Unfolding Case Study Mr. W is a

Unfolding Case Study Mr. W is a 55-year-old man who is recovering in the orthopedic unit of the hospital from a right total knee replacement of two days ago. Mr. W has type I diabetes and was diagnosed with the condition at 12 years old. He has been managing his illness with blood glucose checks 4 times a day: before meals and once at bedtime. He currently takes Humulin-R on a sliding scale based on his glucose results. He weighs 315 lbs and has developed osteoarthritis in both knees, requiring surgical replacement of the knee joint on the right side. The nurse caring for Mr. W enters his room at 8:15 am for morning assessment. She finds Mr. W lying in his bed awake, but his mental status is altered and there is a fruity odor to his breath. His vital signs are HR 100 bpm, RR 32/minute, BP 116/78 mmHg. The nurse notes that his last blood glucose level was 156mg/dL the previous night before bed and he received 2 units of insulin at that time, but he has not received his morning glucose check or any insulin yet today. Rapid bedside glucose reveals a blood glucose level of 468 mg/dL. The nurse contacts the physician and upon further examination, Mr. W is diagnosed with diabetic ketoacidosis. Mr. W complains of feeling very thirsty and that he cannot see very well because his vision is suddenly blurry. The nurse notes that he has a large amount of clear urine in his catheter bag. She takes a sample of urine, and it tests positive for ketone bodies. The physician has placed orders for stat laboratory work, including a metabolic profile and arterial blood gases. The metabolic panel results are: Na 130 mEq/L K 6.1 mEq/L Cl 94 mmol/L Ca 8.5 mg/dL BUN/Creatinine Ratio 22 mg/dL . The ABGs are as follows: pH 7.31 pCO2 20mmHg pO2 95mm/Hg HCO3 12mmol/L. 1. Explain why Mr. W would have increased urinary output, blurred vision, and increased thirst. 2. Analyze the ABG results. Explain why DKA would most likely produce these types of blood gas results. The physician has given orders to administer 0.9% Sodium Chloride IV at 500mL/hour for 1 hour, then 200mL/hr for the next 4 hours. The nurse is to start a drip of Regular insulin Intravenous at 0.1mg/kg/hour. 3. What is the rationale for the IV fluids to be given at this rate? 4. Based on the metabolic profile results, what is the red flag that the nurse would most likely need to be aware of related to the medication: Insulin drip? An hour after the insulin was started, the nurse checks Mr. W’s blood glucose levels and notes it has decreased to 208mg/dL. A POCT (Point of Contact) lab testing was completed for Serum Potassium (K+) level. The results are: 3.7. He appears more comfortable ad his vital signs are: HR 92 bpm, RR 22/minute, BP 111/70 mmHg, O2 Saturation 95% on 2L of oxygen.

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