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The patient is in a diabetic ketoacidosis (DKA) state if the following conditions apply: (a) Hyperglycemia—blood glucose > 11mmol/L, and (b) Metabolic acidosis— venous pH < 7.3 or plasma HCO3 < 15 mmol/L plus (c) ketosis—ketones in the blood or urine or beta-hydroxybutyrate concentration > 3 mmol/L (Wolfsdorf et al., 2014). The patient’s deep respirations are perfectly normal given the condition of the patient: the respirations are explained by the lungs working to expel CO2 from the body. The body does not want CO2 levels to rise too highly, which happens during the event of ketoacidosis.
Because the patient is a type 1 diabetic—also known as a juvenile diabetic as Type 1 is found primarily in children and young adults—the condition with which the patient has presented is most likely diabetic ketoacidosis, probably caused by an illness or infection which compels the body to produce more hormones (adrenaline, cortisol) to fight the infection. The problem is that the hormones counteract the insulin’s work, which is to help cells absorb blood sugar. If the hormones prevent the insulin from doing its job, the blood glucose levels will rise sharply because the body’s cells are not absorbing them. This will trigger commonly a DKA.
The arterial blood gases (ABGs) likely to be seen in this state, therefore,...
DKA pH would be around 7.36 for a mild DKA, and PaCO2 would be 25 mm Hg. The carbon dioxide level is explained by the fact that the patient’s body is implementing a compensatory mechanism because of the metabolic acidosis. Blowing off CO2 (acid)—i.e., releasing carbon dioxide from the lungs via Kussmaul respirations (hyperventilation in an attempt to compensate for the acidosis)—is the body’s line of defense. HCO3 would be 9 mEq/L in a mild DKA. The patient would be in metabolic acidosis, fully compensated.
One likely explanation for what happened is that the patient probably had an infection prior to getting sick with the diabetic ketoacidosis. The patient’s mother might be in a position to confirm or deny this hypothesis. Even if unknown, to the mother, a quick examination of the anion gap would help to clarify the state of the patient’s helath with respect to acidosis severity. The hyperventilation is compensation for the acidosis and should not be viewed as a cause of immediate concern for the mother or the nurse. The patient has ketonuria (a high amount of ketone bodies in the urine), anorexia, nausea, abdominal pain, thirst, and polyuria. Bicorbanate could be used to facilitate the CO2 reduction process, but this is not without its own risks: as Leung,…
References
Leung, J. S., Perlman, K., Rumantir, M., & Freedman, S. B. (2015). Emergency department ondansetron use in children with type 1 diabetes mellitus and vomiting. The Journal of Pediatrics, 166(2), 432-438.
Wolfsdorf, J. I., Allgrove, J., Craig, M. E., Edge, J., Glaser, N., Jain, V., ... & Hanas, R. (2014). Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatric Diabetes, 15(S20), 154-179.
There was therefore no coercion, evasion or unethical procedure in the study. The authors also make it clear that adequate information was provided to all those agreed to participate. There was obviously an open and transparent sharing of informstion about the project. After discussing the homework, the theme of the session was introduced and patients were invited to share their beliefs, emotions and experiences with regard to the theme. Subsequently,
drowsy, confused, pale sweaty detect a fruity odour breath. You initiate a MET call a set vital signs a BGL. Questions 1 What complications occurring Tanya? Connect signs symptoms? 2 What pathophysiology complication? 3 What blood glucose reading situation ? 4 What nursing interventions required complication? 100 WORDS EACH 1 reference Farrell & Dempsey 2014 Smeltzer Bare textbook medical surgical nursing 3rd edition. Tonya is suffering from diabetic ketoacidosis. This
Nic.in/ibi/t02/i6/ibit02i6p379.pdf)." Fewer injections. Flexible eating and schedule. Match insulin doses precisely to need. Correct the Dawn Phenomenon. Less hypoglycemia and hypoglycemia unawareness. Reduces insulin quickly for exercise. Provide better health through better control (http://www.diabetesnet.com/diabetes_technology/insulin-pumps-advanced.html)." Problems With Pumps While the insulin pump has many advantages, it is not immune to problems. One of its basic problems "is the potential alteration of the administered insulin by motion, contact with pump surfaces and changes in temperature. Insulin forms aggregated macromolecules that have
Diabetes Management Diabetes mellitus is one of the non-communicable diseases that have continued to be in the forefront of public health challenges. Diabetes occurs when the body system is unable to produce sufficient insulin. Typically, insulin is a hormone secreted from the beta cell within the pancreases that regulates the blood sugar as well as assisting in conversion of glucose into energy. Diabetes occurs when there is high level of glucose
Diabetes mellitus (DM) is a multisystem disease with both biochemical and anatomical consequences. It is a chronic disease of carbohydrate, fat, and protein metabolism caused by the lack of insulin. In type 1 diabetes, insulin is functionally absent because of the destruction of the beta cells of the pancreas. Type 1 DM occurs most commonly in juveniles but can occur in adults, especially in those in their late 30s and
Ketoacidosis occurs when patients with Type 1 diabetes do not take their insulin shots or when patients with Type 2 diabetes develop ancillary complications such as chest or urinary tract infections. Therefore, the condition can be prevented with proper care and effective monitoring of blood sugar levels. Hyperosmolar hyperglycemic nonketotic coma (HHNK) results from an excess concentration of sugar in the blood, which occurs mostly in patients with Type 2