BSN 366 George’s DKA Case Study (2026) | 100% Score | Complete
Management, Assessment & Rationales |Nightingale College
George, Diabetic Ketoacidosis [SNR111US]
Learning Objectives
Diagnosis
Diabetic ketoacidosis secondary to inconsistent insulin use.
Case Summary
Vomiting and lethargic with high blood glucose, acidosis and ketosis.
DKA likely precipitated by not adjusting insulin regimen correctly due to social factors.
Clinical Findings
Tachycardic, tachypneic and borderline hypotensive
Generalized abdominal tenderness
Metabolic acidosis
High blood glucose, ketone positive
Technical Skills
Assessment
Complete a full set of vital signs and document on EWS chart
Establish a history of the presenting complaint
Establish medical history (including Type 1 Diabetes)
Establish medication history (including insulin use)
Ask allergy status
Perform basic physical exam (examine abdomen, auscultate chest, check skin)
Initial Investigations
Check blood glucose (via blood gas or capillary) and identify as raised
Check ketones (urine or capillary)
Obtain labs and a blood gas
Management
Perform SBAR report and request urgent medical review
Insert IV access
Deliver oxygen (to maintain saturations above 94%)
Administer all drugs and fluids (prescribed by medical team)
Commence urine output monitoring
Non-technical Skills
Make rational, timely clinical decisions
Effectively communicate with patient and team
Maintain patient safety and comfort
Apply clinical knowledge and adapt to changes in patient condition
Appropriately utilize other team members
Escalate and refer appropriately
1/20
,What went well - critical aspects
Verify name and date of birth
You verified your patient's name and date of birth
Hide rationale
Rationale
The National Patient Safety Goals (NPSG) are set yearly as an industry standard and emphasize the use of
patient identifiers as goal number 1 in promoting quality and patient safety in all levels of patient care.
Healthcare providers should use two patient identifiers with every patient, every time. In order to prevent
instances of mis-identification and near-miss error, two identifiers such as a patient’s full name, date of birth
and/or medical identification (ID) number should be used for every patient encounter, confirmed both
verbally and by a patient wristband visually.
Reference: Two Patient Identifiers - Understanding The Requirements
(https://www.jointcommission.org/standards/standard-faqs/ambulatory/national-patient-safety-goals-
npsg/000001545/)
Person-Centered Care Quality & Safety
00:42
5 Rights of medication administration
You utilized the 5 rights of medication administration before administering medication to your patient
Hide rationale
Rationale
In order to reduce medication errors and harm it is an expected practice to use the “five rights of medication
administration" before administering any medication to a patient (after receiving an order or script) : the
right patient, the right drug, the right dose, the right route, and the right time, are the basic rights. Note that
in the context of treatment and administration, IV fluids are also considered a medication. Other "rights"
have been added over time to further increase the safety and well-being of patients such as: right
documentation, right client education, right to refuse, right assessment, and right evaluation. There is always
a risk of giving the wrong pill, the wrong dose, or the wrong person’s medication.
If this happens, harm to the person can occur and some reactions can be deadly. It is therefore imperative to
always verify a patient’s name and date of birth, ask about their allergy status, and review their MAR and
fluid prescription record prior to administering medications and fluids.
Reference: Nursing Rights of Medication Administration
(https://www.ncbi.nlm.nih.gov/books/NBK560654/)
Person-Centered Care Knowledge for Practice Systems-Based Practice Quality & Safety Professionalism
00:42
Presenting complaint
The history of feeling generally unwell and vomiting was consistent with several differentials in George's case
Hide rationale
Rationale
2/20
, Try to ask the presenting complaint as an open question. This will allow the patient to focus on what they feel
is important. In a patient presenting with acute sickness and abdominal pain, there are a number of
differentials including gastroenteritis, DKA (in a type one diabetic) or even intra-abdominal infection or
obstruction.
Person-Centered Care Knowledge for Practice Systems-Based Practice Quality & Safety Professionalism
01:00
Past medical history
You correctly ascertained George's past medical history of Type 1 Diabetes
Hide rationale
Rationale
This is important to know, regardless of the ultimate diagnosis as it is likely to impact how you manage
George.
Reference: The Importance of the History and Physical (https://www.nursingcenter.com/pdfjournal?
AID=2409975&an=00006205-201404000-00006&Journal_ID=54012&Issue_ID=2409929)
Person-Centered Care Knowledge for Practice Systems-Based Practice Quality & Safety Professionalism
01:12
Medication history
George's insulin use and recent self-amends to his dose are significant contributors to his presentation
Hide rationale
Rationale
In this case it is particularly important to ascertain whether George has been taking his insulin appropriately.
Poor insulin compliance is a common precipitant of DKA.
Reference: Nurse's Role in Medication Reconciliation (https://www.ena.org/docs/default-
source/resource-library/practice-resources/position-
statements/roleofednurseinmedicationreconcilation.pdf?sfvrsn=8c413f53_8)
Person-Centered Care Knowledge for Practice Systems-Based Practice Quality & Safety Professionalism
01:16
Allergies
You correctly asked about allergies
Hide rationale
Rationale
This is particularly important when you suspect you will have to administer medications to a patient and can
be life threatening if forgotten.
