Question

Using the case study below, prepare a 3-5 page paper.

A 21-year old female (A.M) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since she’s been ill and unable to keep any food down. She’s only tolerated sips of water and juices. Since she’s also been unable to eat, she hasn’t taken any insulin as directed. While helping A.M. from the lobby to the examining room you note that she’s unsteady, note that her skin in warm and flushed and that she’s drowsy. You also note that she’s breathing rapidly and smell a slight sweet/fruity odor. A.M. has a challenge answering questions but keeps asking for water to drink.

You get more information from A.M. and learn

• She had some readings on her glucometer which were reading ‘high’
• She vomits almost every time she takes in fluid
• She hasn’t voided for a day but voided a great deal the day before
• She’s been sleeping long hours and finally woke up this morning and decided to seek care

Current labs and vital signs:

1. What is the pathophysiology for the condition you believe A.M. has?
2. Relate the etiology and clinical manifestations for the condition you identified for A.M.

The practitioner at the urgent care facility makes the decision that A.M. needs to go to the hospital by ambulance. Once at the Emergency Department (ED), the ED physician orders these items:

1. 1000 ml Lactated Ringer’s (LR) IV stat
2. 36 units NPH (Humulin N) and 20 units regular (Humulin R) insulin SQ now
3. CBC with differential; CMP: blood cultures X2 sites; clean-catch urine for UA and C&S; stool for ova and parasites; Clostridium difficile toxin, and C&S; serum lactate; ketone; osmolality; ABGs on room air
4. 1800 calorie, carbohydrate controlled diet
5. Bed rest
6. Acetaminophen (Tylenol) 650 mg orally Q4 hrs PRN
7. Furosemide (Lasix) 60 mg IV push now
8. Urinary output every hour
9. VS every shift

The orders above -- which are questionable related to her condition and which are appropriate?

3. What are the expected treatments for this condition?

Instructions:

formulate what may be happening with A.M. and how you would improve her condition. I need 3 pages please don't just answer the questions it's a paper . 3 pages no less please , if you can't do it please don't do it . like I said don't just answer the questions one by one but just add them all together it is a research paper . NOTHING IS MISSING. i need a full 3 pages please

Answer 1

Pathophysiology of Ms.A.M is DIABETIC KETOACIDOSIS:

• In this condition the blood sugar levels are increased due to imbalance in its absorption and usage by the cells because to lack of insulin function.
• Increase of potassium in the blood leading to hyperkalemia that results to nausea, vomiting, diarrhea.
• This results in loss of electrolytes from the body that altering the acid base balance, hypotension.To normalize the heart rate and skin become warm so prefer to take fluid.
• The increase of Ketone leads to increase in increase and fruity odor smell.The impairment of renal system leads to decreased urine output and prone to develop infection resulting in elevation of body temperature.

Etiology and signs of A.M:

Etiology:

• Uncontrolled blood glucose level
• Medication non compliance
• Lack of adequate and appropriate diet

Clinical Manifestations:

• Nausea
• Vomiting
• Decreased urine output
• Fruit odor smell
• Tachycardia
• Tachypnea
• Diarrhea
• Hypotension
• Pyrexia

The appropriate test are:

• Complete Blood count
• Blood culture
• Urine test to rule out infection
• Ketones to analysis ketoacidosis
• Arterial blood gas is to assess oxygen,pH and carbon dioxide from the artery.
• Serum lactate is used to assess for shock.

The investigation that are questionable are:

• Stool test
• Clostridium difficile can be done to assess gastrointestinal infection.

The expected treatment:

• Insulin therapy:To reduce blood glucose level.
• Insulin calcium bicarbonate infusion to decrease potassium level.
• Intravenous fluids to manage blood volume and urine output.
• Antibiotics
• Antipyretics
• Antiemetic to reduce nausea and vomiting
• Antidiarrheal