Diabetes/Renal Failure/Dialysis Case Study

Concept: Fluid and Electrolytes

Can be done individually or in groups (best if there is no more than 4students/group)

Your neighbor Janice, a 43 year old divorced mother of three, stopped you on the sidewalk to tell you that she was recently diagnosed with Type II diabetes. She tells you that she is really afraid of the diagnosis. Her mother had diabetes and had one complication after the other until it finally killed her. What would happen to her kids if something happened to her? She asks for your advice since you are a ‘nurse’.

You remind her that you are still in school but will soon be a nurse…and can give her information about diabetes. You tell her that you will come over in the next couple days and talk. Since you are a student nurse you are able to give her a lot of information on Type II diabetes.

She asks you about any community resources that are available in your area. She is especially interested in getting information that will help her kids (ages 12, 14, & 16) understand the disease and any health promotion/prevention they can start to incorporate in their lives.

What information are you able to provide for her?

Over the next year you noticed that Janice was doing everything she could to prevent complications from her diabetes but lately does not seem to be taking care of herself anymore. Lately, whenever you are at neighborhood, school or social functions you notice that she does not seem to watch her diet and she does not appear to get much physical activity.

You notice that she has recently started to wear glasses. When you ask how she’s doing, she angrily replies that despite taking care of herself for almost a year, her recent check up showed that she has developed diabetic retinopathy as well as renal insufficiency. She states that she should probably be even more aware of her diet but is not really sure what to do now. She feels like she is becoming depressed due to the recent diagnosis of renal insufficiency. She asks why this is happening to her even though she took good care of herself.

How would you respond to her concerns?

You run into Janice a few months later and she tells you that she has started counseling. She’s worried that she should be feeling better by now but only feels tired all the time. She has started to eat more and has gained quite a bit of weight. A friend gave her a book on medications (PDR) and she looked up the anti-depressant she is taking. She thinks she looked it up right and found that some of the side effects of the medication are weight gain and decreased activity.

You encourage her to go see her physician. She agrees that she will. When you see her daughter a few weeks later, you ask about Janice. She says that her mother never went to the doctor and she is worried about her. She states that her mom isn’t feeling very well and that she just sleeps all the time. You go to Janice’s house and you find her at a lowered level of consciousness (stuporous). You instruct her daughter to call 911.

When you go to the hospital to visit Janice you find that she is in acute renal failure and is not responding to treatment. The physician is talking to her about hemodialysis. After the MD leaves, Janice tells you that the doctor says that she is very lucky to be alive. Her lab values were ‘through the roof’. He says that she will need to go to dialysis 3 times per week or she will die.

Janice is very afraid and doesn’t want to die but doesn’t’ know how she is going to care for her children, work and receive dialysis. When you ask her about it she says isn’t ready to talk about it yet. She says she needs a couple days to let things sink in. You promise that you will help her get things organized when she gets out of the hospital.

Because you are a very organized person (or just a type A personality) you immediately start to look up resources in your county that offer dialysis services. You want to be able to give her the information the next time you go to the hospital to alleviate her fears. Because you are very thorough in your research, you also look up resources that will help Janice’s children deal with this diagnosis and change in their lifestyle.

After reading the case study –

  • Identify all issues you have associated with this situation
  • Are there potential biases or stigmas involved in this situation? If so, what are they?
  • Knowing that each case is individualized, what information would you be able to provide to Janice regarding the common course dialysis?
  • What else could you do for Janice at this point?
  • In your area, what community resources are available for Janice and her family?

Developed by Carol Thorn, RN, MS

May use with permission for the purposes of nursing education

If questions/comments, please contact Carol Thorn at