Question

In the ER, A mother has brought in her 20-year-old daughter, C.J., who has type 1 diabetes mellitus (DM) and has just returned from a trip to Mexico. She has had a 3-day fever and diarrhea with nausea and vomiting (N/V). She has been unable to eat and has tolerated only sips of fluid. Because she was unable to eat, she did not take her insulin. Because C.J. is unsteady, you bring her to the examining room in a wheelchair. While assisting her onto the examining table, you note her skin is warm and flushed. Her respirations are deep and rapid, and her breath is fruity and sweet-smelling. C.J. is drowsy and unable to answer your questions. Her mother states, “She keeps telling me she's so thirsty, but she can't keep anything down.”

The mother also tells you the following:

• “Blood glucose monitor has been reading ‘high.’ ”
• “C.J. has had sips of ginger ale but that's all.”
• “She has been vomiting about every other time she drinks.”
• “When she first got home, she went [voided] a lot, but yesterday she hardly went at all, and I don't think she has gone today.”
• “She went to bed early last night, and I could hardly wake her up this morning. That's why I brought her in.”

Vital Signs

• Blood pressure 90/50 mm Hg
• Heart rate 124 beats/min
• Respiratory rate 36 and deep
• Temperature 101.3° F (38.5° C) (tympanic)

Laboratory Test Values

• Glucose 577 mg/dL
• Potassium 5.8 mEq/L

After evaluating C.J., the ED physician admits the patient with DKA.

ANSWER THE FOLLOWING QUESTIONS:

1. Describe the pathophysiology of diabetic ketoacidosis (DKA) and how it differs from hyperglycemic-hyperosmolar state (HHS)

2.Explain the rationale for C.J.'s presenting signs and symptoms.

3.What medical treatments are appropriate for this patient?

4.List five priority nursing interventions and the rationale for each.

5.The physician orders an insulin drip infusion at 4 units per hour. The label on the bag reads, “100 units regular (Humulin R) insulin in 250 mL of normal saline.” At how many milliliters per hour will you set the infusion pump?

Answer 1

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radual Onset erum oo m uLoSe

enough msulinJy present to

vomitting → omiting duu to teb acidesis Ete vaked, wiat end to cels. Hypotewi u se

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ex) hrimula laye