Diabetic Ketoacidosis ( I think )

[Stillawannabe]

I am a LPN student and have a question that Im not to sure where Im going with this.

A medical pt. has gone out on a 3 hour pass with relatives and returns refusing to perform the interventions stated on the care plan. the pt. is argumentative but answers questions appropriatley. Your data collection on this pt. includes fruity odor on breath, mood swings, and hunger. You need to make some corrections or additions to the care plan but are unable to contact the RN on call. What do you think might be considered as nursing diagnoses? What interventions can you perform and still be within your scope of nursing practice?

[Iridescent Orchid, CNA, LPN]

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[akulahawkRN, ADN, RN, EMT-P]

Where was this patient when he went out on his pass? If he was in good control before he left, he shouldn't be in DKA that quickly. Progression into DKA normally takes time - as in days or weeks. If he's in DKA upon return, consider that perhaps he needs to be checked more often or even specifically for diabetic issues. This would be something to discuss with the RN and/or bring up with the MD. Something else to consider is the possibility of substance abuse.

Something about just a 3 hour window from being (probably) in control of blood sugar levels to DKA just doesn't make sense to me.

[tsm007]

Where was this patient when he went out on his pass? If he was in good control before he left, he shouldn't be in DKA that quickly. Progression into DKA normally takes time - as in days or weeks. If he's in DKA upon return, consider that perhaps he needs to be checked more often or even specifically for diabetic issues. This would be something to discuss with the RN and/or bring up with the MD. Something else to consider is the possibility of substance abuse.

Something about just a 3 hour window from being (probably) in control of blood sugar levels to DKA just doesn't make sense to me.

Not a nurse just a prenursing student, but I have 2 kids with type 1 diabetes so this post caught my attention. Some people are more prone to DKA than others. One of my kids goes into DKA pretty easily and the other has never been in DKA. It can happen in hours, but he'd most likely have to miss an insulin dose. Pumpers can go into DKA pretty quickly, but people on injections it'd take a little time. My personal experience with DKA is they usually have more than just fruity breath and moodiness. The fruity breath can just be from high blood sugars and ketosis without actually being in DKA. His blood sugars could certainly be way out of whack within 3 hours. I've seen my son's go from 40 to 500 within an hour so certainly possible. I usually avoid these questions since I'm not even in nursing school yet, but diabetes, particularly type 1 I have a lot of experience with so I figured what the heck I'd throw my two cents in.

[mpihl]

Couldn't he just be experiencing hyperglycemia? You said he was hungry maybe he left around meal time but did not eat anything. This would also cause him to be acting differently than he was before. I agree with akulahawk in 3 hours DKA wouldn't make sense unless his blood sugars were not completely controlled before hand but substance abuse could also be a factor.