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Dka Case Study Nursing

48345115 Diabetic-ketoacidosis-case-study

48345115 Diabetic-ketoacidosis-case-study

48345115 diabetic-ketoacidosis-case-study 1. 1 QUEENY MARIE MARTINEZ BSN III – B NURSING CASE STUDY DIABETIC KETOACIDOSIS (DKA) 1. Introduction/description of the disease DKA is caused by an absence or markedly inadequate amount of insulin. This deficit in available insulin results in disorder in the metabolism of carbohydrate, protein and fat. The three main clinical features/manifestations of Diabetic Ketoacidosis (DKA) are based on the following concepts: 1) Hyperglycemia 2) dehydration and electrolyte loss 3) acidosis. Blood glucose levels range from 300 to 800 mg/dL. Low serum bicarbonate and a low pH are present. It is a life-threatening complication of DM type I. this is due to severe insulin deficiency. 2. Risk factors o Patient with Type I diabetes mellitus are at risk to develop DKA. o Persons who are frequently stressed out or due to stress-induced by surgery and o persons with frequent or severe illness/infection are also at risk of developing DKA. 3. Causes  Underdose or missed dose of insulin  Illness or infection  Overeating  Stress, surgery  Undiagnosed and untreated type I DM. 2. 2 4. Pathophysiology Without insulin, the amount of glucose entering the cells is reduced, and production and release of glucose by the liver is increased. Both factors lead to hyperglycemia. In an attempt of the body to get rid of the excess glucose, the kidneys excrete the glucose along with water and electrolytes. This osmotic diuresis, which is characterized by excessive urination (polyuria), leads to dehydration and marked electrolytes loss. Lack of insulin Increasedbreakdown of fats  Decreasedutilizationof glucose bymuscles,fat, and liver  Increasedproductionof glucose byliver. Hyperglycemia Increased fatty acids Increased ketonesbodies  Acetone Continue reading >>

Dka Case Study

Dka Case Study

Jerry Thomas is a 26-year-old Type I Diabetic. He was originally diagnosed at the age of 14, and currently manages his disease with an intensive regimen of insulin injections. Jerry is employed as a schoolteacher and soccer coach. He presents today with a 2-day history of vomiting and diarrhea. He has been closely monitoring his blood glucoses, and is using regular insulin for high blood glucose levels. He has only been able to tolerate liquids such as Gatorade, but today he is unable to even tolerate that, and comes to the clinic for evaluation of possible Diabetic Ketoacidosis (DKA). Describe the pathophysiology of DKA and why it occurs in patients with Type I Diabetes Mellitus. (5 points) Patients with Type 1 diabetes do not produce insulin in their body, so instead of using glucose to burn in their metabolism, their body starts burning proteins. The metabolism of proteins produces ketones as a by product and as this accumulates, causes diabetes ketoacidosis, an acidification of the blood. Based upon the diagnosis of DKA, what assessment findings does the nurse correlate to this disorder? (5 points) Polydipsia, polyuria, fruity breath, weakness, nausea and vomiting, abdominal pain, hyperglycemia, high levels of ketones in urine The physician orders a complete metabolic panel, and Jerry’s blood glucose is 425. Other lab values include a serum sodium of 152, serum potassium of 3.0, and BUN of 64. What is your assessment of these results? (10 points) High blood glucose (random glucose over 200), high sodium (>145, dehydration due to polyuria), low potassium (>3.5, hyperglycemia), high BUN (>21, kidneys not functioning due to high protein metabolism) Explain why it is important for Jerry to continue to take his insulin even though his oral intake is decreased. (2 point Continue reading >>

