lOMoARcPSD|228917 87 Diabetic Ketoacidosis -DKA -
UNFOLDING EXAM REASONING QUESTIONS AND ANS WERS Diabetic Ketoacidosis (DKA) Diana Humphries, 45 years old Primary Concept Fluid and Electrolyte Balance Interrelated Concepts (In order of emphasis) lOMoARcPSD|228917 87 1. Acid -Base Balance 2. Glucose Regulation 3. Infection 4. Pain 5. Clinical Judgment 6. Patient Education 7. Communication 8. Collaboration lOMoARcPSD|228917 87 History of Present Problem: Diabetic Ketoacidosis (DKA) Diana Humphries is a 45 -year-old woman with chronic kidney disease stage III and diabetes mellitus type1 who checks her blood sugar daily, or whenever she feels like it. She has been feeling increasingly nauseated the past 12 hours. She has had a harsh, pr oductive cough of yellow sputum the past three days. She checked her blood glucose before going to bed last night and it was 382, but then she fell asleep early and missed her bedtime dose of glargine (Lantus) insulin. When she awoke this morning, she had generalized abdominal pain and continued to feel nauseated and had a large emesis. Her glucometer was unable to read her blood glucose because it was too high. She took 10 units of lispro (Humalog) insulin this morning. Her nausea has increased all morning and she has been unable to eat or keep anything down despite having an increased thirst and appetite. She also has had increased frequency of urination. When her lunchtime glucometer gave no reading because it was too high and out of range, she called 9-1-1 to be evaluated in the emergency department (ED). Personal/Social History: Diana has been inconsistently compliant with her medical/diabetic regimen due to her struggles with anxiety and depression that have worsened since her mother died three months ago. She considers 200 a good blood sugar reading. She is divorced with no children and has been homeless and has lived in a shelter off and on for the past month. She is on Social Security disability because of complications related to diabetes. At one point during the intake interview, she expressed to the nurse, “I’m going to die anyway, why does all this matter?” What data from the histories is RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: - Chronic kidney disease stage III and DM1 - Nauseous for 12 hours - Not compliant with daily glucose checks or drug therapy - Productive cough of yellow sputum the past three days. - Glucose level 382, and the patient forgot to administer insulin. - High glucose level, not being able to read on the glucometer. - Increase frequent urination - Called 911 for an evaluation in the ER due to her high glucose level. - Patient is on deteriorative health state, non-compliant with her DM1 care plan and insulin regimen. - Showing acute state of hyperglycemia - The patient can go into shock or coma soon. - The patient is dehydrated since she hasn't been able to keep anything down and is having nausea. - The patient is showing some signs and symptoms of DKA such as: polyuria, dehydration, glycosuria, just as expected on urine lab results. RELEVANT Data from Social History: Clinical Significance: - The patient is not compliant with the care plan. - The patient has anxiety and depression - Patient’s mother passed away 3 months ago. - Homeless and living on a shelter/streets for a month. - The patient is depressed and has no backup support, and since she is homeless it is an indication of lacking many needs. Her health is not a priority. - She is neglecting her health - Risk for suicide - The patient needs a care plan that offers community services to meet basic needs. © 2016 Keith Rischer/ www.KeithRN.com
UNFOLDING EXAM REASONING QUESTIONS AND ANS WERS Diabetic Ketoacidosis (DKA) Diana Humphries, 45 years old Primary Concept Fluid and Electrolyte Balance Interrelated Concepts (In order of emphasis) lOMoARcPSD|228917 87 1. Acid -Base Balance 2. Glucose Regulation 3. Infection 4. Pain 5. Clinical Judgment 6. Patient Education 7. Communication 8. Collaboration lOMoARcPSD|228917 87 History of Present Problem: Diabetic Ketoacidosis (DKA) Diana Humphries is a 45 -year-old woman with chronic kidney disease stage III and diabetes mellitus type1 who checks her blood sugar daily, or whenever she feels like it. She has been feeling increasingly nauseated the past 12 hours. She has had a harsh, pr oductive cough of yellow sputum the past three days. She checked her blood glucose before going to bed last night and it was 382, but then she fell asleep early and missed her bedtime dose of glargine (Lantus) insulin. When she awoke this morning, she had generalized abdominal pain and continued to feel nauseated and had a large emesis. Her glucometer was unable to read her blood glucose because it was too high. She took 10 units of lispro (Humalog) insulin this morning. Her nausea has increased all morning and she has been unable to eat or keep anything down despite having an increased thirst and appetite. She also has had increased frequency of urination. When her lunchtime glucometer gave no reading because it was too high and out of range, she called 9-1-1 to be evaluated in the emergency department (ED). Personal/Social History: Diana has been inconsistently compliant with her medical/diabetic regimen due to her struggles with anxiety and depression that have worsened since her mother died three months ago. She considers 200 a good blood sugar reading. She is divorced with no children and has been homeless and has lived in a shelter off and on for the past month. She is on Social Security disability because of complications related to diabetes. At one point during the intake interview, she expressed to the nurse, “I’m going to die anyway, why does all this matter?” What data from the histories is RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: - Chronic kidney disease stage III and DM1 - Nauseous for 12 hours - Not compliant with daily glucose checks or drug therapy - Productive cough of yellow sputum the past three days. - Glucose level 382, and the patient forgot to administer insulin. - High glucose level, not being able to read on the glucometer. - Increase frequent urination - Called 911 for an evaluation in the ER due to her high glucose level. - Patient is on deteriorative health state, non-compliant with her DM1 care plan and insulin regimen. - Showing acute state of hyperglycemia - The patient can go into shock or coma soon. - The patient is dehydrated since she hasn't been able to keep anything down and is having nausea. - The patient is showing some signs and symptoms of DKA such as: polyuria, dehydration, glycosuria, just as expected on urine lab results. RELEVANT Data from Social History: Clinical Significance: - The patient is not compliant with the care plan. - The patient has anxiety and depression - Patient’s mother passed away 3 months ago. - Homeless and living on a shelter/streets for a month. - The patient is depressed and has no backup support, and since she is homeless it is an indication of lacking many needs. Her health is not a priority. - She is neglecting her health - Risk for suicide - The patient needs a care plan that offers community services to meet basic needs. © 2016 Keith Rischer/ www.KeithRN.com
