Question

2. Jerry Thomas is a 26-year-old type 1 diabetic. He was originally diagnosed at the age of 14, and currently manages his disease with an intensive regimen of insulin injections. Jerry is employed as a schoolteacher and soccer coach. He presents today with a 2-day history of vomiting and diarrhea. He has been closely monitoring his blood glucoses, and is using regular insulin for high blood glucose levels. He has only been able to tolerate liquids such as Gatorade, but today he is unable to even tolerate that, and comes to the clinic for evaluation of possible diabetic ketoacidosis (DKA). (Learning Objective 9)

1. Describe the pathophysiology of DKA and why it occurs in patients with type 1 diabetes.

2. Based on the diagnosis of DKA, what assessment findings does the nurse correlate to this disorder?

3. The physician orders a complete metabolic panel, and Jerry’s blood glucose is 425. Other lab values include a serum sodium of 152, serum potassium of 3.0, and BUN of 64. What is your assessment of these results?

4. Explain why it is important for Jerry to continue to take his insulin even though his oral intake is decreased.

Answer 1

a.Insulin is the basic thing which keeps the blood sugar level under control by certain process by providing energy.When there is absence or inadequate insulin to meet body's requirements, then the triglyceride and aminoacids are used in place of glucose to get energy.This increases the glycerol, fatty acids and alanine.Here glycerol and alanine aides in gluconeogenesis in th liver and increases the glycogen level.This glycogen is the main contributor to convert fatty acids to ketone.This process is called ketogenesis producing ketoacids (aceto acetic acid and hydroxybutyric) This process can be stopped only if there is insulin thus it leads to continuous ketogenesis and causing metabolic acidosis increased ketoacids called as Ketoacidosis.

b.DKA has a clinical symptoms like increased blood sugar level,nausea, vomiting, abdominal pain.The nurse can correlate these symptoms for assessing the patients DKA

c.The results gives an information on the patient condition like

• Hypernatremia
• Hypokalemia
• Increased BUN level is suggest one of DKA

These levels indicate the patient is in DKA. These levels are possible only when the serum similarity level of the blood is greater than 330mOsm /kgH20 [2 (Na+K)+BUN÷3 +Glucose ÷18]

[2×(152+3)+64 +425÷18]

354.9 mOsm/Kg H20

If not treated promptly can lead to coma and death

d.Ketogenesis will lead to increased production of ketoacids on the blood causing ketoacidosis.This can be inhibited if there is insulin in the body.Hence it is a must to administer enough insulin to stop the production of ketoacids