N.B., a 34 year-old Native American man, was admitted to the emergency department after he was found unconscious by his wife in their home.
· Was diagnosed with type 1 diabetes mellitus 12 months ago
· Was taking 50 units of insulin daily; 5 units of lispro insulin with breakfast, 5 units with lunch and 10 units with supper plus 30 units of glargine insulin at bedtime
· Has a history of flu for 1 week with vomiting and anorexia
· Stopped taking insulin 2 days ago when he was unable to eat
· Breathing is deep and rapid
· Acetone smell on breath
· Skin flushed and dry
· Blood glucose level of 730 mg/dL (40.5 mmol/L)
· Blood pH of 7.26
1. Briefly explain the pathophysiology of the development of diabetic ketoacidosis (DKA) in this patient
2. What clinical manifestations of DKA does this patient exhibit?
3. What factors precipitated this patient’s DKA?
4. Priority Decision: What is the priority nursing intervention for N.B.?
5. What distinguishes this case history from one of hyperosmolar hyperglycemic syndrome (HHS) or hypoglycemia?
6. Priority Decision: What is the priority teaching that should be done with this patient and his family?
7. What role should N.B.’s wife have in the management of his diabetes?
8. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?