Medical/Surgical history:
Type 1 diabetes mellitus x8 years. Uses an insulin pump and self-manages care. Has never been hospitalized for diabetes previously. Appendix removed at age 7 years. No other medical or surgical history.
Social History:
Roommate says the patient drinks on the weekends only and does not use drugs or tobacco. Says she is a "hard-working college student."
Family History:
Family lives out of state and includes married parents and a younger brother. No family medical history obtained.
Physical Assessment:
Arousable but lethargic. PERRLA 3 mm: moves all extremities but does not follow commands. Mucous membranes dry, lips chapped, acetone breath. Lungs clear to auscultation: rapid and deep respiratory pattern. Tachycardic and hypotensive. Red, raised rash on lower extremities. Hypoactive bowel sounds.
Medications:
Regular insulin via an insulin pump in the left medial abdomen. Pump found to be shut off.
3/29/XX
1315
Patient brought to the emergency department by a college roommate. Recently traveled with friends to Mexico for spring break, returning 2 days ago. Roommate says that there was a lot of "partying." Over the last 24 hours, patient has experienced nausea and vomiting, has been sleeping a lot, and has developed blurred vision and headache.
3/29/XX
1325
Patient placed on a cardiac monitor for irregular pulse. Sinus tachycardia noted. Serum labs drawn and sent to the lab; 20-gauge peripheral IV inserted in left forearm and 20-gauge peripheral IV inserted in right forearm. NS initiated at 250 mL/hr.
3/29/XX
1430
Orders implemented. Receiving IV NS. IV insulin per titration. Urine output 50 mL/hr. Dark amber color. Continues to be lethargic
1035
DKÁ has resolved over the past 4 days. Alert and oriented. vital signs stable, Insulin being delivered via pump with stable blood glucose levels
3/29/XX
1320
Temp 100.2°F (37.8°C)
HR 115 bpm: irregular
RR 26 breaths/min; rapid, deep SpO2 98% on room air
BP 87/52 mm Hg 3/29/XX
1430
Temp 100.4°F (37.8°C)
HR 110 bpm: regular
RR 24 breaths/min: rapid, deep Sp02 98% on room air
BP 94/56 mm Hg
3/29/XX
1315
Glucose 525 mg/dL. per glucometer 3/29/XX
1335
WBC: 12.2 103/mm3 (4.5-11.1 103/mm3)
RBC 3.5 million/mm3 (3.61-5.11 million/mm3) Platelets: 355.000/mm3 (150,000-450,000/mm3) BUN: 35 mg/dL (8-21 mg/dL)
Creatinine: 1.2 mg/dl (0.5-1.2 mg/dL)
Sodium: 145 mEq/L (135-145 mEq/L)
Potassium: 3.1 mEq/L (3.5-5.0 mEq/L)
Glucose: 530 mg/dL (65-99 mg/dL)
ATC: 6.9% (6.5% or lower) 3/29/XX
1430
Glucose 460 mg/dL per glucometer 1035
Glucose 89 mg/dL per glucometer
The nurse recognizes the patient is demonstrating signs of diabetic ketoacidosis (DKA). Which findings support this recognition? (Select All that Apply.)
