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NRSG370: Nursing - Mr. Daniel Hughes Case Study Assessment Answer
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Internal Code: E_AI_DGCF_EH
Code: NRSG370
Mr. Daniel Hughes Case Study Assessment Answer
Assignment Task: NRSG370 Mr. Daniel Hughes is a 28-year-old man admitted to the High Dependency unit (HDU) of a large metropolitan hospital. Daniel was brought in via the Emergency Department early this morning 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 Daniel 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. Medications: Humalog 8 -16 u/s PC, Lantis 28u/s nocte On admission in HDU: NRSG370- Vital signs: SpO2 98% on RA, HR 125bpm, RR 35 (Kussmaul type with acetone smell), Temp 37.3° Celsius, BP 100/60; GCS 14/15 PEARL, pain 3/10 central abdomen.
- Physical assessment: restless, c/o thirst and nausea with intermittent vomiting. Abdo is lax, chest is clear, skin in dry.
- Urine output 0.25ml/hr
- 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
- 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
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