NU424 Diabetic Ketoacidosis
Case Study # 3
Case Presentation:
You are working in an outpatient clinic when a mother brings in her 20-year-old
daughter, C.J., who has type 1 diabetes mellitus (DM) and has just returned from a
trip to Mexico. She has had a 3-day fever and diarrhea with nausea and vomiting.
She has been unable to eat and has tolerated only sips of fluid. Because she was
unable to eat, she did not take her insulin as directed. You note C.J. is unsteady, so
you take her to the examining room in a wheelchair. While assisting her onto the
examination table, you note her skin is warm and flushed. Her respirations are
deep and rapid, and her breath is fruity and sweet smelling. C.J. is drowsy and
m
unable to answer your questions. Her mother states, "She keeps telling me she's so
er as
thirsty, but she can't keep anything down."
co
eH w
o.
rs e
1. List four pieces of additional information you need to elicit from C.J.'s
ou urc
mother.
How long ago was she diagnosed with diabetes? How did this start? What
o
was her fever? Has she been peeing? What did she eat and drink in Mexico?
What is her glucose level? What has she been drinking?
aC s
vi y re
Case Study Progress
Case Progression:
ed d
The mother tells you the following:
ar stu
“Blood glucose monitor has been reading ‘high.’"
“C.J. has had sips of ginger ale, but that’s all.”
is
“She has been vomiting about every other time she drinks.”
Th
“When she first got home, she went [voided] a lot, but yesterday she hardly went
at all, and I don't think she has gone today.”
sh
“She went to bed early last night, and I could hardly wake her up this morning.
That's why I brought her in.”
This study source was downloaded by 100000822479833 from CourseHero.com on 04-01-2021 19:34:37 GMT -05:00
https://www.coursehero.com/file/54244300/DKA-Case-Studypdf/
, 2. Describe the pathophysiology of diabetic ketoacidosis (DKA).
When insulin levels get so low that the body starts breaking down fatty acids
and producing ketones in the urine.
m
er as
co
eH w
3. Interpret C.J.'s VS, relating your discussion to the underlying
o.
pathophysiology.
rs e
The glucose is through the roof because there is no insulin in the body.
ou urc
Potassium is high because of the acidosis and increase in extracellular
potassium. The blood pressure is so low and pulse so high because she
o
is extremely dehydrated. She has high and deep respirations because of
aC s
her metabolic acidosis as well as the body trying to expel carbon
vi y re
dioxide. Lastly her temp is his because she probably has an infection or
virus that triggered all this.
ed d
4. Explain the rationale for C.J.'s other presenting signs and symptoms.
ar stu
Polyuria is due to the electrolyte imbalance and expelling ketones. Excessive
thirst due to dehydration. Vomiting due to metabolic acidosis. Oliguria due
to extreme dehydration. The skin is warm and flush due to the fever and
is
dehydration. She is unsteady and drowsy due to dehydration and metabolic
Th
acidosis. Her breath is fruity due to the high glucose levels.
5. A decision is made to transport C.J. by ambulance to the local
sh
emergency department (ED). After evaluating C.J., the ED physician
writes the following orders. Carefully review each order. Mark with an
A if the order is appropriate; mark with an I if inappropriate. For each
This study source was downloaded by 100000822479833 from CourseHero.com on 04-01-2021 19:34:37 GMT -05:00
https://www.coursehero.com/file/54244300/DKA-Case-Studypdf/
Case Study # 3
Case Presentation:
You are working in an outpatient clinic when a mother brings in her 20-year-old
daughter, C.J., who has type 1 diabetes mellitus (DM) and has just returned from a
trip to Mexico. She has had a 3-day fever and diarrhea with nausea and vomiting.
She has been unable to eat and has tolerated only sips of fluid. Because she was
unable to eat, she did not take her insulin as directed. You note C.J. is unsteady, so
you take her to the examining room in a wheelchair. While assisting her onto the
examination table, you note her skin is warm and flushed. Her respirations are
deep and rapid, and her breath is fruity and sweet smelling. C.J. is drowsy and
m
unable to answer your questions. Her mother states, "She keeps telling me she's so
er as
thirsty, but she can't keep anything down."
co
eH w
o.
rs e
1. List four pieces of additional information you need to elicit from C.J.'s
ou urc
mother.
How long ago was she diagnosed with diabetes? How did this start? What
o
was her fever? Has she been peeing? What did she eat and drink in Mexico?
What is her glucose level? What has she been drinking?
aC s
vi y re
Case Study Progress
Case Progression:
ed d
The mother tells you the following:
ar stu
“Blood glucose monitor has been reading ‘high.’"
“C.J. has had sips of ginger ale, but that’s all.”
is
“She has been vomiting about every other time she drinks.”
Th
“When she first got home, she went [voided] a lot, but yesterday she hardly went
at all, and I don't think she has gone today.”
sh
“She went to bed early last night, and I could hardly wake her up this morning.
That's why I brought her in.”
This study source was downloaded by 100000822479833 from CourseHero.com on 04-01-2021 19:34:37 GMT -05:00
https://www.coursehero.com/file/54244300/DKA-Case-Studypdf/
, 2. Describe the pathophysiology of diabetic ketoacidosis (DKA).
When insulin levels get so low that the body starts breaking down fatty acids
and producing ketones in the urine.
m
er as
co
eH w
3. Interpret C.J.'s VS, relating your discussion to the underlying
o.
pathophysiology.
rs e
The glucose is through the roof because there is no insulin in the body.
ou urc
Potassium is high because of the acidosis and increase in extracellular
potassium. The blood pressure is so low and pulse so high because she
o
is extremely dehydrated. She has high and deep respirations because of
aC s
her metabolic acidosis as well as the body trying to expel carbon
vi y re
dioxide. Lastly her temp is his because she probably has an infection or
virus that triggered all this.
ed d
4. Explain the rationale for C.J.'s other presenting signs and symptoms.
ar stu
Polyuria is due to the electrolyte imbalance and expelling ketones. Excessive
thirst due to dehydration. Vomiting due to metabolic acidosis. Oliguria due
to extreme dehydration. The skin is warm and flush due to the fever and
is
dehydration. She is unsteady and drowsy due to dehydration and metabolic
Th
acidosis. Her breath is fruity due to the high glucose levels.
5. A decision is made to transport C.J. by ambulance to the local
sh
emergency department (ED). After evaluating C.J., the ED physician
writes the following orders. Carefully review each order. Mark with an
A if the order is appropriate; mark with an I if inappropriate. For each
This study source was downloaded by 100000822479833 from CourseHero.com on 04-01-2021 19:34:37 GMT -05:00
https://www.coursehero.com/file/54244300/DKA-Case-Studypdf/
