A 38-year-old male client is transferred to

A 38-year-old male client is transferred to inpatient rehabilitation following an extended hospitalization. The client’s medical history includes diabetes mellitus type 1, bacterial septicemia, and peripheral neuropathy. During the second week of rehabilitation, the client falls during physical therapy and states, “My legs just gave out on me. I am not sure why I am feeling so weak.” Upon safely returning the client to his room and bed, a nurse completes and documents the following assessment: Alert and oriented x 3 Able to move all extremities equally but with less strength than yesterday Temperature 98.9° F (37.2° C), heart rate 102 beats/min, blood pressure 110/66 mm Hg, respiratory rate 26 breaths/min, oxygen saturation 94% on 2 L nasal cannula Auscultated lung fields clear throughout Respiration’s labored with accessory muscle use Breath has a rotting citrus fruit odor Skin warm and diaphoretic Abdomen round and soft Bowel sounds hypoactive Nausea and abdominal discomfort present Intake and output for past 4 hours: Intake 2500 mL; output 3750 mL 1. What information is relevant? Why is this information relevant? (NCSBN CJM: Recognize cues) 2. What additional information will help the nurse differentiate potential conditions? (NCSBN CJM: Analyze cues) The client’s laboratory results are: Glucose: 430 mg/dL (23.9 mmol/L) Sodium: 145 mEq/L (mmol/L) Potassium: 3.8 mEq/L (mmol/L) Arterial blood gas: pH 7.38; PaO2 88 mm Hg; PaCO2 33 mm Hg; HCO3 18 mEq/L BUN: 36 mg/dL (12.8 mmol/L) Creatinine: 1.8 mg/dL (0.64 mmol/L) Urine ketones: Positive The client is diagnosed with diabetes ketoacidosis (DKA), transported to the critical care unit at a local hospital and prescribed the following: Infuse 0.9% normal saline at 15 mL/kg/hr for 1 hour, then decrease the infusion to 10 mL/kg/hr; change intravenous fluids to 5% dextrose in 0.45% saline when blood glucose levels erase 250 mg/dL Bolus regular insulin 0.1 unit/kg/hr, the start regular insulin infusion at 0.1 unit/kg/hr; Titrate insulin infusion hourly based on blood glucose sliding scale 3. What interventions will the nurse implement to minimize complications of the prescribed therapy? (NCSBN CJM: Generate solutions) These interventions were effective and 2 days ago the client was transferred to a medical-surgical unit. Today he is scheduled for discharge and will be returning to the inpatient rehabilitation center. At 7:20 a.m. (0720), two nurses enter the client’s room for bedside change-of-shift report and find the client drowsy and oriented to person and place only. The client is experiencing tachycardia and tachypnea, and has cold, clammy skin. 4. What is the most likely explanation for this client’s assessment data? (NCSBN CJM: Prioritize hypotheses) 5. Which interventions are most important at this time? (NCSBN CJM: Take action) 6. What will the nurse teach the client to help prevent future hypoglycemia episodes? (NCSBN CJM: Take action) SCIENCE HEALTH SCIENCE NURSING NURSING VN120

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