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NPP6104 Assessment 2: Case Study

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Case Study

Parvana is a 13-year-old girl admitted to the emergency department via ambulance due to hyperglycaemic shock (Diabetes ketoacidosis-DKA). She was later transferred to your ward for further management.

Parvana’s parents are Amina, 35 (baker) and Ali, 38 (human resource personnel). She has two other siblings; Moro, 5 and Diana, 3. They were displaced from their home when the Taliban took over Kabul in Afghanistan. Ali used to work for the Australian embassy in Afghanistan. When the Taliban took over, he managed to get Amina and the children to Australia while he remained in Afghanistan to work. They spent one month in a refugee camp in Pakistan before moving to an Australian refugee facility in Perth. Ali has recently joined his family in the facility.

Parvana has a history of type 1 diabetes and has been on insulin injections since she turned 2 years. Moro and Diana are healthy kids with no medical or social issues. The parents have spent so much money and time on Parvana, and they have mentioned that their extended family was of huge assistance when they were in Afghanistan. The extended family assisted with caring for the three kids while Amina and Ali worked. The couple says they are now feeling lonely, overwhelmed with the children’s care and are worried about their family and friends in Afghanistan. Amina speaks limited English language, but Ali is proficient in English language. Both Amina and Ali are currently unemployed.

Parvana’s parents stated that since their arrival in Perth, she has lost interest in her usual activities, she has become more anxious and apprehensive, she is experiencing unexplained withdrawal, loss of appetite, loss of more than 30% of body weight, disordered sleep due to frequent nightmares and was diagnosed with post-traumatic stress disorder some few weeks ago. Prior to this, Parvana was described as a bubbling and lively elder sister who was keen on assisting and playing with her siblings. Amina has not been checking Parvana’s BGLs because the glucometer supplies run out and she is unaware of where to get the supplies and Parvana’s insulin. This morning when you took over Parvana’s care, her vital signs were: BGL= 29mmol/L; blood ketones 2.2 mmol/l, temperature 35.9, heart rate 120, respiratory rate 28, urinalysis (pH 5, specific gravity 1.035, glucose 2mmol/l, protein >30). She was sleepy and weak, and she was excessively thirsty but could not keep anything down. She was sweaty, clammy, pale and cold to touch.