Med surg case study 2-13 DKA.docx -...

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Ignatavicius: Medical-Surgical Nursing, 8th Edition Chapter 64: Care of Patients with  Diabetes Mellitus Case Studies  The Patient with Diabetes Mellitus  The patient is a 48-year-old unconscious woman admitted to the emergency department.  She has a known history of type 1 diabetes mellitus. Her daughter accompanies her and  tells the staff that her mother has had the “flu” and has been unable to eat or drink very  much. The daughter is uncertain whether her mother has taken her insulin in the past 24  hours. The patient’s vital signs are: temperature, 101.8 °   F; pulse, 120 beats/min, weak and  irregular; respirations, 22 breaths/min, deep, and fruity odor; and blood pressure, 80/42  mm Hg. Blood specimens and arterial blood gases are drawn and an IV infusion is begun.  1. Based on this patient’s history, give the probable changes in laboratory results for serum  glucose, serum osmolarity, serum acetone, blood urea nitrogen, arterial pH, and arterial  PCO2. What medical emergency do these data indicate? 
2. What types of IV solutions should the nurse be prepared to administer to this patient? What drugs should the nurse be prepared to give? Explain your answers.
loss slower than the 0.9% NaCl. The D5 ½ NS is used to prevent hypoglycemia and cerebral edema. The drugs the nurse should be prepared to administer are insulin, sodium bicarbonate, and potassium. The goal of insulin administration is to lower blood glucose by 50-75. Regular insulin is administered by continuous IV infusion. Can use a bolus initially to reach insulin levels quickly. This method is used because insulin half-life is short so a continuous infusion helps to keep the glucose levels more maintained and subcutaneous insulin has a delayed onset of action. Bicarbonate is used for severe DKA. This med is given slowly by IV infusion over several hours. Indication for the use of this med is when the patients PH is 7.0 or less or serum bicarbonate is less than 5mEq. Potassium replacement may also be necessary. Potassium replacement is initiated when serum potassium falls below 5.0 and when urine output is adequate.

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