Question

Tony Chadwick is a 16-year-old African American male admitted to ICU from the urgent care with newly diagnosed type 1 DM with DKA. His mother took him to the local urgent care with a 2-day history of vomiting and abdominal pain. Tony also complained of thirst, blurry vision, and fatigue. His mother smelled a fruity odor on his breath this morning. The nurse at the urgent care clinic found that Tony had a blood glucose level of 520 mg/dL and urine positive for ketones. Tony was immediately transferred to the local hospital, where he was admitted to ICU. He is in the 11th grade and was doing well in school until about 2 weeks ago, when he started to become easily fatigued and irritable. His mother thought that he was just staying up too late and not getting enough sleep. Tony has been well except for an upper respiratory viral infection about 2 months ago that kept him home from school for 3 days.

On arrival in the ICU, Tony is drowsy but wakes to verbal stimuli. He complains of nausea and is vomiting green-colored bile in small amounts. He complains of abdominal pain and a need to urinate.

His mother accompanies him and expresses fear that he will not survive this acute episode. She was told at the urgent care clinic that Tony has diabetes, but she does not believe it. She says no one in her family or her husbands has diabetes.

Lab Results:

• A_IC 12%
• Anion gap 20
• ABGs pH 7.22
• pCO₂ 21
• Bicarb 18
• Electrolytes are pending.
• Chest x-ray is negative.

Physical Assessment:

• Vital signs: T 99.5°F orally; P 120 bpm, thready; R 28/min, deep and labored; BP 90/60 mmHg
• Neuro: As above
• Resp: Lungs clear to auscultation
• CVS: All pulses palpable with radial pulses thready. HS are S1, S2.
• Skin: Cool and clammy but skin turgor poor
• GI: Diminished bowel sounds in all quadrants
• GU: Has not voided
• An IV is started and 0.9% NaCl is infusing. An insulin drip is started per protocol. Tony is connected to a cardiac monitor and exhibits sinus tachycardia. A Foley catheter is inserted and connected to an hourly drainage chamber (for hourly urine output measurement).

QUESTIONS:

1. Tony is concerned about being embarrassed when he has to check his blood sugar and take his insulin at school. What interventions could the nurse suggest helping him with privacy?

2. Tony admits to drinking alcohol occasionally. What should the nurse teach Tony about alcohol use and diabetes?

3. List and explain at least four nursing diagnoses for Tony.

Answer 1

1)It is important to provide privacy as the children might be embarrassing about their disease condition and it is the right of the child.In order to meet the needs, the school officials need to get a written consent from parents regarding the child's condition and the school will be able to provide privacy when information shared. The nurse should counsel parents and child about the important of blood sugar checking, taking meals and injection on time.The nurse can make sure the child should get enough help when necessary from school.

2)Moderate alcohol intake can increase the blood sugar level while excess alcohol intake cause drop of sugar .Also , alcohol intake stimulates increase appetite which makes the body overheat and results in change in blood sugar level.Alcohol also have lots of calories which further increase blood sugar.

3)

1) Fluid volume deficit related to excess gastric loss due to nausea and vomiting , hyperglycemia induced osmotic pressure.

2)Imbalanced nutrition less than body requirement related to insufficient insulin evidenced by increased ketones, anorexia, nausea, weakness.

3) Anxiety related to disease condition.

4) Knowledge deficit related to disease condition evidenced by concerns from mother.