Today, three months post-diagnosis, Melanie is brought

Today, three months post-diagnosis, Melanie is brought to the Emergency Department and DKA is suspected from the outset. The triage nurse learns that she gradually but significantly decreased her insulin and CHO intake to “stop the weight gain” and for the past two days “was back in the bathroom again because I was so thirsty.” Appears somewhat confused when discussing rationale for her actions. Admitting VS: 86/48, 136 and regular; 28, deep, and smelling ‘fruity’ Current blood glucose: 424 mg/dL and urine + for ketones 1) Briefly explain the pathophysiology of DKA and why Melanie is demonstrating such at this time. Also, explain her presenting VS, BG, and the fact that ketones are present in her urine. Describe her expected fluid status in all 3 spaces. 2) Presentation confirms the diagnosis of DKA: provide an expected ABG for Melanie (complete interpretation and actual numbers) with rationale for each value. 3) Serum potassium will fluctuate in DKA: describe the rationale for the common hypokalemia early in the process and then later hyperkalemia followed by a drop again with treatment. Why must this be monitored closely? 4) State the priority nursing diagnosis at this time. 5) What orders do you expect from the physician to manage her BG/insulin and fluid needs? Be specific and provide rationale to demonstrate your understanding of initial DKA treatment. Do not simply copy isolated facts from your references. And, why is it important to control the change in serum osmolality carefully during initial therapy? 6) Melanie’s treatment is successful and she is ready for discharge 36 hours later. What must she be taught prior to discharge to prevent a repeat of a potentially life-threatening DKA episode in the future? Consider that she is a 19 year-old college student who has had a life-long weight problem. SCIENCE HEALTH SCIENCE NURSING NURS 4210

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