3/20
Management, Assessment & Rationales |Nightingale College
George, Diabetic Ketoacidosis [SNR111US]
Learning Objectives
Diagnosis
Diabetic ketoacidosis secondary to inconsistent insulin use.
Case Summary
Vomiting and lethargic with high blood glucose, acidosis and ketosis.
DKA likely precipitated by not adjusting insulin regimen correctly due to social factors.
Clinical Findings
Tachycardic, tachypneic and borderline hypotensive
Generalized abdominal tenderness
Metabolic acidosis
High blood glucose, ketone positive
Technical Skills
Assessment
Complete a full set of vital signs and document on EWS chart
Establish a history of the presenting complaint
Establish medical history (including Type 1 Diabetes)
Establish medication history (including insulin use)
Ask allergy status
Perform basic physical exam (examine abdomen, auscultate chest, check skin)
Initial Investigations
Check blood glucose (via blood gas or capillary) and identify as raised
Check ketones (urine or capillary)
Obtain labs and a blood gas
Management
Perform SBAR report and request urgent medical review
Insert IV access
Deliver oxygen (to maintain saturations above 94%)
Administer all drugs and fluids (prescribed by medical team)
Commence urine output monitoring
Non-technical Skills
Make rational, timely clinical decisions
Effectively communicate with patient and team
Maintain patient safety and comfort
Apply clinical knowledge and adapt to changes in patient condition
Appropriately utilize other team members
Escalate and refer appropriately
1/20
,What went well - critical aspects
Verify name and date of birth
You verified your patient's name and date of birth
Hide rationale
Rationale
The National Patient Safety Goals (NPSG) are set yearly as an industry standard and emphasize the use of
patient identifiers as goal number 1 in promoting quality and patient safety in all levels of patient care.
Healthcare providers should use two patient identifiers with every patient, every time. In order to prevent
instances of mis-identification and near-miss error, two identifiers such as a patient’s full name, date of birth
and/or medical identification (ID) number should be used for every patient encounter, confirmed both
verbally and by a patient wristband visually.
Reference: Two Patient Identifiers - Understanding The Requirements
(https://www.jointcommission.org/standards/standard-faqs/ambulatory/national-patient-safety-goals-
npsg/000001545/)
Person-Centered Care Quality & Safety
00:42
5 Rights of medication administration
You utilized the 5 rights of medication administration before administering medication to your patient
Hide rationale
Rationale
In order to reduce medication errors and harm it is an expected practice to use the “five rights of medication
administration" before administering any medication to a patient (after receiving an order or script) : the
right patient, the right drug, the right dose, the right route, and the right time, are the basic rights. Note that
in the context of treatment and administration, IV fluids are also considered a medication. Other "rights"
have been added over time to further increase the safety and well-being of patients such as: right
documentation, right client education, right to refuse, right assessment, and right evaluation. There is always
a risk of giving the wrong pill, the wrong dose, or the wrong person’s medication.
If this happens, harm to the person can occur and some reactions can be deadly. It is therefore imperative to
always verify a patient’s name and date of birth, ask about their allergy status, and review their MAR and
fluid prescription record prior to administering medications and fluids.
Reference: Nursing Rights of Medication Administration
(https://www.ncbi.nlm.nih.gov/books/NBK560654/)
Person-Centered Care Knowledge for Practice Systems-Based Practice Quality & Safety Professionalism
00:42
Presenting complaint
The history of feeling generally unwell and vomiting was consistent with several differentials in George's case
Hide rationale
Rationale
2/20
, Try to ask the presenting complaint as an open question. This will allow the patient to focus on what they feel
is important. In a patient presenting with acute sickness and abdominal pain, there are a number of
differentials including gastroenteritis, DKA (in a type one diabetic) or even intra-abdominal infection or
obstruction.
Person-Centered Care Knowledge for Practice Systems-Based Practice Quality & Safety Professionalism
01:00
Past medical history
You correctly ascertained George's past medical history of Type 1 Diabetes
Hide rationale
Rationale
This is important to know, regardless of the ultimate diagnosis as it is likely to impact how you manage
George.
Reference: The Importance of the History and Physical (https://www.nursingcenter.com/pdfjournal?
AID=2409975&an=00006205-201404000-00006&Journal_ID=54012&Issue_ID=2409929)
Person-Centered Care Knowledge for Practice Systems-Based Practice Quality & Safety Professionalism
01:12
Medication history
George's insulin use and recent self-amends to his dose are significant contributors to his presentation
Hide rationale
Rationale
In this case it is particularly important to ascertain whether George has been taking his insulin appropriately.
Poor insulin compliance is a common precipitant of DKA.
Reference: Nurse's Role in Medication Reconciliation (https://www.ena.org/docs/default-
source/resource-library/practice-resources/position-
statements/roleofednurseinmedicationreconcilation.pdf?sfvrsn=8c413f53_8)
Person-Centered Care Knowledge for Practice Systems-Based Practice Quality & Safety Professionalism
01:16
Allergies
You correctly asked about allergies
Hide rationale
Rationale
This is particularly important when you suspect you will have to administer medications to a patient and can
be life threatening if forgotten.
3/20
