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Read Chapter  47 & 48 pg 1108-1155

Patient Profile

Tony Chadwick is a 16-year-old African American male admitted to ICU from the urgent care with newly diagnosed type 1 DM with DKA. His mother took him to the local urgent care with a 2-day history of vomiting and abdominal pain. Tony also complained of thirst, blurry vision, and fatigue. His mother smelled a fruity odor on his breath this morning. The nurse at the urgent care clinic found that Tony had a blood glucose level of 520 mg/dL and urine positive for ketones. Tony was immediately transferred to the local hospital, where he was admitted to ICU. He is in the 11th grade and was doing well in school until about 2 weeks ago, when he started to become easily fatigued and irritable. His mother thought that he was just staying up too late and not getting enough sleep. Tony has been well except for an upper respiratory viral infection about 2 months ago that kept him home from school for 3 days.

On arrival in the ICU, Tony is drowsy but wakes to verbal stimuli. He complains of nausea and is vomiting green-colored bile in small amounts. He complains of abdominal pain and a need to urinate.

His mother accompanies him and expresses fear that he will not survive this acute episode. She was told at the urgent care clinic that Tony has diabetes, but she does not believe it. She says no one in her family or her husband has diabetes.

Lab Results:

AIC 12%
Anion gap 20
ABGs pH 7.22
pCO2 21
Bicarb 18
Electrolytes are pending.
Chest x-ray is negative.

Physical Assessment:

Vital signs: T 99.5F orally; P 120 bpm, thready; R 28/min, deep and labored; BP 90/60 mmHg
Neuro: As above
Resp: Lungs clear to auscultation
CVS: All pulses palpable with radial pulses thready. HS are S1, S2.
Skin: Cool and clammy but skin turgor poor
GI: Diminished bowel sounds in all quadrants
GU: Has not voided
An IV is started and 0.9% NaCl is infusing. An insulin drip is started per protocol. Tony is connected to a cardiac monitor and exhibits sinus tachycardia. A Foley catheter is inserted and connected to an hourly drainage chamber (for hourly urine output measurement).
Please answer the following questions regarding the Case Study.

Question 1

Tony is a 16-year-old male who is involved in sports. What are some of the fears and anxieties that he may have as he resumes his normal life? How can the nurse help Tony deal with these issues?

Question 2

At the urgent care clinic, Tonys mother said this couldnt be diabetes because no one in the family has ever had it. What could the nurse tell Tonys mother to help her understand the disease and its etiology?

Question 3

Discuss the electrolyte imbalance and blood gas results that occurred on the first day of Tonys admission. How do his vital signs reflect the pathophysiology of DKA?

Question 4

Tony is concerned about being embarrassed when he has to check his blood sugar and take his insulin at school. What interventions could the nurse suggest helping him with privacy?

Question 5

Tony admits to drinking alcohol occasionally. What should the nurse teach Tony about alcohol use and diabetes?

Question 6

List and explain at least four nursing diagnoses for Tony.

Diabetes Case Study
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