Nursing Care for an Elderly Patient with Hypoglycemia, Acute Cholecystitis, and Shock: A Case Study

Abstract

Older adults with diabetes are at high risk of hypoglycemia, particularly when oral intake decreases, acute illness occurs, or glucose-lowering medications are continued. Acute cholecystitis may progress to severe infection and shock, especially in older adults with multiple comorbidities. Nursing care therefore requires rapid assessment, safe correction of hypoglycemia, close hemodynamic monitoring, timely antimicrobial therapy, fluid resuscitation, and prevention of complications. The objective of this case study was to examine the nursing care process for an elderly patient with hypoglycemia, acute cholecystitis, and shock. This case study included one elderly patient admitted to Wiset Chai Chan Hospital. Data were obtained from medical records, physician’s orders, laboratory findings, treatment records, and nursing notes, and were analyzed according to the nursing process and current academic principles.

The results revealed that a 72-year-old Thai female with type 2 diabetes mellitus and metabolic comorbidities was admitted to Wiset Chai Chan Hospital with hypoglycemia associated with poor oral intake and fatigue. During hospitalization, she developed right upper quadrant abdominal pain with positive Murphy’s sign and clinical findings suggestive of acute cholecystitis with shock. Nursing care included close DTX monitoring, correction of hypoglycemia, adjustment of antidiabetic medications, intravenous fluid therapy, antimicrobial therapy, fasting during the acute phase, vasopressor support during hemodynamic instability, and continuous monitoring of laboratory findings. Her blood glucose became more stable, abdominal symptoms improved, and shock gradually resolved.

Nursing care should focus on early assessment, close blood glucose and hemodynamic monitoring, infection surveillance, complication prevention, and discharge education for patients and relatives to prevent recurrent hypoglycemia and reduce readmission.