CASE SCENARIO. DIABETIC KETOACIDOSIS.

A 40years old female is brought in by 🚑 ambulance.Admitting diagnosis Diabetic Ketoacidosis/ Hyperglycemia. Admitted to ICU for DKA protocol.Diabetic ketoacidosis(DKA) is an acute life threatening complications of uncontrolled diabetes mellitus loss of water through urination, potassium, ammonium, electrolytes imbalance and this leads to hypovolemia. The blood sugar levels will be extremely high, totally uncontrollable.The result will be a breakdown of free fatty acids which will cause acidosis.It will often result in patient being in Coma.The individual will be uncomfortable, restless, flushed in appearance, agitated, diaphoretic,fruity odor in the breath,nauseated, confused or coma will be noted.

(Blood sugar of 750 in emergency room. ( Patient complained of generalized body ache)Secondary diagnosis ESRD,Hemodialysis Monday ,Wednesday and Friday. Left upper extremity AV fistula. Anemia,Seizure disorder, Right BKA,Hypertension.DNR( Comfort care only pending doctor updated orders)

Weight 145lbs,Height 5ft 4inches. Standard precautions.High risk for fall. (Fall prevention protocol in place)No advance Directive. Copy of advance Directive on the chart.

Impaired skin integrity. Stage 11 to the coccyx.

Myperlix applied after pictures taken.Accucheck Q4hours +prn.Carb controlled diet.Alert and oriented x 3.

Allergy: Vancomycin ( Red big rashes)Norco (Anxiety, Rashes)

Medication reconciliation done.

Medications: Meropenem 1gm IV Q8hours.Synthroid 1tablet QAMAC 0630 scheduled. Normal saline 10ml flush Q8hours.Dilaudid 0.5mg Q4hours prn severe pain. Pantoprazole 40mg po Bidac scheduled. Metroprolol Tartrate 50mg po Bid scheduled. Morphine sulfate 2mg IV Q6hours prn moderate pain.

Motrin 400mg po Q6hours prn temperature. Laboratory test in am.Cbc with differential, Chem 7. Vital signs Q4hours. QUESTIONS: 1.To reduce the possibility of a needle injury which of the following techniques should the nurse employ to dispose of needle used to inject insulin?.

A.Leave the needle unsheated discard it into a puncture resistant container.

B.Put it in the trash.

C.It is a tiny needle and cannot poke anyone. D.You should do all of the above except A.Correct answer is A. 2.The doctor orders tolbuatmide ( Orinase)for Diabetic type 11 patient. The nurse will explain to the patient that talbutamide(Orinase)is effective for diabetes patient who?.

A.For type 1 Diabetic patient.

B.For patient who produces minimal amount of insult.

C.It is used more with hypovolemia patient.

D.Identify that the patient met the criteria. Correct answer B.Rationale: Oral hypoglycemia agents are given to diabetes type 11patients who are able to produce minimal amount of insulin.

Published by edochie99

A Registered Nurse with over twenty years of hospital experience, an author with Masters Degree in Nursing,also Bachelor Degree in Nursing,graduated in 1996 from USC,University of Southern California.MSN in 2009 University of Phoenix.

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