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, her skin is 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 the following:
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:
What is the disorder and its pathophysiology that you expect the health care provider to diagnose and treat?
Describe the etiology of the disorder A.M is experiencing.
Identify and describe the clinical manifestations of the disorder A.M. is experiencing.
Identify and describe the expected treatment options for A.M. based on the disorder and clinical manifestations.
Instructions:
Summarize the questions above and formulate what may be happening with A.M. and how you would improve her condition.
Harding, M.M. & Snyder, J.S. (2015). Winningham’s critical thinking cases in nursing: Medical-surgical, pediatric, maternity, and psychiatric. Retrieved from:
Expert Solution Preview
Introduction:
A 21-year-old female with type I diabetes presents with symptoms of nausea, vomiting, diarrhea, and fever for three days and has not been managing her blood sugars. With this information and analysis of her vital signs, the following questions should be answered:
1. What is the disorder and pathophysiology that you expect the healthcare provider to diagnose and treat?
The disorder that the healthcare provider is likely to diagnose is diabetic ketoacidosis (DKA). DKA is a severe complication of diabetes characterized by high levels of blood ketones, acidic blood, and dehydration. In individuals with type I diabetes, insulin deficiency causes the body to burn fatty acids instead of glucose for energy, resulting in ketone accumulation, metabolic acidosis, and dehydration.
2. Describe the etiology of the disorder A.M is experiencing.
The etiology of DKA in individuals with type I diabetes is insulin deficiency and insufficient glucose utilization by cells. This can be triggered by illnesses, missed insulin doses, emotional stress, and other stressors that cause a spike in the release of stress hormones, which in turn boost blood glucose levels.
3. Identify and describe the clinical manifestations of the disorder A.M is experiencing.
The clinical manifestations of DKA include high blood glucose levels, dehydration, electrolyte imbalances, metabolic acidosis, and ketonemia and/or ketonuria. Additionally, the patient may experience symptoms that include fatigue, abdominal pain, nausea/vomiting, fruity breath, and altered mental status such as confusion or disorientation.
4. Identify and describe the expected treatment options for A.M. based on the disorder and clinical manifestations.
The immediate goals of treatment upon diagnosing DKA in a patient are to rehydrate, reverse acidosis, and normalize blood glucose levels. The expected treatment options include intravenous insulin therapy to reduce blood glucose levels, fluids to rehydrate, and electrolytes to replace losses. Additionally, the underlying cause of DKA must be identified and treated, including treating any precipitating infections, stressors, or illnesses, along with any nutritional deficiencies.
Instructions:
A.M is most likely experiencing diabetic ketoacidosis due to her symptoms and through the analysis of her vital signs. Immediate treatment is necessary to stabilize A.M’s condition. As a medical professor, I would advise the healthcare provider to provide immediate intravenous insulin therapy, replace fluid losses with electrolyte solution, and identify and treat any underlying infection or stressor that triggered DKA. Once A.M’s condition has stabilized, steps should be taken to ensure that she is properly educated on diabetes management and can self-manage her condition to prevent future relapse.
