Question Answered step-by-step You are working in an outpatient clinic when a mother brings in her… You are working in an outpatient clinic when a mother brings in her 17-year-old daughter, C.J., who has type 1 diabetes mellitus (DM) and has just returned from a trip to Mexico. She has had a 3-day fever and diarrhea with nausea and vomiting. She has been unable to eat and has tolerated only sips of fluid. Because she was unable to eat, she did not take her insulin as directed. You note C.J. is unsteady, so you take her to the examining room in a wheelchair. While helping her onto the examination table, you note her skin is warm and flushed. Her respirations are deep and rapid, and her breath is fruity and sweet smelling. C.J. is drowsy and unable to answer your questions. Her mother states, “She kept telling me she’s so thirsty, but she can’t keep anything down.”1. List 5 pieces of additional information you need to obtain from C.J.’s mother.2. Describe the pathophysiology of diabetic ketoacidosis (DKA).CASE STUDY PROGRESSC.J.’s mother tells you the following:”Blood glucose monitor has been reading ‘high.'””C.J. has had sips of ginger ale, but that’s all.””She has been vomiting about every other time she drinks.””When she first got home, she went [voided] a lot, but yesterday she hardly went at all, and I don’t think she has gone today.””She went to bed early last night, and I could hardly wake her up this morning. That’s why I brought her in.”Vital SignsBlood pressure90/50 mm HgHeart rate124 beats/minRespiratory rate36 and deepTemperature101.3° F (38.5° C) (tympanic)Laboratory Test ValuesGlucose677 mg/dL (37.6 mmol/L)Potassium6.3 mEq/L (6.3 mmol/L)3. Interpret C.J.’s VS and laboratory results, relating them to the pathophysiology.4. Explain the reason for C.J.’s other presenting signs and symptoms.The decision is made to transport C.J. by ambulance to the local emergency department (ED).5. After assessing C.J., the ED resident on call writes the following orders. Review each order. Mark an A if the order is appropriate; mark an I if inappropriate. For each order you mark as I, explain why it is inappropriate, and correct the order.____ 1000 mL lactated Ringer’s IV stat____ 36 units NPH (Humulin N) and 20 units regular (Humulin R) insulin subQ now____ CBC with differential; CMP; blood cultures × 2 sites; clean-catch urine for UA and C&S; stool for ova and parasites, Clostridium difficile toxin, and C&S; serum lactate, ketone, and osmolality; ABGs on room air____ 1800-calorie, carbohydrate-controlled diet____ Bed rest____Acetaminophen 650 mg rectal suppository q4h as needed____Furosemide 60 mg IV push now____Urinary output every hour____VS every shift6. List 4 other collaborative interventions that C.J. needs and the reason for using each.7. Which ABG results would you expect to see in C.J.? Why?pH 7.40, Pao2 88, PaCO2 34, HCO3 23pH 7.48, Pao2 90, PaCO2 30, HCO3 28pH 7.27, Pao2 90, PaCO2 50, HCO3 20pH 7.26, Pao2 94, PaCO2 23, HCO3 18CASE STUDY PROGRESSAll orders have been corrected and therapies started. C.J. receives fluid resuscitation and insulin drip via infusion pump. After several hours, her latest laboratory findings are as shown in the chart.Laboratory Test ResultsNa149 meq/L (149 mmol/L)K3.0 meq/L (3.0 mmol/L)Cl119 meq/L (119 mmol/L)Total CO221 meq/L (21 mmol/L)BUN12 mg/dL (4.28 mmol/L)Creatinine1.2 mg/dL (106 mcmol/L)Glucose298 mg/dL (17 mmol/L)8. Based on C.J.’s laboratory results, what changes in her IV fluids would you anticipate, and why?9.When providing care for a patient with DKA, there are several nursing interventions that need to be done.  List at least 5 things that should be monitored and frequency of that monitoring.C.J. asks when her IV insulin will be turned off.  What would be an appropriate response by the nurse? 11. C.J. asks when she can start eating.  What would be an appropriate response by the nurse?12.C.J.’s insulin is at 195 and her insulin drip is discontinued and is moved to the floor where she receives dinner.  Her insulin orders are the following:  Check BGS before meals.  For glucose greater than 150- for every 20 above 150, give 1 unit of Humalog.  For every 8 gms of carbs she eats, give 1 unit of Humalog. Before dinner C.J.’s BGS is 345.  She eats 23 gms of carbs.  Calculate how much insulin you will give her.What other type of insulin do you think will be ordered for C.J?  When will this be given?Before C.J. goes home, the diabetic nurse educator is scheduled to meet with her.  List 7-10 things that would be important for the nurse educator to teach C.J. and her mom. Health Science Science Nursing NUR 445TB9 Share QuestionEmailCopy link Comments (0)