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.
1400:
Client admitted to the medical-surgical unit at 1200 today. Alert and orientated x4, heart and lung sounds clear. Client urinating 100 mL/hour. Client is tolerating soft diet and oral fluids. Bowel sounds are hyperactive in all 4 quadrants. Bilateral pedal pulses 2+. Blood glucose 310 mg/dL (74 to 106 mg/dL)

Vital Signs
0900:

ÔÇó Temperature 36.8┬░ C (98.2┬░ F)
ÔÇó Pulse rate 110/min Respiratory rate 18/min
ÔÇó Blood pressure 96/65 mm Hg
ÔÇó Oxygen saturation 96% on room air

1400:
ÔÇó Temperature 36.8┬░ C (98.2" F) Pulse rate 84/min
ÔÇó Respiratory rate 16/min
ÔÇó Blood pressure 106/76 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) S
ÔÇó odium 138 mEq/L (136 to 145 mEq/L)
ÔÇó Chloride 101 mEq/L (98 to 106 mEq/L)
ÔÇó 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)

Provider Prescriptions
0930:
ÔÇó Administer 0.9% sodium chloride at 15 ml/kg/hr for 1 hr and then reduce to 10 ml/kg/hr.
ÔÇó Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L
ÔÇó Regular insulin continuous infusion, titrate per DKA protocol once potassium is greater than 3.3 mEq/L.
ÔÇó ondansetron 4mg intravenous bolus every 4 hr PRN nausea
ÔÇó Acetaminophen 650 mg every 4 hr. PRN pain
ÔÇó Magnesium sulfate 2 g intravenously over 2 hr for hypomagnesemia
ÔÇó Strict I & O
ÔÇó Blood glucose level hourly
ÔÇó Initiate cardiac monitoring