NUR-2063 Rasmussen College – A 21-year old female (A.M.) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhoea, and a fever for 3 days.

QUESTION

A 21-year old female (A.M.) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhoea, 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 slightly sweet/fruity odour. 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:

blood pressure:88/46mmHg

heart rate: 132 bpm

respiratory rate: 36/min deep

temperature:101.3 (tympany)

Additional data: lab result

Glucose: 657mg/dl

potassium : 6.2mEq/l

1. What is the disorder and its pathophysiology that you expect the health care provider to diagnose and treat?
2. Describe the etiology of the disorder A.M is experiencing.
3. Identify and describe the clinical manifestations of the disorder A.M. is experiencing.
4. 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.

ANSWER

Diabetic Ketoacidosis (DKA): Diagnosis, Etiology, Clinical Manifestations, and Treatment Options

Introduction

A 21-year-old female, A.M., presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and fever. A.M. reveals a history of Type I diabetes and inadequate blood sugar management due to illness. Upon examination, the healthcare provider notes unsteadiness, warm and flushed skin, drowsiness, rapid breathing, and a fruity odor. This essay aims to discuss the probable disorder and its pathophysiology, describe its etiology, explore the clinical manifestations, and propose suitable treatment options for A.M.’s condition.

Diagnosis and Pathophysiology

Based on the symptoms and clinical findings, the healthcare provider is likely to diagnose A.M. with diabetic ketoacidosis (DKA). DKA is a severe complication of diabetes resulting from a combination of hyperglycemia, metabolic acidosis, and ketone accumulation. In A.M.’s case, her inability to manage blood sugar levels, lack of food intake, and non-compliance with insulin therapy have contributed to sustained hyperglycemia and metabolic imbalance.

Etiology

A.M.’s condition can be attributed to several factors. Firstly, her illness-induced inability to consume food has disrupted her insulin administration and led to uncontrolled hyperglycemia. Secondly, inadequate fluid intake has caused dehydration, further exacerbating the metabolic derangement. These factors, combined with her underlying Type I diabetes, have set the stage for the development of DKA.

Clinical Manifestations

The clinical manifestations observed in A.M. are consistent with those typically associated with DKA. Nausea, vomiting, and diarrhea are common due to the metabolic disturbance. The fever indicates an inflammatory response triggered by acidosis. A.M.’s unsteady gait, warm and flushed skin, drowsiness, rapid breathing, and fruity odor on her breath are all indicative of metabolic acidosis and ketone accumulation resulting from the breakdown of fatty acids.

Treatment Options

To improve A.M.’s condition, prompt and appropriate treatment for DKA is crucial. The healthcare provider should focus on stabilizing her vital signs and addressing the underlying metabolic imbalances. Intravenous fluid resuscitation is essential to correct dehydration, restore blood pressure, and improve tissue perfusion. Administering isotonic saline or a balanced electrolyte solution will help replenish fluid and electrolyte deficits.

Simultaneously, initiating insulin therapy is crucial in lowering blood glucose levels and inhibiting ketone production. Regular insulin is typically administered intravenously for precise control. Insulin promotes glucose uptake by cells, reducing hyperglycemia and halting ketone formation. Frequent monitoring of blood glucose and electrolyte levels will guide insulin administration and ensure appropriate correction of imbalances.

Conclusion

A.M.’s clinical presentation and accompanying lab results strongly suggest the diagnosis of diabetic ketoacidosis. Prompt recognition and intervention are vital to prevent further deterioration and potential life-threatening complications. The healthcare provider should focus on correcting fluid and electrolyte imbalances, while closely monitoring glucose and potassium levels. Simultaneously, insulin therapy should be initiated to lower blood sugar and inhibit ketone production. By addressing these aspects comprehensively, A.M.’s condition can be improved, allowing for a more favorable outcome and subsequent management of her Type I diabetes.

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