Question

Critical Thinking Case Four-DKA

Mrs. S is a 28-year-old patient, with a 12-year history of type I diabetes mellitus. Her husband states that she has had a “bad cold” for several days. Yesterday she stayed in bed and slept all day. She was “too ill” to check her blood sugar, and since she was not really eating, she did not take her insulin. This morning, she was not able to stand up and vomited twice. A Gram stain of Mrs. S’s blood contains gram-positive cocci in clusters. Her admission vital signs are: BP = 90/60; HR = 118 bpm (sinus tachycardia); RR = 32/min; T = 102.3° F; O₂ sat via pulse oximetry = 96%. Her serum glucose is 398 mg/dl, and she is positive for serum ketones. She is admitted with a diagnosis of DKA.

Her baseline ABGs on 2 L of oxygen are: pH = 7.25; PCO₂ = 28; HCO₃ = 14; PaO_{2 =} 92; O₂ sat = 96%. Her respirations are deep, rapid, and labored. She has bronchial breath sounds in the right axillary area. There is bilateral chest expansion and no evidence of cyanosis.

A regular insulin bolus is given and a regular insulin drip is initiated. Mrs. S’s IV fluids are infusing at 800 ml/hr. Her vital signs after 2 hours in the unit are: BP = 120/70; HR = 78 bpm (normal sinus rhythm); RR = 22/min; O₂ sat = 100%. Her serum glucose is 250 mg/dl and serum potassium is 4.0 mEq/L. She is more alert and is feeling hungry.

What is insulin’s function in the body? What is the most significant basic defect in the development of DKA?

What is the cause of Ms. S experiencing DKA? Describe the pathophysiologic rationale for your answer.

List the classic signs and symptoms of DKA. Which signs and symptoms did Ms. S experience? What are the pathophysiologic causes of these signs and symptoms?

What is an anion gap? Why is the anion gap important to follow in the treatment of DKA?

What acid base disturbance is Ms. S experiencing? What compensatory mechanisms are in effect at this time?

What is the primary nursing diagnosis for Ms. S.? What are the goals for treatment (both independent and collaborative)? What interventions are imperative to initiate immediately? What interventions are important within the next 12-24 hours?

What are potential lab abnormalities for a patient in DKA?

What nursing considerations are important in planning Ms. S’s discharge? What I need is each question answered with resource Please Lori

Answer 1

1. FUNCTION OF INSULIN IN THE BODY -

Insulin is a harmone created by beta cells inthe islets of langergans of pancreas.Insulin brings down the blood glucose, the ordinary range is 70-120 mg/dl,Averagely 40-50U or 0.6U/Kg of body will be emitted

Insulin advances glucose transport from circulation system to the cell membrane.

2.Sinificant basic defect of DKA-

DKA is caused by significant lack of insulin described by hyperglycemia, ketosis, acidosis and parchedness, it is normally found in type 1 diabetes mellitus condition.

3.Cause of DKA-

Factors, for example, infection and any illness, deficient insulin measurement, un analyzed type 1 diabetes mellitus, poor self administration and disregard.

4. Pathological rationale-

At the point when the body insulin is inadequate the body repays by separating fat stores as an optional wellspring of sustenance. Ketones are acidic results of fat digestion that can cause significant issues when they end up over the top in the blood, it modifies the pH adjust, causing metabolic acidosis , Ketonuria is a procedure that happens when ketone bodies are discharged in the urine. insulin additionally impaires protein union and causes excessive protein debasement.

5.Classical symptoms-

Lack of hydration is the essential and established manifestation confirm by poor skin turgor, dry mucous layer, tachycardia and orthostatic hypotension,

Early indications are dormancy and weakness acetone breath with fruity scent breath and a few times with kussmaul respiration