PLEASE HELP, confused

Nurses General Nursing

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K so im working on my first case study and am a tad bit lost. Ive been researching for hours but am getting discouraged... anyone know of a good website to look this up? All the ones I search nothing correlates with the data given as a whole... heres the scenario:

Patient is diabetic, had cancerous tumor removed one day ago... complains of nausea. Several hours later, she was found nconscious with Cheyene-Stokes respirations, Pulse 67, BP 60 systolic, ABGS drawn: Ph 7.13 HCO3 19.8 O2 sat 18.4% (IS THIS EVEN POSSIBLE?) PaCO2 59.5 PaO2 18.8

Ive been trying to find data and assess the situation but am getting discouraged really easily. Im trying to figure out what a diagnosis for this could be... I ws thinking respiratory acidosis due to the increased PaCo2 level and her bicarbonate level being low....

any suggestions? Anything would help.

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I am still a student myself, but I was thinking DKA. The patient is diabetic and the stress of surgery can cause increased blood sugars leading to the acidotic state.

Just a thought...

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Yah I was thinking that too... but still not sure... Thanks so much for responding

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Specializes in ER, Trauma.

ER/EMS view: Draw blood for a glucose or fingerstick, give D50W IV even if you don't have a glucose reading. DKA has a very slow onset. Insulin shock is fast and immediately life threatening. (the brain can only metabolize glucose). 1 or 2 amps of D50W will counteract insulin shock fast. If it's DKA, the D50W won't make that big of an immediate differance.

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Thanks so much for responding... glucose level is 383... potassium is 6.9 sodium levels are normal... any other ideas?

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Specializes in Med-Surg.

I am a student, but I actually had a patient like this (maybe not so severe). The deep respirations (kussmals), coma/lethargy/stupor, nausea, vomiting, ....

Usually you see dehydration with this.. and a low BP, along with that you will have tachycardia.. but this HR 67 is normal, and in response and increase resp rate.

As well, the bicarb (if i remember correctly) looks a little low along with the pH... o2 is quite high.. so you have no compensation there...

You would need to know blood glucose levels, you would need to know any electrolyte imbalances, what about doing urine for ketones, you would smell that ketone "fruity" breath.

Anyways hope this helps. I need to go back to my own studying! :p

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Specializes in ER, Trauma.

FYI: Pulse oximetry is designed to be most accurate above 85% or so. Below that is inaccurate and inconsequential. If the O2 sat is that low it needs treatment no matter what. Same with glucometers, they're most accurate at lower numbers. The difference a glucose of 20 and 120 is more critical than a difference of 400 and 420. Another tip; automatic BP cuffs will cut a rapid pulse in half sometimes. A pt that looks like junk with an automatic pule of 80 may have a palpable pulse of 160! I've seen at least 5 different brands of VS machines do this. Heal long and prosper.

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ah thank you... you all are helping ease my mind :)

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Specializes in ER, Trauma.
Thanks so much for responding... glucose level is 383... potassium is 6.9 sodium levels are normal... any other ideas?

Call a code.You need lots of help with this pt fast. Was the tumor on anything interesting like the thyroid or something else that could get angry and cause this?

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doesnt say...just says that it was in the abdomen. It states that the o2 sat was 18.4%...is that even possible? seems way off. the only thing I can think of is metabolic acidosis due to increased Paco2 and lowered bicarbonate...

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Specializes in ER, Trauma.

If the O2 sat is anywhere near 18%, you need to be doing the ABC's. Dead people can have much higher O2 sats! Airway, breathing, circulation. Again, I'm strictly an ER nurse, so I don't care what the diagnosis is. This patient needs his ABC's addressed first. The doctor is responsible for making a diagnosis, not a nurse. Sorry if I'm not giving you what you want, maybe a med/surg nurse will jump in with better info. All I see is an emergency that needs to be addressed now, and fine tune things with a diagnosis later if the patient lives long enough.

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I can't help you with your situation because I'm not a nurse (one day!) but I do enjoy trying to solve problems like these. I'm the dork furiously looking in my medical reference books while I watch "Life in the ER' type shows. I'm always wrong but it's my little hobby.

I just wanted to ask what type of cancer this patient had and where the tumor was removed from. Could it be any type of chemo that could be interacting with their diabetes?

I know those questions are probably silly to you seasoned RNs but I'm just curious. :)

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