Case Study- Diabetic Ketoacidosis

Case Study- Diabetic Ketoacidosis

Case Details A 22- year-old diabetic comes to the Accident and Emergency department. She gives a 2-day history of vomiting and abdominal pain. She is drowsy and her breathing is deep and rapid. There is distinctive smell from her breath What is the most likely diagnosis? What is the biochemical basis for all the presenting symptoms? Which laboratory test would you request? Case discussion The patient is most probably suffering from diabetic ketoacidosis. She is a known diabetic and the presenting symptoms like abdominal pain, vomiting, rapid breathing and distinctive smell of breath, all indicate associated ketoacidosis. Basic concept Diabetic Ketoacidosis (DKA) is a state of inadequate insulin levels resulting in high blood sugar and accumulation of organic acids and ketones in the blood. It is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in type 1 diabetes mellitus, but it can also occur in type 2 diabetes mellitus under certain circumstances. Causes- DKA occurs most frequently in knownDiabetics. It may also be the first presentation in patients who had not been previously diagnosed as diabetics. There is often a particular underlying problem that has led to DKA episode. This may be- 1) Inter current illness such as Pneumonia,Influenza, Gastroenteritis, Urinary tract infection or pregnancy. 2) Inadequate Insulin administration may be due to defective insulin pen device or in young patient intentional missing of dose due to fear of weight gain. 3) Associated myocardial infarction, stroke or use of cocaine 4) Inadequate food intake– may be due to anorexia associated with infective process or due to eating disorder in children. Diabetic keto acidosis may occur in those previously known to have diabetes mellitu Continue reading >>

Diabetic Ketoacidosis And Pediatric Stroke

Diabetic Ketoacidosis And Pediatric Stroke

THE CASE: A 6-year-old previously healthy right-handed girl presented with a 3-day history of progressive epigastric abdominal pain, polydipsia and secondary nocturnal enuresis and a 2-week history of weight loss of 5 kg. Her initial assessment revealed tachypnea with Kussmaul's respiration, tachycardia and moderate dehydration, with an estimated fluid deficit of 6%– 9%. The girl was hyperglycemic (plasma glucose level 43.4 mmol/L) and acidotic (pH 7.13, bicarbonate level 3.8 mmol/L), with urinalysis revealing ketonuria and glucosuria. After admission, appropriate fluid resuscitation and insulin treatment were started. The patient's diabetic ketoacidosis resolved over 20 hours, at which point a diabetic diet was introduced along with subcutaneous insulin therapy. On the morning after admission, the patient was found by the nursing staff to be irritable, lethargic and intermittently combative. Twelve hours later a right hemiparesis and aphasia became evident. A cranial CT scan showed an evolving infarct in the left basal ganglia. Transcranial Doppler ultrasonography and magnetic resonance angiography showed occlusion of the proximal left middle cerebral artery (Fig. 1). Echocardiography showed 2 thrombi, measuring 11 х 9 mm and 1 х 1 mm respectively, on the underside of the anterior mitral valve leaflet. There was no associated congenital heart disease. Because of a high risk of further thromboembolic events, heparin infusion was begun, and open thrombectomy was performed on the third day. Pathological examination revealed inflammatory cells and an organized thrombus. Blood cultures and prothrombotic studies yielded negative findings. Intensive rehabilitation therapy and low-molecular-weight heparin (enoxaparin, 30 mg subcutaneously every 12 hours) were started after Continue reading >>

Diabetic Emergencies, Part 5: Dka Case Studies

Diabetic Emergencies, Part 5: Dka Case Studies

Case Study 1 A 32-year-old male with type 1 diabetes since the age of 14 years was taken to the emergency room because of drowsiness, fever, cough, diffuse abdominal pain, and vomiting. Fever and cough started 2 days ago and the patient could not eat or drink water. He has been treated with an intensive insulin regimen (insulin glargine 24 IU at bedtime and a rapid-acting insulin analog before each meal). On examination he was tachypneic, his temperature was 39° C (102.2° F), pulse rate 104 beats per minute, respiratory rate 24 breaths per minute, supine blood pressure 100/70 mmHg; he also had dry mucous membranes, poor skin turgor, and rales in the right lower chest. He was slightly confused. Rapid hematology and biochemical tests showed hematocrit 48%, hemoglobin 14.3 g/dl (143 g/L), white blood cell count 18,000/ μ l, glucose 450 mg/dl (25.0 mmol/L), urea 60 mg/dl (10.2 mmol/L), creatinine 1.4 mg/dl (123.7 μ mol/L), Na+ 152 mEq/L, K+ 5.3 mEq/L, PO4 3−2.3 mEq/L (0.74 mmol/L), and Cl− 110 mmol/L. Arterial pH was 6.9, PO 2 95 mmHg, PCO 2 28 mmHg, HCO 3−9 mEq/L, and O 2 sat 98%. The result of the strip for ketone bodies in urine was strongly positive and the concentration of β-OHB in serum was 3.5 mmol/L. Urinalysis showed glucose 800 mg/dl and specific gravity 1030. What is your diagnosis? The patient has hyperglycemia, ketosis, and metabolic acidosis. Therefore, he has DKA. In addition, because of the pre-existing fever, cough, localized rales on auscultation and high white blood cell count, a respiratory tract infection should be considered. The patient is also dehydrated and has impaired renal function. Do you need more tests to confirm the diagnosis? Determination of the effective serum osmolality and anion gap should be performed in all patients presenti Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

