Diabetes Mellitus
Client Profile
Mr. J is a 20-year-old college student with a history of diabetes mellitus type I for the past six years. Mr. J lives at home with his extended family. Mr. J’s father and grandmother have a history of diabetes mellitus type I. Mr. J is the only other member of the family diagnosed with the disease.
Case Study
Mr. j is a respiratory therapist major at a community college and is a member of the basketball team. Mr. J is brought to the emergency department (ED) by emergency medical services after Mr. J collapsed during basketball practice at the college. A member of the basketball team accompanies Mr. J in the ambulance. Mr. J is 6’3” and weighs 220 pounds. His family is notified by college authorities
and arrives at the ED while Mr. J is being triaged. On arrival at the ED, he is responsive to verbal and tactile stimuli, is very diaphoretic, mildly lethargic, and is complaining of abdominal pain and nausea. He hyperventilates, manifesting acetone breath. Stat serum glucose, arterial blood gas (ABG), and serum electrolytes for sodium and potassium are done and reveal:
Blood glucose: 450 mg/dL
pH: 6.9
pCO2: 20 mm Hg
HCO3: 12 mEq/L
Sodium (NA): 128 mEq/L
Potassium (K+): 3.0 mEq/L
His vital signs on admission are:
Blood pressure: 100/70
Pulse: 88, rapid but regular
Respirations: 22
Temperature: 98.1 degrees F
Mr. J is seen by the ED health care provider, and a diagnosis of diabetic ketoacidosis (DKA) is made. Mr. J is transferred to the medical intensive care unit (MICU).
Questions:
What are specific cultural considerations of diabetes mellitus?
What is an extremely critical indicator of diabetes?
What are common nursing diagnoses for clients with diabetes?
What is a primary collaborative problem for Mr. J because of the elevated blood glucose level on arrival to the ED?
What are the defining characteristics of DKA?
What are the priorities of management for a client experiencing DKA?
The following are prescribed:
0.9% NaCL at 1 liter per hour x two hours
Human regular (Novolin-R) initial bolus 0.4 units/kg, followed by 2.4 units/hr continuous infusion
Sodium bicarbonate (NaHC03) 5 mEq/kg infusion over four hours and low dose insulin at a continuous rate (five units per hour) at 25 mL per hour.
Monitor serum glucose and potassium level; if stable, change infusion to 0.45% sodium chloride at 125 mL/hr
Insulin aspart (NovoLog) insulin 100 units/mL injection four units and NPH ten units in combination Subcut three times per day, before meals
What are the purposes for the prescribed orders?
What are the most common adverse reactions of the prescribed medications?
Discuss the drug-to-drug and drug-to-food/herbal interactions for the prescribed medications.
Explain the difference between Dawn phenomenon and Somagyi’s phenomenon.
What are the critical areas that should be included in client education for type 1 diabetes mellitus?
What are the nursing implications as they relate to diabetes mellitus?