Diabetes Mellitus Type I/DKA SKINNY Reasoning

Diabetes Mellitus Type I/DKA SKINNY 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 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%  SKINNY Reasoning Part I: Recognizing RELEVANT Clinical Data 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 -Always hungry and thirsty -was sick with a respiratory virus 2 weeks ago Fatigue is a symptom Deeper and faster is known as Kussmaul breathing, which is a symptom of DKA if insulin is unable to convert food to energy it causes increased hunger and thirst RELEVANT Data from Social History: Clinical Significance: physically active and plays soccer he is active and is getting the necessary exercise for his age group 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: Temp Pulse Respirations BP A high temperature could be a sign of an infection tachycardia kussmaul low blood pressure could be a sign of dehydration since he is urinating more often