Question

Case #2: Diabetes Mellitus Case Study A Case Scenario: JC is a 72-year-old African American male living alone in his own home. JC was found unconscious by his neighbor who went next door to check on him because “he had not seen him for a while.” The neighbor stated JC has a history of diabetes and has been spending more time alone since his wife passed away last year. JC is lethargic and slow to respond to questions. While taking the nursing history, JC admits to abdominal pain and nausea. He also admits to eating poorly because he “doesn’t like to eat alone.” JC also complains of frequent urination and headache. His vital signs are presently: • B/P: 92/50 • P: 132 • R: 22 • SaO2: 95% room air • T: 100.2° (orally) Labs: • Glucose: 880 • Blood pH: 7.36 • Na: 130 • K: 2.2 • CO2: 22 • BUN: 94 • Creatinine: 1.0 JC is admitted to the ICU with a diagnosis of HHS. 1. What assessment data supports the pathophysiology of HHS? 2. What psychosocial factors precipitated his condition? . 3. Review the assessment data. What are 3 nursing diagnoses for JC? Which one has the highest priority?

Answer 1

1, Patient blood glucose level will be extremely high it causes frequent urination without significant ketosis(ph will be more than 7.30). Dehydration and hypotension due to frequent urination cause electrolyte loss and coma or altered mental status.
2, Hyperglycemic crisis worsen with the aging process it induces coma and hypotension, confusion, drowsiness, and disorientation. psychosocial factors precipitating his condition due to depression, inadequate eating, and isolation. Higher insulin concentration worsens the hyperglycemic crisis.
3, nursing diagnosis:
Fluid volume deficit due to poor eating habits and oliguria or increased urination.
Acute pain due to metabolic decompensation
Chronic confusion or coma due to hyperglycemic crisis
Fluid volume replacement has the highest priority to avoid dehydration. Fluid replacement with isotonic will be helpful for effective osmolarity. Volume replacement corrects the hyperglycemic hyperosmolarity.