Passage / Scenario

History and Physical
The client has a history of type 1 diabetes mellitus for 16 years, which is managed with insulin at bedtime and before each meal. The client measures capillary blood glucose twice daily. He had a motor-vehicle crash 3 years prior.
Nurses Notes
The client is lethargic and rouses with physical stimulation. His Glasgow Coma Scale score has decreased from 14 to 12. Auscultation of the lungs reveals rales in the right lower lobe. The right upper lobe is diminished but clear. Kussmaul respirations are noted. An 18-gauge IV in the right forearm is edematous and cool to touch. Capillary refill is 3 seconds. He has dry mucous membranes and decreased skin turgor.
Vital Signs
ÔÇó Supine blood pressure: 100/70 mm Hg
ÔÇó Sitting blood pressure: 85/50 mm Hg
ÔÇó Heart rate: 120/min
ÔÇó Respiratory rate: 24/min
ÔÇó Temperature: 37.9┬░C (100.2┬░F)
ÔÇó Oxygen saturation: 95% on room air
Medical History
The client was admitted to the unit from the emergency department. The client's partner reports lethargy, vomiting, diarrhea, and fever lasting for 2 days.
Diagnostic Results
ÔÇó Casual blood glucose: 580 mg/dL (normal: <200 mg/dL)
ÔÇó Sodium: 152 mEq/L (normal: 136-145 mEq/L)
ÔÇó Potassium: 5.3 mEq/L (normal: 3.5-5.0 mEq/L)
ÔÇó BUN: 32 mg/dL (normal: 10-20 mEq/L)
ÔÇó Creatinine: 1.8 mg/dL (normal: 0.5-1.3 mg/dL)
ÔÇó Serum pH: 7.2 (normal: 7.35-7.45)
ÔÇó HCO3-: 13 mEq/L (normal: 21-28 mEq/L)
ÔÇó Urine reagent strip testing: pH 4.4 (normal: 4.6-8.0), Specific gravity: 1.036 (normal: 1.005-1.030), Ketones: positive (negative), Glucose: present (none)
ÔÇó Glycosylated hemoglobin: 9.69% (normal: <7.9% indicates good diabetic control)
ECG Findings
ECG indicates tachycardia with a prolonged PR interval, widened QRS, and peaked T waves.