Type 1 Diabetes Mellitus Type I/DKA UNFOLDING Reasoning

Type 1 Diabetes Mellitus Type I/DKA UNFOLDING Reasoning Jack Anderson, 9 years old Primary Concept Glucose Regulation Interrelated Concepts (In order of emphasis) ● Fluid and Electrolyte Balance ● Acid-Base Balance ● Clinical Judgment ● Patient Education ● Communication ● Collaboration NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment Management of Care 17-23% Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity Basic Care and Comfort 6-12% Pharmacological and Parenteral Therapies 12-18% Reduction of Risk Potential 9-15% Physiological Adaptation 11-17% History of Present Problem: Jack Anderson is a 9-year-old boy who presents to the emergency department because he has been more sleepy and his breathing is “not normal;” it is deeper and faster, according to his parents. Jack was sick with a respiratory virus two weeks ago but has since recovered. Jack began feeling more tired a few days ago when he started to complain of abdominal pain, headache, muscle aches, and consistently being hungry and thirsty. He is urinating more frequently during the day and at night. His mother reports a normal full-term pregnancy and Jack has been healthy with no known medical conditions. Personal/Social History: Jack lives with both parents and two siblings; a younger sister four years old and a 12-year-old brother. Both parents work as middle school teachers in the community. Jack is in the 4th grade and earns above-average marks. He is physically active and plays soccer on the school team. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance: He's more sleepy His breathing is "not normal" it's deeper and faster Was sick with a respiratory virus 2 weeks ago Always hungry and thirsty Fatigue is a common symptom and can result from high blood sugar levels Kussmaul breathing is rapid or labored breathing, a symptom of DKA Lack of insulin or insulin resistance helping convert food to energy causes increased hunger and thirst RELEVANT Data from Social History: Clinical Significance: Has a support system from family Physically active, plays soccer Shows he will get the care he needs with his support system Being active can lead to hypoglycemia once he manages his diabetes Patient Care Begins: Current VS: P-Q-R-S-T Pain Assessment: T: 100.4 F/38.0 C (oral) Provoking/Palliative: Made worse with solid food. P: 136 (regular) Quality: Dull and aching R: 44 (deep/rapid) Region/Radiation: Confined to abdomen, generalized within abdominal region BP: 80/48 Severity: He states his pain is a 4/10 on the numeric scale. O2 sat: 98% on RA Timing: States, “All the time” Weight: 64.0 lbs/29.1 kg What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential Reduction of Risk Potential/Health Promotion and Maintenance) RELEVANT VS Data: Clinical Significance: T: 100.4 F (oral) High temperature could be a sign of infection P: 136 (regular) Tachycardia is present R: 44 (deep/rapid) Kussmaul respirations is present BP: 80/48 Very low blood pressure, could be a sign of dehydration with the excessive urination Pain: Made worse with solid food, dull and aching, generalized within abdominal region, states pain is all the time Abdominal pain could be a side effect of not getting enough insulin