DKA Case Study part 2
History of Current Problem:
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, productive 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 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?”
1. What is the RELATIONSHIP between RELEVANT current problem data and the primary
medical problem?
RELEVANT Current Problem Clinical Significance
Data:
Chronic Kidney Disease Decreased function of the kidneys and if patient is in
DKA there is an increased load on kidneys due to
polyuria
Type 1 Diabetes and checks BG
Puts her at risk for developing DKA especially since she
whenever she feels like it
doesn’t check her BG regularly
BG 383 before bed and didn’t
BG already high before bed so we know it was high for a
take her bedtime Lantus
while before she called 911
Generalized abdominal pain,
S/S of hyperglycemia
nausea, emesis
, Increased thirst, appetite,
urination
S/S of hyperglycemia
Lunchtime glucometer gave no
reading because too high
Severely hyperglycemic
RELEVANT From Social Clinical Significance
History:
Divorced Lack of family support
Homeless and lives in the Other struggles to deal with on top of her illnesses
shelter
Inconsistent with medication
Non-compliant
regimen
Lack of education/non-compliance
Considers BG of 200 to be good
Feeling hopeless which could contribute to her non-
Death of mother
compliance
Feeling hopeless which could contribute to her non-
Suicidal Ideation compliance
Struggles with anxiety and Can contribute to her non-compliance
depression
2. Past Medical History and Medications Identify the pharmacologic classification and effect for
each medication. Then Identify which medication is given for each past medical problem
PMH Home Meds Pharm Effect
Classification
History of Current Problem:
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, productive 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 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?”
1. What is the RELATIONSHIP between RELEVANT current problem data and the primary
medical problem?
RELEVANT Current Problem Clinical Significance
Data:
Chronic Kidney Disease Decreased function of the kidneys and if patient is in
DKA there is an increased load on kidneys due to
polyuria
Type 1 Diabetes and checks BG
Puts her at risk for developing DKA especially since she
whenever she feels like it
doesn’t check her BG regularly
BG 383 before bed and didn’t
BG already high before bed so we know it was high for a
take her bedtime Lantus
while before she called 911
Generalized abdominal pain,
S/S of hyperglycemia
nausea, emesis
, Increased thirst, appetite,
urination
S/S of hyperglycemia
Lunchtime glucometer gave no
reading because too high
Severely hyperglycemic
RELEVANT From Social Clinical Significance
History:
Divorced Lack of family support
Homeless and lives in the Other struggles to deal with on top of her illnesses
shelter
Inconsistent with medication
Non-compliant
regimen
Lack of education/non-compliance
Considers BG of 200 to be good
Feeling hopeless which could contribute to her non-
Death of mother
compliance
Feeling hopeless which could contribute to her non-
Suicidal Ideation compliance
Struggles with anxiety and Can contribute to her non-compliance
depression
2. Past Medical History and Medications Identify the pharmacologic classification and effect for
each medication. Then Identify which medication is given for each past medical problem
PMH Home Meds Pharm Effect
Classification
