Question

1. You are caring for a 40-year-old patient with diabetes admitted with a 4-day history of nausea and vomiting. The lab reports that the patient is hypokalemic, with blood glucose of 406 mg/dL.

- How might have diabetes contributed to the patient’s clinical signs and symptoms.

- Describe signs and symptoms that would likely be encountered during your physical assessment.

- Develop one appropriate nursing diagnoses, including etiologies and outcomes.

2. Your patient has physician orders to receive 2 units of whole blood with IV diuretic administered between units. What is the rationale for the diuretic administration? What other nonpharmacologic intervention might be used in addition to the diuretic administration?

Answer 1

Answer 1) Insulin facilitates the uptake of glucose into the cells which results in an intracellular shift of potassium. In diabetes as the insulin production is impaired. The insulin which is potent stimulator for hypokalemia sparing body potassium from urinary excretion by transporting it into the cells.In turn the renin angiotensin aldosterone system affects the glucose tolerance by modulating the plasma potassium levels, which acts as a stimulus for glucose induced insulin release.

The signs and symptoms that can be seen during the physical examination includes decreased level of consciousness, nausea and vomiting, muscle cramps, abdominal pain, lethargy,blurred vision etc.

The nursing diagnosis can be risk for electrolyte imbalance related to diabetes mellitus as evidenced by hypokalemia.

Answer 2) IV diuretics are prescribed between the blood transfusion is to prevent circulatory overload which may be caused due to the increased blood volume after blood administration. The other non pharmacological interventions includes the adequate monitoring of intake and output, keeping patient hydrated during transfusion and after transfusion. Unless in emergency situation two blood units should be given simultaneously. There should be an adequate gap of certain hours between two transfusions and its also important to watch for signs of circulatory overload.