I have a 78 year old female patient (with history of IDDM) who had a medical diagnosis of DKA.
She is nauseous and has been vomiting. She is frequently urinating. Upon assessment I find her to find sunken eyes and a dry burrowed tongue. She has sinus tachycardia. chest xrays reveal infiltrates
Her respiratory rate is 36
Her BP is 92/54
Her pulse rate is 108 bpm
Well we need to have 3 actual diagnoses and I said
Temperature
Respiration
Dehydration
Vomiting/Nausea
I came to the conclusion that the dehydration must be first addressed... but I'm getting it confused ... Now Idk if the vomiting should be first... but then I think temperature must be addressed first... AHH lol.
Well my reasoning is that the temperature could be causing the high respiration, no? If there is a fever the metabolic activities speed up and well that includes breathing because we need oxygen and in this case more to keep up with the high metabolic rate. I figure that the fever could be caused by an infection and if that's so ... How do I(as the nurse) even address that I will fix it? I suppose cold packs? and hydration? HA!!! but then if I hydrate I have already knocked out dehydration .... ermm no?
I know the dehydration is caused by the hyperosmolar nature of the blood due to all the glucose outside her cells which cannot absorb the glucose due to the lack of insulin (IDDM)...
No, not askin' for someone to do this for me. As you can tell I'm very much into this case ... But I need some guidance and clearance.. please (=
If you are going to add the extra vowel to ADPIE it should be ADOPIE I remember a dolicious pie, Access, Diagnose, Organize, Plan, Implement, Evaluate. The nursing care plan for dummies as my clinical instructor put it... always remember your ABC's in that order first. Airway, Breathing, and Circulation. The easy way to approach your care plan is like this. Diagnosis: patient is constipated, plan: make patient poop, implement: for each nursing diagnosis you need three interventions, with your interventions you can only encourage or educate (you can not force anything) so interventions would be something like: encourage patient to drink more fluids, educate patient on proper diet and fiber intake, encourage patient to ambulate ect. Evaluation: did the patient poop? How will you know the patient pooped? This patient is in metabolic acidosis. What about her ABGs? With ketoacidosis you have two nursing diagnosis's that take top priority if you are looking at the ABCs. Good Luck
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
If you are going to add the extra vowel to ADPIE it should be ADOPIE I remember a dolicious pie, Access, Diagnose, Organize, Plan, Implement, Evaluate. The nursing care plan for dummies as my clinical instructor put it... always remember your ABC's in that order first. Airway, Breathing, and Circulation. The easy way to approach your care plan is like this. Diagnosis: patient is constipated, plan: make patient poop, implement: for each nursing diagnosis you need three interventions, with your interventions you can only encourage or educate (you can not force anything) so interventions would be something like: encourage patient to drink more fluids, educate patient on proper diet and fiber intake, encourage patient to ambulate ect. Evaluation: did the patient poop? How will you know the patient pooped? This patient is in metabolic acidosis. What about her ABGs? With ketoacidosis you have two nursing diagnosis's that take top priority if you are looking at the ABCs. Good Luck
Everyone here, thank you very much! You have all been very helpful and whether y'all are students or nurses I hope I come across people like everyone of you who posted here! (=
I happen to very interested in the pathology of diseases so that helped.
Here's my knowledge on DKA.
Excess glucose outside the cell cannot enter the cell due to LACK of INSULIN.
Because of this GLUCOSE accumulates outside cells and that accounts for the increased URINATION.
The Diabetic Ketoacidosis happens because catabolism of FATS has a byproduct of KETONES which she tested + for.
These metabolic disturbances are like a domino effect... right?
The DKA causes acidosis and because of that she is VOMITING so much... WHY?
Because vomiting causes metabolic alkalosis... I see it like the body trying to bring it self back... am I right? If So that's pretty cool! but... this is bad because she's losing so many electrolytes... not to mention all the fluid and electrolytes she's losing via the urination which is attributed to the hyperosmolar state of her blood. She has a fever ... and I think that's because she has pneumonia ... we had to guess the second medical diagnosis ... my professor said physicians don't always write in the secondary so it's up to us to understand it to better respond to it.... to respond to the patient response to the illness. yeah?