You’ve become the New York Times and the Wall Street Journal of medicine. A must-read every morning. ” Continue reading >>

Clinical Skills Challenge - Case Study 2

Clinical Skills Challenge - Case Study 2

Full, instant access to all stories Customised email alerts straight to your inbox 5,000+ practice articles in our clinical archive Online learning units on fundamental aspects of nursing care Continue reading >>

Dka Case Study

Dka Case Study

has been brought to the ED by his roommate, who says that John began not feeling well while in their is caused by the buildup of ketones in the body to a point where you can actually smell it on the patient’s breath. A laboratory finding in addition to elevated blood glucose could be elevated serum causes potassium to accumulate in the blood leading to hyperkalemia. An ABG would also reveal One nursing diagnosis associated with DKA is fluid volume deficit. The hyperosmolar state of the volume and potential arrhythmias caused by potassium shifts could cause the heart not to pump One of the most important nursing interventions for a patient in DKA is education. The patient they have been newly diagnosed with diabetes, they will likely need a lot of education not just a concern. Adequate intake can help prevent this. The patient will also be extremely dehydrated levels will be very frequently monitored. The patient’s dehydration will also need to be treated so IV fluids in addition to the IV insulin will be given. Again it is important to monitor potass Continue reading >>

Case Study: Diabetic Ketoacidosis Complications In Type 2 Diabetes

Case Study: Diabetic Ketoacidosis Complications In Type 2 Diabetes

CLINICAL DIABETES VOL. 18 NO. 2 Spring 2000 CASE STUDIES Case Study: Diabetic Ketoacidosis Complications in Type 2 Diabetes Craig D. Wittlesey, MD Presentation A 48-year-old Hispanic woman with a long history of obesity, diabetes, dyslipidemia, and reactive airway disease presented to the hospital emergency department with a 5-day history of weakness, tactile fever, productive cough, nausea, and vomiting. Patient report and chart review confirmed that 2 years before this presentation, her diabetes had been managed with diet alone. In the past year, glipizide (Glucotrol), metformin (Glucophage), and ultralente insulin were added because of poor glycemic control. On examination, her temperature was 99.1° F, blood pressure was 98/64 mmHg, pulse was 136, and respirations were 36. There was a strong smell of ketones in the exam room. The patient was drowsy but cogent. Her head and neck exam revealed poor dentition and periodontal disease. Her lung sounds were clear without wheezes or rhonchi. Her heart sounds were normal. The abdominal exam revealed mild epigastric tenderness to deep palpation but no rebound tenderness or guarding. Extremities were well perfused with symmetric pulses. Laboratory results were remarkable for a room air arterial blood gas with pH of 7.12, pCO2 of 17 mmHg, and bicarbonate of 5.6 mEq/l. Urinalysis revealed 4+ glucose and 3+ ketones. Chemistry panel revealed a glucose of 420 mg/dl, BUN of 16 mg/dl, creatinine of 1.3 mg/dl, sodium of 139 mEq/l, chloride of 112 mEq/l, CO2 of 11.2 mmol/l, and potassium of 5.0 mEq/l. Chest X-ray revealed no infiltrate. Questions Is this patient experiencing diabetic ketoacidosis (DKA)? What type of diabetes does this patient have? What is the etiology of DKA in this patient? What is the rationale for inpatient treatm Continue reading >>

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