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Client Scenario: 

Dennis Bowman, a 39-year-old, 63 kg (140 lbs) African American, was admitted to the hospital with 
diabetic ketoacidosis (DKA). After arrival at the emergency department, he had multiple episodes of 
vomiting. Mr. Bowman said he had been vomiting for the past 2 days and admitted to skipping 
several doses of insulin recently. He mentioned that he had feverish feelings at home and reported an 
occasional cough. Mr. Bowman’s assessment revealed pain throughout all abdominal quadrants, with 
“cramping” reported in all four abdominal quadrants. He was extremely lethargic and difficult to 
arouse at times. He complained of severe thirst. His skin was extremely dry. An electrocardiogram 
showed a sinus tachycardia at 120 bpm. His lungs were clear bilaterally, btit respirations were deep 
and rapid. There was an acetone smell to Mr. Bowman’s breath. Mr. Bowman denied alcohol and 
illicit drug use and could recall no drug or food allergies. He did report that his father and two aunts 
have type 1 diabetes. 

Mr. Bowman’s psychosocial history revealed the following pertinent information. He works part-
time as a janitor and intends to start a second job but only for 2.5 hours a week. He stated, “I’m on a 
fixed income, and my medicine runs out sometimes.” During the past year Mr. Bowman had been 
admitted to the hospital with the diagnosis of DKA on March 2, June 29, and November 8. In 
addition, he had failed to keep his follow-up appointments on July 18 and November 23. Mr. 
Bowman’s diagnostic data were as follows: 

BP 
HR 
Respirations 
Temperature 

124/80mm Hg 
122 bpm 
32 breaths/min 
35.8° C (96.3° F) 
Hematologic studies showed the following: 
Hgb 
Hct 
cl- 
Creatinine 
Cholesterol 
BUN 
14.6 g/dl 
58% 
95 mmol/L 
4.9 mg/dl 
338 mg/di 
52 mg/dl 
ca++ 8.8 mmol/L 
Glucose 560 mg/dl 
Phosphorus 6.8 mg/di 
Acetone Moderate 

Na+ 126 mmol/L 
AST (SGOT) 248 U/L 
K+ 5.3 mmol/L 
CK 34 IU/L 
LDH 38 U/L 
Alkaline Phosphatase 132 U/L

 

 

Arterial blood gas values were as follows: 
pH 7.09 
PCO2 20mmHg 
Po2 100mmHg 
Sao2 98% Room air 
HC03- 16 mEq/L
Urine tests showed the following: 
Specific Gravity 1.015 
Glucose 4+ 
Ketones 4+ Nitrates 0 Leukocytes Few RBCs Many 

Mr. Bowman’s home medications were 16 U of 70/30 insulin in the morning and 12 U of 
70/30 insulin in the evening. 

 

Mr. Bowman’s current insulin regimen is 16 U of 70/30 insulin in the morning and 12 U of 70/30 insulin in the evening. Discuss Mr. Bowman’s insulin coverage and its adequacy. Include the essential aspects of intensive insulin therapy.

 

 

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HEALTH SCIENCE
NURSING
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