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Case Study of Dka Patient

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Case Study of DKA Patient
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November 18, 2011 R.C. is a 42 year old Native-American male that presents to the ER today generally looking ill and, appears to be 10 years older than his stated age. He is dehydrated, and has had Type 1 diabetes, which was diagnosed ten years ago. He has been sick for the last 2 days; as stated by his wife, “I brought him in today (ER) because he is just not getting any better.” Mrs. C. also said that her husband has vomited, over the last 2 days. R.’s chief complaint (c/c) is abdominal pain, voiding frequently, and hasn’t been taking insulin due to nausea. Vital signs (RR) 32, and oxygen saturation (SAO2) 95%. He is alert & orientated (A&O) A&O x 1 (oriented only to person), and his mouth and mucous membranes are very dry.
Doctor’s Orders:
After seeing Mr. C. the doctor orders: CBC, Chem Panel, Electrolytes, UA with ketones, ABG, 12 lead EKG, and sliding scale insulin to be given IVP, oxygen at 2L/min per nasal cannula, and IV bolus of 500 cc/NS.
After initiating a peripheral IV catheter, blood samples are drawn for labs and the nurse administers the 500 cc/NS and rechecked VS: Temperature (T) 100.3, P-106, BP-92/56, and RR-28.
Labs
The labs return with blood glucose of 625, K+5.3, bicarb (HCO3) 8 mEq/l, large amounts of ketones in urine and serum. ABG of pH-7.19, PO2-89, CO2-25, and HCO3-15.
EKG
The EKG is noted for tented T waves. Based off above initial findings, R. has hallmark signs and symptoms (s/s) of Diabetic Ketoacidosis (DKA) which include polyuria, gastrointestinal (GI) upset/abdominal pain, dehydration, orthostatic hypotension, bradypnea with deep respirations, also known as “Kusssmaul breathing.” Also, patient’s breath is acetone which is commonly interpreted as “fruity” and can be

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