Marilyn Wilson, 24 years old, is brought to the emergency department by the paramedics. Marilyn was stopped by the police this morning when the officer noted she was driving erratically. The officer also noted a strong smell on her breath after stopping her; he wondered if it could possibly be due to alcohol ingestion. Marilyn is lethargic and confused when she is asked about time, date and place but, is oriented to self. She denies any chronic illnesses and does not have a medical alert on her body or in her wallet. Her vital signs reveal: blood pressure of 88/56; pulse of 98; respiratory rate of 22 and oral temperature of 97.2ºF, and her weight appears to be in proportion with her height. An IV line of normal saline is started after blood work is drawn and is running at 200mL/hr. An initial finger stick blood sugar is obtained but reads “too high” for the meter to provide results. Blood tests are ordered “stat” and a blood sugar returns with results of 860 mg/dL. Ketones are present in both the urine and the blood. Emily is immediately started on a continuous insulin IV infusion to help slowly normalize her blood sugar. (Learning Objectives 2, 8, 9, 10) 1. Explain what the officer smelled on Emily’s breath.
Case Study, Chapter 79, Endocrine Disorders
Marilyn Wilson, 24 years old, is brought to the emergency department by the paramedics. Marilyn was stopped by the police this morning when the officer noted she was driving erratically. The officer also noted a strong smell on her breath after stopping her; he wondered if it could possibly be due to alcohol ingestion. Marilyn is lethargic and confused when she is asked about time, date and place but, is oriented to self. She denies any chronic illnesses and does not have a medical alert on her body or in her wallet. Her vital signs reveal: blood pressure of 88/56; pulse of 98; respiratory rate of 22 and oral temperature of 97.2ºF, and her weight appears to be in proportion with her height. An IV line of normal saline is started after blood work is drawn and is running at 200mL/hr. An initial finger stick blood sugar is obtained but reads “too high” for the meter to provide results. Blood tests are ordered “stat” and a blood sugar returns with results of 860 mg/dL.
1. Explain what the officer smelled on Emily’s breath.
2. Describe the reason for the disturbance in each of the client’s vital signs.
3. Explain the diagnosis that most likely fits this scenario.
4. Is this client most likely a type 1or Type 2diabetic and what will her future treatment entail?
5. What orders can the nurse expect as treatment for this client?
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