Mr Brad Taylor Case Study - High Dependency Unit - Nursing Assessment Answer

Assessment Task:

Mr. Brad Taylor Case Study Nursing Assessment Answer

Case Study – High Dependency

Mr Brad Taylor

Mr. Brad Taylor is a 28-year-old man admitted to the High Dependency unit (HDU) of a large metropolitan hospital.  Brad was brought in via the Emergency Department by his mother and girlfriend, following a 2-day history of generally feeling unwell, vomiting, polydipsia and malaise. He is also recovering from a very mild cold. You are the nurse caring for Brad in HDU 24 hours post his hospital admission.

History: T1DM for 10 years, and ICU admission for DKA 5 years ago otherwise well, uneventful appendicectomy 5 years ago. Non-smoker, social drinker, NKDA.  Lives with girlfriend, works full time.

History: T1DM for 10 years, and ICU admission for DKA 5 years ago otherwise well, uneventful appendicectomy 5 years ago. Non-smoker, social drinker, NKDA.  Lives with girlfriend, works full time.

Investigations:

BGL 26.1 mmol/l
Ketones high on finger prick
Urinalysis: Ketones +++, Glucose ++, Micro haematuria.
FBE: mildly elevated WCC and haematocrit, otherwise NAD
Urea & Electrolytes: Sodium 150mmol/l, Potassium 3.3mmol/l, Calcium normal range, Magnesium & Phosphorus mildly low.
C-Reactive Protein: Mildly elevated
Blood Cultures: Nil growth after 1 day
Troponin: Within normal limits
Chest XRAY: Clear
Arterial Blood Gas (ABG): pH 7.15, PaO2 105, PaCO2 35, HCO3 14
Interventions:

18g cannula in Left Cubital fossa, with 4hourly Dextrose (5%) alternating with Hartmanns Solution 1L bag insitu (with supplemental KCL in bags)
20g Cannula Right Cubital fossa with Insulin infusion commenced 50u/s Actrapid in 50mls of NSaline (1u/ml) at 4mls/hr
Normal ABG ranges: pH 7.35-7.45, PaO2 85-90, PaCO2 35-45, HCO3 22-26

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