Question

Case Scenario: NB is a 32-year-old Native American admitted to the ED after his wife found him unconscious on the bathroom floor. NB is now lethargic and slow to respond to tactile-verbal stimuli, but answers questions appropriately when awake. NB complains of abdominal pain and nausea. NB’s wife states he was diagnosed with diabetes last year after an admission to the hospital for diabetic coma. NB stopped taking his insulin two days ago because of nausea and “flu-like” symptoms. NB thought that since he was unable to eat, he should not take his insulin. NB vital signs are: • B/P: 112/ 52 • P: 112 • R: 32 with a fruity odor • SaO2: 99% room air • T: 101° (orally) • NB’s skin is hot and dry • He is flushed with dry and cracked mucous membranes Labs: • Glucose: 620 • Blood pH: 7.26 • Na: 135 • K:2.8 • BUN:74 • Creatinine: 1.2 NB is admitted to the ICU with a diagnosis of Diabetic Ketoacidosis (DKA).

1. What precipitating factors contributed to the development of DKA?

2. Explain why the pH is acidic in DKA and normal in HHS.

3. Based on the assessment data above, what are three nursing diagnoses for NB?

4. What teaching points should the nurse review with NB before he goes home?

Answer 1

Diabetic ketoacidosis:

Diabetic ketoacidosis is the complication of diabetes mellitus. In diabetes mellitus the insulin production is so low , so this insulin deficiency inhibits the ability of glucose to enter into the cells. The result the liver breaks down the fat into ketones to fast as energy fuel.

So this ketones accumulate in the blood and urine cause ketoacidosis .

1) Here NB stopped taking insulin two days , so the main precipitating factor for Diabetic ketoacidosis is Stopped insulin administering

The other precipitating factors for diabetic ketoacidosis is

• Infection
• Pancreatitis
• Myocardial infarction
• Cerebrovascular accident
• Discontinuation or inadequate insulin therapy