Question

Case Study Scenario: Ms. Amal is a 22-year-old female student with a history of type 1 diabetes mellitus, diagnosed when she was 5 years old. She has been brought into the emergency department this morning by her father, Mr. Seed, as she is lethargic and unable to make any sense. Mr. Seed reports she has been unwell with a flu-like illness for the past week, with nausea, vomiting, and productive cough over the past two days. Amal had decided not to take her usual insulin dose last night as she had not been eating and her blood sugar was low 8.1 mmol/L. Ms. Amal stated that she so much worries about her status as she always feels tired and unable to concentrate on her study and most often sleep in class. On examination, the nurse finds Amal has deep, rapid respirations, acetone smell on her breath, and her skin is flushed and dry. Her Father, Mr. Seed, reports she had gone to the toilet several times during the night. Her blood glucose level (BGL) is 42.1 mmol/L and her ketone levels are 7.1 mmol/L. Urinalysis shows large amounts of glucose. Her vital signs are: • BP= 102/54 mmHg • HR= 112 beats/minute • RR= 36 breaths/minute, rapid and shallow • T= 36.2°C • SpO2= 96% with no supplemental oxygen. The health care provider suspect Amal has diabetic ketoacidosis (DKA) and order two large-bore intravenous (IV) cannula inserted for fluid resuscitation and IV insulin administration.

Q1. Make a shortlist of Ms. Amal symptoms?

Q2. Distinguish between the subjective and objective signs and symptoms

Q3. Identify potential problems for Ms. Amal?

- Q4:

a. Identify two top priorities health problems for Ms. Amal?

b. Determine two target goals for the selected health problems?

Q5. Determine a nursing diagnosis using the PES format for each selected priority health problem.

- Q6. Develop a care plan that includes A, B, and C for one priority health problem:

a. Identify two of Amal’s need

b. Plan two goals/outcomes

c. Identify six nursing interventions

- Q7:

a. List least 5 different, relevant sources specific to nursing process and NANDA diagnosis to be mentioned for full 5 marks.

b. Follow APA- American Psychological Association style reference format

Answer 1

Q1

Ms. Amal's symptoms are lethargic, unable to make sense, rapid respirations, acetone smell on breath, skin flushed and dry, frequent urination, increase blood sugar level to 42.1 mmol/L, increase ketone level and glucose level in urine analysis, alway feel tired, unable to concentrate on study, most often sleep in the class. She also have flu like symptoms nausea, vomiting, productive cough.

Q2

Answer: subjective symptoms are the symptoms that are reported orally or verbally informed by her father. It includes flu like symptoms vomiting, nausea, productive cough, frequent urination at the night before the admission, always feel tired, unable to concentrate in the study and often sleep in the class.

The objective symptoms are the symptoms that are identify by the nurse or the health care provider during the assessment process or by performing laboratory investigation. These symptoms includes rapid respiration, acetone smeel on breath, skin flushed and dry, increase blood sugar, ketone and glucose in the urine test or analysis.

Q3

Answer: Ms. Amal is diagnosed with Diabetic ketoacedosis. The potential problems related to her condition are risk for fluid volume deficit, risk for respiratory infection, risk for imbalance nutrition less than bodyrequirement, risk for complication like hypokelemia, loss of conciousness, cerebral edema, pulmonary edema, etc.

Q4

Answer: a) The top two target priority health problems is severe hyperglycemia and dehydration

b) The two target goals for the hyperglycemia and dehydration are

- To maintain the serum glucose level to normal

- To maintain normal fluid volume by providing adequate fluid therapy.

Q5

Answer: nursing diagnosis for the health problem dehydration

- Fluid volume deficient related to osmotic dirutic action of hyperglycemia as evidenced by frequent urination and dry skin.