

Chelsea Warren
Thanks, I appreciate it.
Your avatar
Do you take medications?

Question
01/27/21 6:15 PM PST

Chelsea Warren
Um, I mean, I guess I take insulin every day, if that’s what you mean.
Your avatar
Do you monitor your blood glucose levels? (Clarified to Do you check your blood sugar at home?.)

Question
01/27/21 6:15 PM PST

Chelsea Warren
Other people have been checking it for me. I haven’t done it myself yet. (Clarified to if I check my blood sugar.)
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Okay. It is good to closely monitor your glucose levels

Educate
01/27/21 6:16 PM PST

Chelsea Warren
Oh, ok. I think I get it.
Your avatar
thanks for answering the questions Chelsea.

Empathize
01/27/21 6:16 PM PST

Chelsea Warren
Thank you.
Your avatar
Do you have a high heart beat?

Educate
01/27/21 6:17 PM PST

Chelsea Warren
There’s so much to learn. I feel like my brain is full! But thanks for telling me.
Your avatar
Do you have a high heart beat? (Clarified to Does your heart race?.)

Question
01/27/21 6:17 PM PST

Chelsea Warren
Nope, my heart feels fine. (Clarified to if my heart races.)
Your avatar
Do you have fever?

Question
01/27/21 6:17 PM PST

Chelsea Warren
No, I don’t think I have a fever.
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I will now perform a physical assessment

Educate
01/27/21 6:18 PM PST

Chelsea Warren
Oh, ok. I think I get it.
Your avatar
 Checked ID band

Exam Action
01/27/21 6:18 PM PST

Your avatar
 Assessed vitals

Exam Action
01/27/21 6:18 PM PST

Your avatar
Do you feel any pain?

Question
01/27/21 6:30 PM PST

Chelsea Warren
No. No pain.
Your avatar
 Assessed growth

Exam Action
01/27/21 6:30 PM PST

Your avatar
 Assessed growth

Exam Action
01/27/21 6:31 PM PST

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 Inspected IV site

Exam Action
01/27/21 6:31 PM PST

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 Assessed vitals

Exam Action
01/27/21 6:32 PM PST

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Do you have any needs right now? (Clarified to Do you need anything?.)

Question
01/27/21 7:01 PM PST

Chelsea Warren
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.)
Your avatar
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
01/27/21 7:02 PM PST

Chelsea Warren
Ok. Ok. I got it.
Your avatar
 Inspected IV site

Exam Action
01/27/21 7:02 PM PST

Your avatar
 Educate Chelsea in the most therapeutic manner on what supplies she will need to administer insulin.

Exam Action
01/27/21 7:03 PM PST

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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?

Question
01/27/21 7:06 PM PST

Chelsea Warren
Okay, got it.
Chelsea Warren
Actually, what do you mean by a special container?
Your avatar
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
01/27/21 7:07 PM PST

Chelsea Warren
Okay, thanks.
Your avatar
 Educate in the most therapeutic manner on how to prepare a syringe for injection.

Exam Action
01/27/21 7:07 PM PST

Your avatar
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
01/27/21 7:08 PM PST

Ned Warren
Understood. This is how I will prep Chelsea’s syringe when I am going to administer Chelsea’s insulin.
Chelsea Warren
Hey, I thought I was going to be doing that.
Your avatar
 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
01/27/21 7:08 PM PST

Your avatar
 Educate in the most therapeutic manner on how to prepare a syringe for injection.

Exam Action
01/27/21 7:08 PM PST

Your avatar
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
01/27/21 7:09 PM PST

Chelsea Warren
Take the syringe out of the package, get the cap off the needle, pull the plunger back to my correct dose. Roger, dodger.
Your avatar
 Educate Chelsea on the first steps in filling the syringe with insulin.

Exam Action
01/27/21 7:09 PM PST

Your avatar
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
01/27/21 7:10 PM PST

Chelsea Warren
No questions. So far, so good.
Your avatar
 Educate Chelsea on completing the process of filling the syringe with insulin.

Exam Action
01/27/21 7:10 PM PST

Your avatar
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?

Question
01/27/21 7:10 PM PST

Chelsea Warren
I still get it.
Your avatar
 Educate Chelsea on how to evacuate air bubbles from the syringe.

Exam Action
01/27/21 7:10 PM PST

Your avatar
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
01/27/21 7:11 PM PST

Chelsea Warren
Makes sense to me.
Chelsea Warren
Now that I think about it, what’s wrong with air?
Your avatar
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
01/27/21 7:11 PM PST

Chelsea Warren
Understood.
Your avatar
 Educate Chelsea on prepping the insulin injection site.

Exam Action
01/27/21 7:11 PM PST

Your avatar
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
01/27/21 7:12 PM PST

Chelsea Warren
Huh, okay.
Your avatar
 Educate Chelsea on how to complete the injection process.

Exam Action
01/27/21 7:12 PM PST

Your avatar
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
01/27/21 7:12 PM PST

Chelsea Warren
Watch out for leaks, and clean up the blood. I got it.
Your avatar
 Now it’s time for Chelsea to demonstrate what she’s learned.

Exam Action
01/27/21 7:12 PM PST

Your avatar
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
01/27/21 7:12 PM PST

Chelsea Warren
Yep! Let’s do this.
Ned Warren
Are you sure you’re ready for this, sweetie?
Chelsea Warren
I got it, Dad. Don’t worry.
Your avatar
 Chelsea demonstrates the proper technique for how to prep and fill a syringe.

Exam Action
01/27/21 7:13 PM PST

Your avatar
Next.

Question
01/27/21 7:13 PM PST

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 Chelsea demonstrates the proper technique for giving herself an injection.

Exam Action
01/27/21 7:13 PM PST

Your avatar
Next.

Question
01/27/21 7:13 PM PST

Your avatar
 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.
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