Passage / Scenario

Nurses' Notes
0900:

Client came to the emergency department this morning and reports not feeling well for the last 12 hr and increasing blood glucose. Client has a history of type 1 diabetes mellitus and hypertension. Client weight is 88 kg (194 lb). The client was recently treated for bronchitis and pneumonia. Client reports nausea and decreased appetite.

Client is alert and orientated x 4, heart and lung sounds are clear. Client states that they have been frequently urinating and are extremely thirsty. Bowel sounds are hyperactive in all 4 quadrants. Bilateral pedal pulses 1+. Slight tenting of skin. Peripheral IV established and labs drawn.

Vital Signs
0900:
ÔÇó Temperature 36.8┬░ C (98.2┬░ F)
ÔÇó Pulse rate 110/min
ÔÇó Respiratory rate 18/min
ÔÇó Blood pressure 96/65 mm Hg
ÔÇó Oxygen saturation 96% on room air
Laboratory Results
0915:
ÔÇó Blood glucose 468 mg/dL (74 to 106 mg/dL)
ÔÇó pH 7.30 (7.35 to 7.45)
ÔÇó Potassium 5.5 mEq/L (3.5 to 5 mEq/L)
ÔÇó Sodium 138 mEq/L (136 to 145 mEq/L)
ÔÇó Chloride 101 mEq/L (98 to 106 mEq/L) BUN 21 mg/dL (10 to 20 mg/dL)
ÔÇó Creatinine 1.7 mg/dL (0.5 to 1.1 mg/dL)
ÔÇó Urine dipstick positive for ketones (negative)