Question

Using the case study below,

A 21-year old female (A.M) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since she’s been ill and unable to keep any food down. She’s only tolerated sips of water and juices. Since she’s also been unable to eat, she hasn’t taken any insulin as directed. While helping A.M. from the lobby to the examining room you note that she’s unsteady, note that her skin in warm and flushed and that she’s drowsy. You also note that she’s breathing rapidly and smell a slight sweet/fruity odor. A.M. has a challenge answering questions but keeps asking for water to drink.

You get more information from A.M. and learn

• She had some readings on her glucometer which were reading ‘high’
• She vomits almost every time she takes in fluid
• She hasn’t voided for a day but voided a great deal the day before
• She’s been sleeping long hours and finally woke up this morning and decided to seek care

Current labs and vital signs:

1. What is the pathophysiology for the condition you believe A.M. has?
2. Relate the etiology and clinical manifestations for the condition you identified for A.M.

The practitioner at the urgent care facility makes the decision that A.M. needs to go to the hospital by ambulance. Once at the Emergency Department (ED), the ED physician orders these items:

1. 1000 ml Lactated Ringer’s (LR) IV stat
2. 36 units NPH (Humulin N) and 20 units regular (Humulin R) insulin SQ now
3. CBC with differential; CMP: blood cultures X2 sites; clean-catch urine for UA and C&S; stool for ova and parasites; Clostridium difficile toxin, and C&S; serum lactate; ketone; osmolality; ABGs on room air
4. 1800 calorie, carbohydrate controlled diet
5. Bed rest
6. Acetaminophen (Tylenol) 650 mg orally Q4 hrs PRN
7. Furosemide (Lasix) 60 mg IV push now
8. Urinary output every hour
9. VS every shift

The orders above -- which are questionable related to her condition and which are appropriate?

3. What are the expected treatments for this condition?

Instructions:

Summarize the questions above and formulate what may be happening with A.M. and how you would improve her condition.

Answer 1

1. AM is having diabetic ketoacidosis (DKA).

Type 1 diabetes is insulin dependent diabetes. Since the patient is not taken insulin for 3 days blood glucose had risen.

insulun levels is very low to meet body demand for basic metaboluc requirements.

2. There was a 3 days lapse of insulin therapy.

excessive nausea, vommiting, excessive thirst, frequent urination, confusion, weakness fruity odour in brreath indicates DKA

Chart information on vitals substantiate the finding.

Glucose level pottassium levels suggest severe condition

3. Questionable order are stool examination, closyridium difficule toxin test, 1200 calorie diet to the patient.

other orders are appropriate for the condition.

4. IV saline

IV insulin therapy

volume repletion

correction of hyperglycimia and acidosis