HLTEN611B – Apply Principles of Diabetic Nursing Care
Assessment 1 – Case Study

James is 18 years of age and has just presented (with his parents) to his GP with a 2 week history of extreme fatigue, polyuria, polydipsia, and weight loss. His random BGL is 41mmol/l and his blood ketones show 3.2mmol/l. His GP has diagnosed Type 1 diabetes with DKA and has sent him to the emergency department to see an endocrinologist at your public hospital, St Health Skills. The endocrinologist has decided on inpatient stabilisation. James has been deemed stable enough with his DKA to avoid ICU admission, but requires acute nursing care. He is severely dehydrated, his potassium and sodium levels are low and he is experiencing muscle and abdominal …show more content…

I would consider these things in my approach to both James and his family by explaining what nursing interventions we are doing and why it is necessary for these interventions to be carried out. I would also try to promote informed decision making on the part of James and his family. As they are feeling very overwhelmed by what is happening it would be ideal to use simple terminology at this stage. Education about DKA and type 1 diabetes would need to be broken into small easy to understand stages as there is an abundance of information that James and his family need to know. I would encourage the expression of views, feelings and ideas from James and his family.

Question 4 What initial medical management and subsequent nursing care do you think James will require, to treat his diabetic ketoacidosis? (list and explain rationale for each treatment)

Ensure patent airway and administer oxygen via nasal cannula or non-rebreather mask. Establish IV access and begin fluid stabilisation with 0.9% normal saline and potassium. The fluid type and volume to be infused will need to be adjusted dependant on glucose, sodium and potassium levels. Management requires careful monitoring of IV fluids to correct dehydration, administration of insulin therapy per doctor’s order to correct hyperglycaemia, and administration of electrolytes to correct electrolyte imbalance. (Brown & Edwards, 2012) Continue infusion until blood pressure