Mr. J is a 20 year-old college student with a history of diabetes mellitus type I for the past 6 years. Mr. J lives at home with his extended family. Mr. Js father and grandmother have a history of diabetes mellitus type I. Mr. J is the only other member of the family diagnosed with DM type I. Mr. J is a respiratory therapist major at a community college and is a member of the basketball team. Mr. J collapsed at basketball practice and was transported to the ED. Mr. J is 6 3 and weighs 220 pounds. His family is notified by college authorities and arrive at the ED. On arrival to the ED, Mr. J is responsive to verbal and tactile stimuli. he is very diaphoretic, mildly lethargic, and is complaining of abdominal pain and nausea. He hyperventilates manifesting acetone breathe. Stat serum glucose, arteriole blood gases (ABGs), and serum electrolytes for sodium and potassium reveal: Blood glucose: 450 mg/dl pH: 6.9 pCO2: 20 mm Hg HCO3: 12 mEq/L Sodium: 128 mEq/L Potassium: 3.0 mEq/L His vital signs on admission: BP: 100/70; P 88; R 22; T 98.1F What is Mr Js likely diagnosis?_____________________________________________ The following is prescribed: 0.9% NaCL at 1L/h X two hrs Human regular (Novolin-R) initial bolus 0.4units/kg followed by 2.4 u/h continuous infusion Sodium bicarbonate (NaHCO3) 5mEq/kg infusion over 4 hours and low dose insulin at a continuous rate (five units per hour) at 25 mL/h Monitoer serum glucose and potassium levels; if stable, change infusion to 0.45% sodium chloride at 125mL/hr Insulin aspart (Novolog) insulin 100U/mL , inject 4 units plus NPH 10 units SC three times a day before meals 1. What are specific cultural considerations of diabetes mellitus? 2. What is an extremely critical indicator of diabetes mellitus? 3. What are common nursing diagnosis for clients with diabetes mellitus? 4. What is a primary collaborative problem for Mr. J because of the elevated blood glucose level on arrival to the ED? 5. What are the defining characteristics of DKA? 6. What are the priorities of management for the client experiencing DKA? 7. What are the purposes of the prescribed orders? 8. What are the most common adverse reactions of the prescribed orders? 9. Discuss the drug-drug and drug-food.herbal interactions to the prescribed orders. 10. Explain the differences between Dawn phenomenon and Somogyi phenomenon. 11. What are the critical areas that should be included in client education for type 1 diabetes mellitus? 12
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