Diabetes Case Study

Seek out an appropriate evidence-based article on the web to support your
discussion of DKA. The article must be recent (no older than 5 years) and must be
from a nursing journal with at least one nurse author. Highlight the article in yellow
to indicate the portions applicable to your discussion and submit hard-copy, stapled
to your paper on the 12th
.
Melanie, a 19 year-old female college student, was diagnosed with type 1 DM three
months ago and she describes her HPI as follows:
 Always had a ‘weight problem’ but approximately four months before
diagnosis she began slowly losing weight despite “eating more than I every
have in my life.”
 Also described increasing thirst leading to “too many trips to the bathroom”,
interrupting her ability to remain in class as expected.
 Diagnosed with type 1 DM after she had lost 18 pounds and was started on the
following insulin regimen: insulin glargine (Lantus) 35 units at bedtime;
insulin lispro (Humalog) sliding scale before each meal. Her meal plan
developed by the dietician included 1200 calories and 10 servings of
CHO/day with a suggestion of walking 30 minutes at least 3 days/week.
 Her presenting S&S quickly resolved, she had much more “energy to
exercise”, but she also noted a disturbing trend: not only had she stopped
losing weight but was actually gaining.

(1) Concisely explain the above HPI (start with what is type 1 DM) and beginning
treatment. May explain the above in ‘bullet’ format but write in paragraphs and
provide appropriate references.
Today, three months post-diagnosis, Melanie is brought to the Emergency Department
and DKA is suspected from the outset. The triage nurse learns that she gradually but
significantly decreased her insulin and CHO intake to “stop the weight gain” and for the
past two days “was back in the bathroom again because I was so thirsty.” Appears
somewhat confused when discussing rationale for her actions.
Admitting VS: 86/48, 136 and regular; 28, deep, and smelling ‘fruity’
Current blood glucose: 424 mg/dL and urine + for ketones

  1. Briefly explain the pathophysiology of DKA and why Melanie is demonstrating
    such at this time. Also, explain her presenting VS, BG, and the fact that ketones
    are present in her urine. Describe her expected fluid status in all 3 spaces.

(3) Presentation confirms the diagnosis of DKA: provide an expected ABG for
Melanie (complete interpretation and actual numbers) with rationale for each
value.
(4) Serum potassium will fluctuate in DKA: describe the rationale for the common
hypokalemia early in the process and then later hyperkalemia followed by a drop
again with treatment. Why must this be monitored closely?

(5) State the priority nursing diagnosis at this time.

(6) What orders do you expect from the physician to manage her BG/insulin and fluid
needs? Be specific and provide rationale to demonstrate your understanding of
initial DKA treatment. Do not simply copy isolated facts from your references.
And, why is it important to control the change in serum osmolality carefully
during initial therapy?
Melanie’s treatment is successful and she is ready for discharge 36 hours later. What
must she be taught prior to discharge to prevent a repeat of a potentially life-threatening
DKA episode in the future? Consider that she is a 19 year-old college student who has
had a life-long weight problem.

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