Question

Diabetes question

You are a nurse working in the accident and emergency department and have been allocated to assess and care for Jack.

Jack is a 27 years old, single man of Asian heritage who is homeless. He was diagnosed with Type 1 diabetes 12 months ago. He has a history of bipolar disorder. He has presented to the emergency department feeling unwell

An assessment finding reveals the following on Jack

Visually, Jack looks unwell and complains of nausea, abdominal pain, blurred vision, headache, needing to drink a lot and an increasing need to urinate. Jack stated he has lost his supply of insulin, glucometer and finger pricker.

Vital signs and blood and urine test showed

Temp- 35.8, HR 110 bpm, RR 22 rpm, BP 90/50 mmhg, body weight 60kg

Blood test results reveal- BGL 22mmol/L, HbA1c 8%, Ketone 0.4mmol/L

He is considered at risk of DKA and is managed, in the first instance in the emergency department

QUESTION

1, Describe how each of these aspects of the information presented above has led to the diagnosis of pre-DKA state

2, Identify three priority nursing problems and provide rationale for making each of these priority

3, you are required to formulate a goal to address each priority nursing problem

Answer 1

1.The symptoms exhibited by the patient like nausea, abdominal pain ,increase in water intake and increase in urination ,headache are some of the typical signs of pre diabetic ketoacidosis .

2.The priority nursing problems and its rationale are

1. To control his blood glucose levels of 396mg/dL( 22*18=396mg/dL). This is a priority care because this can lead to vital organ dysfunction like stroke ,renal impairment ,cardiac dysfunction ,acid base imbalance ,nerve damage ,altered vision ,neuro impairment ,etc. ,
2. To normalise his blood pressure and tachycardia as he is in hypotension .This is to be done so that the blood supply to other organs can be established .
3. To maintain ketones to normal level as the reading of patient is a clear indicator of diabetic ketoacidosis which may need emergency attention or care

3.The goals for each nursing problems are

1. To maintain normal blood glucose level in a day
2. To maintain normal blood pressure and heart rate within few hours to minutes respectively
3. To decrease the level of ketones in a day.