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 Covered in
Category/Subcategory 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%
© 2020 KeithRN LLC. All rights reserved.
No part of this case study may be reproduced, stored in retrieval system or transmitted in any form
or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior
written permission of KeithRN
, 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 Fatigue is a symptom
-His breathing is “not Deeper and faster is known as Kussmaul breathing,
normal”, it’s deeper and which is a symptom of DKA
faster if insulin is unable to convert food to energy it
-Always hungry and thirsty causes increased hunger and thirst
-was sick with a respiratory
virus 2 weeks ago
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:
Tem A high temperature could be a sign of an
p infection tachycardia
Puls kussmaul
e low blood pressure could be a sign of dehydration since he is
Respiratio urinating more often
© 2020 KeithRN LLC. All rights reserved.
No part of this case study may be reproduced, stored in retrieval system or transmitted in any form
or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior
written permission of KeithRN
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 Covered in
Category/Subcategory 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%
© 2020 KeithRN LLC. All rights reserved.
No part of this case study may be reproduced, stored in retrieval system or transmitted in any form
or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior
written permission of KeithRN
, 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 Fatigue is a symptom
-His breathing is “not Deeper and faster is known as Kussmaul breathing,
normal”, it’s deeper and which is a symptom of DKA
faster if insulin is unable to convert food to energy it
-Always hungry and thirsty causes increased hunger and thirst
-was sick with a respiratory
virus 2 weeks ago
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:
Tem A high temperature could be a sign of an
p infection tachycardia
Puls kussmaul
e low blood pressure could be a sign of dehydration since he is
Respiratio urinating more often
© 2020 KeithRN LLC. All rights reserved.
No part of this case study may be reproduced, stored in retrieval system or transmitted in any form
or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior
written permission of KeithRN