Well if I was a nurse, I see she was prescribed antibiotics.. she had elevated WBC... she had a fever and her CXR was positive for infiltrates... so I put down pneumonia ... not to mention that INFECTION is the underlying cause of DKA (usually). Because of the whole complex hormonone stuff. haha... I sorta for about that but I guess it has to do with your glucose levels going up because you have an infection... right? don't steroids raise that suga!? lol.
Umm well I... ended up choosing her breathing patterns as the priority issue... but now I think I was wrong )= I took my friends advice and put down that...
I wanted to do dehydration... address her dehydration and the temp might go down... you will bring her back to homeostasis ... temperature might be knocked out down a bit too... I think water is essential to ALL life... so yeah.. shoulve gone with my gutt but maybe she was right too.. lets hope..
Here's my problem list. nursing process. and data collection if yall are curious lol.
I don't need feedback unless yall wanna give it. but here they are if yall want to see.
Also this is NOT a real patient so I'm not putting real pt info out there. JS. (=
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Great job! This is your first one? I'm impressed.
Here are my thoughts.....I would place the dehydration first. Your patient is hypotensive and dehydrated AEB her elevated heart rate, low B/P increased urine production (typical of DKA) sunken eyes and a dry furrowed tongue. All big signs that the patient is VERY DEHYDRATED. The deep and labored breathing (kussmals) is a compensatory mechanism for the metabolic acidosis. So is it ineffective breathing? The fever may be from dehydration but is probably from the infiltrates. Many things upset the balance of diabetic......especially infection. Is this really non-compliance? If the acidotic/ketotic state continues can lead to coma. She is also at risk for electrolyte imbalance from the loss of potassium which can cause cardiac arrhythmia.
Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes. DKA mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. Medscape: Medscape Access requires registration but is an excellent source and reference. I strongly suggest you read this.
I have a 78 year old female patient (with history of IDDM) who had a medical diagnosis of DKA.
She is nauseous and has been vomiting. She is frequently urinating. Upon assessment I find her to find sunken eyes and a dry burrowed tongue. She has sinus tachycardia. chest xrays reveal infiltrates
Her respiratory rate is 36
Her BP is 92/54
Her pulse rate is 108 bpm
Some ideas.....
Imbalanced nutrition less than body requirements AEB....vomiting and nausea RT DKA
Unstable blood glucose AEB....your glucose/DKA RT underlying infection and long standing IDDM
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
The DKA causes acidosis and because of that she is VOMITING so much... WHY? Because vomiting causes metabolic alkalosis...
No.....the acidosis (build up of lactic acid) causes nausea and vomiting and can cause abd pain and cramping. Future potassium is lost but a majority of the electrolyte imbalance is the shifting of the electrolytes from inside the cell to outside the cell. a common cause of upsetting the status quo are added stressors which pneumonia/underlying infection are common causative factors. These symptoms are present because the body/glucose/acidosis is out of control and the body is trying to compensate(kussmals) to return to normal.
studentrnchristine
12 Posts
If you are going to add the extra vowel to ADPIE it should be ADOPIE I remember a dolicious pie, Access, Diagnose, Organize, Plan, Implement, Evaluate. The nursing care plan for dummies as my clinical instructor put it... always remember your ABC's in that order first. Airway, Breathing, and Circulation. The easy way to approach your care plan is like this. Diagnosis: patient is constipated, plan: make patient poop, implement: for each nursing diagnosis you need three interventions, with your interventions you can only encourage or educate (you can not force anything) so interventions would be something like: encourage patient to drink more fluids, educate patient on proper diet and fiber intake, encourage patient to ambulate ect. Evaluation: did the patient poop? How will you know the patient pooped? This patient is in metabolic acidosis. What about her ABGs? With ketoacidosis you have two nursing diagnosis's that take top priority if you are looking at the ABCs. Good Luck