DKA, Pancreatitis and Cholelithiasis Case Study – Unfolding (2 parts)

CONCEPT: Metabolism, Inflammation

You are receiving the following report from the off going nurse on your unit:

Juanita Garcia is a 45 year old Hispanic, Spanish speaking female with long standing history of Type I diabetes mellitus. She is a single mother of 2 children – ages 10 and 12. Nine months ago she lost her job as a factory line worker. She and her children have been homeless and living out of their car for the past 6 months.

She presented to the emergency department (ED) early this morning with complaint of severe right abdominal pain (knife-like and radiating to the dorsal region of her back as well as costal margins) and nausea. She has confirmed cholelithiasis and her amylase/lipase levels are elevated as well.

While in the ED her labs showed blood glucose of 878 and WBC’s of 18,200. She was diagnosed with DKA and is on an insulin drip at 12 units/hour. Her vitals in the ED were BP of 102/64, HR of 106/m (sinus tachycardia), resp. rate of 32/m (shallow) and a temp of 39.2 C. Her oxygen saturation is 94% on 2 l/nc.

She just came up from the ED so admission intake will need to be completed.

Answer the following questions regarding this patient:

· Are there any ethical, cultural or age-related issues associated with this patient? If so, what are they?

· What would you anticipate noticing when you walk into the patient’s room?

· What medical treatment/nursing interventions would you anticipate finding on the plan of care/orders?

· What medications would you anticipate finding on the patient’s medication administration record (MAR)/orders?

· If you could ask the off-going nurse only 3 questions, what would they be and why?

· If you were going to do a focused assessment on this patient, what would you concentrate on and why?

· What issues can you identify as being a priority in caring for this patient?

· What are some potential complications that could occur in this patient that the nurse needs to be aware of/monitor for?

· What members of the multi-disciplinary team have been/or will be involved in the care of the patient and what is their role?

Developed by Carol Thorn, RN, MS

May use with permission for the purposes of nursing education

If questions/comments, please contact Carol Thorn at