nurse, working in the emergency department, is caring for a 42-year…
Nurse, working in the emergency department, is caring for a 42-year oldmale patient who has not been feeling well for the past 5 days. The patientreports fever, fatigue, no appetite, abdominal pain, and nausea with vomiting. The patient states they have not been eating but is drinking juices when able because they are so thirsty. The wife adds that the patient has been urinating a lot the past few days.
• diabetes type I• HTN, CAD• DME (diabetic macular edema).
• Insulin: glargine 27 units at HS; aspart 12 units with meals; has not take insulin in past 2 days other than aspart 1 time the previous day• Irbesartan 150 mg daily• ASA 81 mg chewable daily• Atorvastatin 80 mg daily
• VS: BP 100/70, HR 116, RR 24 – deep and rapid, POX 95%, T 102.2 F (39 C)• Mentation: obtunded• Lungs: crackles in the right lower chest• Skin: hot and dry, mucous membranes dry; poor skin turgor• Abdomen: hypoactive bowel sounds; abdomen soft
The HCP is notified, and diagnostic tests are ordered as well as an IV 0.9 % NaCl at 125 mL/hour.
Hgb: 16.3 gm/dLGlucose: 450 mg/dLNa: 152 mEq/LpH: 6.9 (arterial)
Hct: 58%BUN: 60 mg/dLK: 5.4 mEq/LCO2: 28 (arterial)
WBC: 18 thousand/microLCreatinine 1.4 mg/dLHCO3: 15 (arterial)
Ketones: positivePaO2: 95 (arterial)
The urine dip was positive for ketones, glucose, and sp. gr. 1.030
Do you suspect DKA or HHS? Why?
Which of the following lab values confirm the diagnosis? Select all that apply.
A.Glucose 450 mg/dL
C.K+ 5.4 mEq/L
What acid base imbalance is present?
A. Completely compensated respiratory acidosis
B.Respiratory alkalosis with hypoxemia
C.Partially compensated metabolic acidosis
D.Uncompensated metabolic alkalosis
What is the reason for the polyuria?
A.Hypovolemia triggers the hypothalamus to stimulate ADH
B.Catabolism of protein and fats causing a negative energy balance
C.Increase in concentration of glucose causing osmotic diuresis
D.The breakdown of fats causing the release of ketones
The Hct is:
A.Decreased due to the loss of RBCs
B.Increased due to the production of RBCs
C.Decreased due to the destruction of RBCs
D.Increased due to the hemoconcentration of RBCs
The potassium is:
A.Elevated due to the hydrogen ion moving into the cell and forcing the K out of the cell
B.Elevated due to the hemoconcentration of potassium from dehydration
C.Decreased due to loss from polyuria
D.Decreased due to lack of nutritional intake of potassium
What is the rationale for the respiratory pattern the patient is exhibiting?
A.To release heat
B.To blow off CO2
C.To conserve base
D.To retain acid
What is the cause of the DKA?
What do the BUN, creatinine, and specific gravity indicate?
For a patient diagnosed with HHS, the major difference between DKA and HHS is with HHS: Select all that apply.
A.Ketoacidosis is typically not present
B.Glucose is typically over 600 mg/dL when diagnosed
C.Significant dehydration is a major concern
D.Dehydration causes hyperosmolality and polyuria
E.Hemoconcentration may dispose the patient to thrombosis formation