Please help Case study for Type 1 Diabetes

What else do you know about the pt?.

Blood sugar dropped 1/2 while fluid volume was increased by well under 2X. Where did the remaining glucose go? Is more going to follow? What are we adding D5 to? What happens to dextrose in IV fluid?

Jessica is 13 y.o who has had diabetes sice she was 7. The case study says Jessica developed a cough, nasal congestion, and a low grade temp 3 days ago, but told her parents she felt well enough to go to school and didn't want to miss any of her classes or softball practice. Today she felt worse so her mom called the pediatrician, who told the mom to bring jessica to his office. Dr recommended that she take jessica to the ER at which point she noted Jessica's pulse and respirations were elevated, her breath had a fruity odor, and her capillary blood sugar level was elevated. At the ER, Jessica's diagnostic test are: glucose 480, NA 130, CL 79, K 3.3. Arterial bloog gases: pH 7.19, PaCO2 25, HCO3 10, PaO2 92, Oxygen saturation 97%

That is all it states. It doesn't say what IV fluids they are giving.

She's in DKA, diabetic ketoacidosis. Her blood pH tells you this.

They are adding dextrose to her IVF because they do not want to drop her blood glucose too quickly. She is no doubt also getting an insulin drip. Dropping too quickly can cause a fluid shift that can result in brain damage.

You might wonder if you should just reduce the insulin, but you need insulin to clear the ketones, so you must give dextrose at the same time.

BTW, her URI symptoms contributed to the problem because illness causes insulin resistance.

Thanks soooo much!

Don't know if you need info from a book for reference but here is a great way for finding it.

Go to Google at the top of the Google page see gmail and beside that a dropdown arrow. Click the dropdown arrow and select books.

On this page in tiny words to the right click Advanced Book Search.

In the 1st textbox type in "diabetic ketoacidosis nursing"

Below the textboxes for Search click on Limited Preveiw and Full View.

For Content click on Books

For Language choose the language you want.

Then up in the right hand corner click on Google Search

You will find links to nursing books with what you are looking for such as the book of the link below. See page 203 right hand column under "Rehydrating"

http://books.google.com/books?id=3Yz1QlhFEi4C&pg=PA208&dq=diabetic+ketoacidosis+nursing&lr=lang_en&as_drrb_is=q&as_minm_is=0&as_miny_is=&as_maxm_is=0&as_maxy_is=&as_brr=3&as_pt=BOOKS#v=onepage&q=diabetic%20ketoacidosis%20nursing&f=false

This is a great way to search for care plan or term paper info.

Just remember to save the name of the book, author, website etc. for the bibliography.