CASE 2: Molly PART 1/1 -Student Version

CASE 2: Molly PART 1/1 -Student Version HPI: Molly is a 13-year-old female with a chief complaint of hyperventilation brought to the ED by her mother. Previously healthy female with no known medical problems. Last week she had burning with urination that progressed to increasing urinary frequency and intermittent nausea. Over the past couple of days, she’s become aware of rapid, deep breathing. She reports a five-pound weight loss over past 2 weeks. Her mother is very anxious, speaking rapidly while pacing around the exam room. PMH: NKDA, childhood/routine vaccines up to date. No medications. 1.After reviewing the client information, highlight parts of the paragraph that are most concerning. What is the clinical significance (analyze) of the cues highlighted? Relevant Data Clinical Significance 2. Review and interpret the lab data. What is the clinical significance of each lab value relative to the client’s clinical status? N= normal, A=abnormal, AA-abnormal but anticipated, C= critical LAB Current N, A, AA, C high/low – relevance Na 148 Glucose 473 BUN 30 Creatinine 1.7 ketones 3.1 ABG pH 7.29 PaCO2 35 HCO3 16 PaO2 100 UA + ketones + glucose + nitrates 4. What data is relevant and must be interpreted as clinically significant by the nurse? Data Clinical Significance T: 98.6 F/37.0 BP: 100/64 HR: 112 RR: 28 SaO2: 97% RA Neuro: AA0 x 4 Cardiac: S1/S2 RRR Resp: Clear GI: Hyperactive bowel sounds x 4 GU: Clear, pale-yellow urine Skin: Dry, cracked lips 5. What is the client’s primary problem, the cause and the anticipated nursing role in the medical interventions? DKA, Type 1 DM, dehydration 6. What nursing priority(ies) will guide your plan of care? (If more than one-list in order of priority) 7. Using 2 priorities identified in # 6 list three or more interventions for both concerns and the expected outcome for each intervention. Problem Interventions Expected Outcome/ Evaluation 8. Choose the most likely options for the information missing from the statements below by selecting from the list of options provided. Based on the assessment, findings and laboratory results, the nurse suspects the client is experiencing __1__ because her ___1__ is very high and other laboratory results indicate that she has __1__ the nurse anticipates that the client will need __2__ and __2__ as soon as possible to manage her diabetic complication. Options for 1 Options for 2 Arterial pH IV fluid replacement Diabetic ketoacidosis Enteral feedings Hyperglycemic hyperosmolar state Intravenous long-acting insulin Metabolic acidosis Hemodialysis Respiratory alkalosis Parental nutrition Serum glucose IV regular insulin Serum potassium Fruit juice The primary health provider provides a treatment plan which includes: 0.9% normal saline IV infusion at 500 mL/hr. for 1 L followed by 0.45% normal saline IV infusion at 250mL/hr. until client’s blood sugar is less than 250 mg/dL. 0.1 unit/kg. regular insulin IV bolus followed by regular insulin IV infusion at 0.1 unit/kg/hr. 9a. The client’s weight is 90.4 pounds and implement prescribed care and nursing interventions. What is the dose for the bolus? Round to the whole number. 9b. The pharmacy sends up an infusion bag of regular insulin 100 units/100 mL 0.9% NS, what is rate do you set the pump for the infusion? Round to the whole number ______ 10. Use an X indicate whether the nursing actions below are Indicated (appropriate or necessary), Contraindicated (could be harmful), or Non-essential (make no difference or not necessary.) for the clients care at this time. Nursing action Indicated Contraindicated Non-essential initiate potassium replacement for hospital protocol. Check the clients blood glucose level hourly. Administered 4 units regular insulin subcutaneously STAT Offer 120 mL of fruit juice Insert an indwelling catheter closely monitor output Monitor the client for orthostatic hypotension Check the client’s vital signs every 15 minutes Fun Practice: Analyze the ABG of client’s mother. What are the therapeutic interventions? Can you intervene? pH= 7.48 PaCO2= 28 HCO3= 22 PaO2= 85 Metabolic disorder pH Paco2 HC03 BE Uncompensated, acidosis ↓ N ↓ ↓ Partial comp. acidosis ↓ ↓ ↓ ↓ Uncomp. Alkalosis ↑ n ↑ ↑ Partial alkalosis ↑ ↑ ↑ ↑ compensated N ↑ ↑ ↑

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