A Report On The Emergency Department

926 WordsFeb 1, 20154 Pages
S (situation): Hi, my name Kelsey and I am a nurse in the emergency department. I am calling about Shannon O’Reilly’s most recent laboratory results. B (background): Ms. O’Reilly is 24 years old who came to the emergency in a DKA crisis earlier this morning and has been DM1 since she was 3 years old. A (assessment): Ms. O’Reilly’s vital signs are temperature of 37.5 C, pulse of 112, blood pressure of 102/52, and respirations of 24. Her respirations are still deep but have a regular rhythm. She has a CBS of 8.1 and regular insulin running as per orders. The lab work shows uncompensated metabolic acidosis with no hypoxia. Ms. O’Reilly’s neurological status has improved with a GSC of 13. Her dehydration is being treated with NS containing 40mEQ KCL/L running at 200ml/hr and potassium levels maintained at 4. R (recommendation): Do you want to continue with the current care plan continued with frequent CBS and potassium monitoring? Describe your rationale for the recommendations made. Shannon’s glucose levels are still high (above 6.1 mmol/L) thus still needs the insulin drip (Robbins et al., 2010). Administration of insulin and efforts made to correct metabolic acidosis forces potassium into the cells causing hypokalemia (Bopp, 2010). Thus, even though the potassium is within therapeutic levels (3.5-5 mmol/L) there is a high chance that Shannon may experience hypokalemia and the administration of NS with potassium is necessary (Bopp, 2010). More Clinical Reasoning:
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