Case Study of Acute Life-Threatening Condition Assignment

Assignment Task

Aim

The aim of this assessment is to enable students to:

1. Demonstrate knowledge by analyzing the information provided in the case

2. Apply the clinical information provided in the case study and describe this clinical information within a pathophysiological and patient-focused framework.

3. Discuss nursing strategies and evidence-based rationales for managing a patient with a diabetic

4. Discuss the pharmacological interventions related to the management of a patient with diabetic ketoacidosis.

Case study

Mrs Sandra Mirza is a 24-year-old lady presenting to the emergency department at 1900hrs with nausea, vomiting, and malaise for 2 days. Decreased oral intake. Vague historian. Denies urinary or bowel symptoms. Denies cough, chest pains or fevers. Currently breastfeeding 4 months old infant. Husband reports patient has history of Type I Diabetes, variable insulin compliance- not measured BGL for last 2-3 weeks, and not taking insulin regularly for the last 2-3 weeks as patient is trying ‘home remedies.’ Non-Medicare, BUPA health insurance.

Past Medical History:

Type I Diabetes, ?nil community follow-up

Lower Segment Caesarean Section-postpartum 4 months

Current Medications: Inj Levimur 4U nocte, Inj Novarapid 3U TDS, Ferograd 1 tablet daily

Nursing Assessment at 2000hrs:

1. Patent, own

2. RR-37/mt, SPO2-99% on 2L Spontaneous, fruity odour breath, some increased work of breathing, chest clear, good air entry B/L, no adventitious lung sounds.

3. Heart Rate Regular- 145/mt, BP- 90/58 mmHg. Capillary Refill Time 3 sec, heart sounds dual no murmur.

4. GCS-14/15 E4V4M6, anxious and distressed +

5. Dry mucous membrane +++

Abdo: soft and non-tender, bowel sounds present, IVCx2 Rand L antecubital fossa in situ, IVCx1 L arm.

1. IVF fluids in progress, Nil by mouth, ice

2. BSL- 7 mmol/L (on arrival BGL- Hi), Ketones- 7.9 mmol/L Venous blood gas at 1930 hrs pH- 6.83

Plan:

• Transfer to ICU within 1 hour
• Chase urine and blood culture results
• Continue current Normal Saline infusion
• Continue DKA protocol: Continue current insulin (Actrapid) infusion at 5u/hr Hourly BGLs, ketones, 2-hourly VBGs,

Potassium replacement as per protocol.

• ECG
• IDC to be inserted
• Nurse manager to organise bed boarding for baby
• Endocrine review

Question

1. Explain the pathophysiology leading to all the clinical manifestations with which Mrs Mirza presents. Please use information from diagnostic results where relevant.

2. Mrs. Mirza has been prescribed the below two interventions.

• Briefly explain/provide the rationale why each of these two (both) interventions are prescribed for Mrs Mirza using pathophysiological linking and appropriate evidence
• Discuss briefly the specific mechanism of action of the medication and relate the medication to the underlying pathophysiology
• Describe briefly the impact of not performing the interventions
• Insulin replacement
• Replace Potassium as per protocol

This Nursing has been solved by our PHD Experts at My Uni Paper.