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Dka Case Study

An 18-year-old female was brought to the emergency room in a coma and showed signs of dehydration. Lab tests revealed hyperglycemia, metabolic acidosis, and other abnormalities. She displayed symptoms of polydipsia, polyuria, and weight loss over the past month. The patient was assessed as having diabetic ketoacidosis along with a respiratory tract infection based on additional symptoms and lab findings. Treatment would involve intravenous fluids, insulin, electrolyte replacement, and correction of acidosis followed by transition to subcutaneous insulin and feeding once stabilized.

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Maryjoy Gabriellee De La Cruz
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644 views3 pages

Dka Case Study

An 18-year-old female was brought to the emergency room in a coma and showed signs of dehydration. Lab tests revealed hyperglycemia, metabolic acidosis, and other abnormalities. She displayed symptoms of polydipsia, polyuria, and weight loss over the past month. The patient was assessed as having diabetic ketoacidosis along with a respiratory tract infection based on additional symptoms and lab findings. Treatment would involve intravenous fluids, insulin, electrolyte replacement, and correction of acidosis followed by transition to subcutaneous insulin and feeding once stabilized.

Uploaded by

Maryjoy Gabriellee De La Cruz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Case Study:

An 18-year-old female was taken to the emergency room in coma. Her parents noticed that she
had polydipsia, polyuria, and rapid weight loss which started approximately 1 month ago and
had worsened in the last week. She had not been taking any medications and the clinical
history was otherwise unremarkable. On examination, breathing was deep and rapid (Kussmaul
respiration), pulse rate was 100 beats per minute, and blood pressure 110/70 mmHg; she also
had signs of dehydration. She was drowsy and confused. Rapid hematology and biochemical
tests showed hematocrit 44%, hemoglobin 13 g/dl (140 g/L), white blood cell count 12,000/ μl,
glucose 520 mg/dl (28.9 mmol/L), urea 50 mg/dl (8.5 mmol/L), creatinine 0.8 mg/dl (70.7
μmol/L), Na+ 148 mEq/L, K+ 4.6 mEq/L, PO4 3-2.0 mEq/L (0.64 mmol/L), and Cl− 112
mmol/L. Arterial pH was 7.0, PO 2 98 mmHg, PCO 2 25 mmHg, HCO 3−12 mEq/L, and O 2
sat 98%.

1. List down your assessments

 Increased thirst & urine outpu


 Nausea; diarrhea
 Poor appetite
 Sudden weight loss
 Weakness
 Hyperglycemia
 Increased WBC
 Hypernatremia
 Increased BUN
 Alkalinic urine
 Hyperchloremia

2. Formulate your nursing 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.

3. Make a nursing care plan for this patient

Nursing Diagnosis
 Impaired Skin Integrity related to disruption of skin surface with destruction of skin
layers as evidenced by an absence of viable tissue

Nursing Assessment

Assess and document size, color, depth of wound, noting necrotic tissue and condition of
surrounding skin.
Nursing Interventions

 Maintain wound covering as indicated (Synthetic dressings: DuoDerm)


 Elevate grafted area if possible. Maintain desired position and immobility of area when
indicated.
 Maintain dressings over newly grafted area and/or donor site as indicated: mesh,
petroleum, nonadhesive
 Keep skin free from pressure
 Evaluate color of grafted and donor site(s); note presence or absence of healing.
 Wash sites with mild soap, rinse, and lubricate with cream several times daily after
dressings are removed and healing is accomplished.

Desired Outcomes

 Wound Healing:

 Demonstrate tissue regeneration.

 Achieve timely healing of burned areas.

4. How can you manage the patient medically?

 Urgent administration of intravenous fluid and insulin should begin together with careful
monitoring, replacement of electrolytes, and correction of acidosis.
 After resolution of DKA and as long as the patient is conscious, feeding can start.
Transition from intravenous to subcutaneous insulin administration should begin. A bolus
of rapid-acting insulin should be administered subcutaneously based on the results of the
finger stick test 1-2 hours before discontinuation of intravenous insulin.
 A total daily dose of insulin of 0.5-0.8 IU/kg is required, divided as 30-50% basal insulin
and the remainder as rapid-acting insulin before each meal.

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