Question

The patient is a 48-year-old unconscious woman admitted to the ED. She has a known history of type 1 diabetes mellitus. Her daughter accompanies her and tells the staff that her mother has had the “flu” and has been unable to eat or drink very much. The daughter is uncertain whether her mother has taken her insulin in the past 24 hours.

The patient’s vital signs are temperature 101.8° F; pulse 120, weak and irregular; respiration 22, deep, and fruity odor; and blood pressure 80/42 mm Hg. Blood specimens and arterial blood gases are drawn and an IV infusion began.

1. During the first 24 hours, what complications should the nurse monitor for in this patient? Why?
2. Which aspect of diabetic self-care should the nurse discuss with this patient before her discharge?

The patient is to be discharged on a mixed-dose regimen for insulin. She is to receive 10 units regular insulin and 18 units NPH insulin before breakfast and another 5 units regular insulin and 12 units NPH at dinnertime.

3. What should the nurse discuss with this patient about diabetes, insulin, and illness?
4. What can this patient do to prevent future emergency episodes?

Answer 1

This is a case of diabetic ketoacidosis. It occurs in people with diabetes. when body is not able to use glucose due to low levels of insulin, it uses fats as an alternate source of energy. It occurs when fats break down at much faster rate to produce ketones. The excess of ketones in the body makes the blood acidic. Hence called diabetic ketoacidosis.

1. During first 24 hours , the nurse should monitor the CVS failure symptoms. Because rapid infusion of electrolytes can overload the circulatory system and may cause pulmonary edema or congestive heart failure.

2. Diabetes self care include proper foot care, keeping blood sugar and BP in check . The patient should prevent injury from diabetic neuropathy. The patient should be taught to keep their feet clean and soft., trim toenails regularly, wear proper fitted shoes, avoid walking bare footed, avoid heel cracking. If there is any non healing breaks in the skin of foot, the patient should report to doctor immediately. Foot necrosis is the major complication of diabetes leading to lifelong disability.

3. The nurse should educate the patient about the insulin medication. She should be informed about the dosage and effects of long acting insulin and short acting insulin. She should be educated about the technique of administration of insulin. She should be taught how to draw insulin following the rule cloudy clear, cloudy clear rule. Nurse should demonstrate the patient how to inject insulin in the subcutaneous tissue by pinching skin at injection site, avoiding the insulin going into the muscle.   The patient should be advised to rotate the injection within one anatomic location that if she injected insulin in the abdomen she should administer in the abdomen only but at different locations avoiding one inch area around the belly button. 90- degree angle should be used for injection, if patient is frail then 45-degree angle can be used. Lastly patient should be advised to store unused insulin in the refrigerator.

4. To prevent future emergency episodes patient should be advised to keep blood sugar level in check. patient should take proper doses of insulin at proper frequencies as directed by the doctor. Patient should eat healthy diet- diet rich in fiber and avoid high calorie diet. Healthy weight should be maintained by doing exercise daily and or engaging in physical activity. Patient should monitor blood sugar level and if blood sugar level is consistently higher than 300 mg/dl emergency care is needed.

please upvote