Please help me answer the questions on the bottom! Thank you! Case Study #7- DKA Hector Stevens is an 18-year-old African American foster youth who ran away from the foster care system when he was 16. He is a diabetic who has been noncompliant with medications for the last two years. He says that he was put in the foster care system when he was 10 years old after his parents died from drug abuse. He does not think he has any family since DCFS was unable to locate anyone. Hector was able to graduate from high school at 17, he enrolled himself in online high school and would use the library computers for his homework. Currently Hector has secured living placement with JobCorps and is in trade school to become a chef. Hector brought himself into the ER after vomiting for three days- he thought he had food poisoning. He had been increasingly weak over the last three days, and had not taken his insulin. He thought that since he was unable to keep food down that he didn't need to take his insulin. On arrival to the ER he was weak, a&ox 4, diaphoretic. Vitals were as follows: HR 48, BP 100/76, Temp 98.9, 02 99%, RR 28, Pain 0/10 EKG showed a bradycardic rhythm with peaked T-waves and widened QRS Orders are as follows STAT: 10mg Albuterol INH , IV Insulin 10 units, 50 ml Dextrose 50% and 30ml Calcium Gluconate 10% Insulin drip: Sunits IV/HR until BS under 200, then transition to inpatient sliding scale Labs are as follows WBC 11; BG 890; K 7.2; Anion Gap 15; Serum bicarb 12; NA 160; Phosphate 5 When Hector was moved to the ICU with an admission diagnosis of DKA his EKG was normal sinus rhythm. Admission orders were as follows: • Endocrinology consult • Diet- ADA • Insulin sliding scale • NS 50ml/hr continuous • Strict I&0 Insert Foley Catheter Hectors past medical history is as follows- laceration to spleen, asthma (ProAir 90mcg 2 puffs PRN SOB q2h), seasonal allergies (Benadryl 50mg qhs PRN allergic reaction), diabetes (Lantus 20 units qhs), IBS (benty1 20mg qhs PRN diarrhea) 1). Assessment: What are the identified abnormal findings: List S&S= (Signs and symptoms, i.e., Abnormal Subjective and Objective Assessment Findings/lab results, etc. 2). Analysis/Hypothesis: What is the cause of the patients problem that must be prioritized at this time? Evaluate the Hypothesis = (Signs and symptoms, i.e., Abnormal Subjective and Objective Assessment Findings/lab results, etc.) 3). Planning (Patient goals focus on resolving the problem), Must be SMART goals Generate Solutions Develops a list of actions to address the priority hypothesis. The student nurse then selects the appropriate action from the list and carries out the action. TIME OUT!! The desired outcome must meet criteria to be accurate. The outcome must be specific, realistic, measurable, and include a time frame for completion. Does the action verb describe the patient’s behavior to be evaluated? Can the outcome be used in the evaluation step of the nursing process to measure the patient’s response to the nursing interventions listed below? Pt. will (verbalize, demonstrate, be able to, increase & maintain, or decrease & maintain)?
Please help me answer the questions on the bottom! Thank you!
Case Study #7- DKA
Hector Stevens is an 18-year-old African American foster youth who ran away from
the foster care system when he was 16. He is a diabetic who has been noncompliant
with medications for the last two years. He says that he was put in the foster care
system when he was 10 years old after his parents died from drug abuse. He does not
think he has any family since DCFS was unable to locate anyone. Hector was able to
graduate from high school at 17, he enrolled himself in online high school and would
use the library computers for his homework. Currently Hector has secured living
placement with JobCorps and is in trade school to become a chef.
Hector brought himself into the ER after vomiting for three days- he thought he had
food poisoning. He had been increasingly weak over the last three days, and had not
taken his insulin. He thought that since he was unable to keep food down that he
didn't need to take his insulin. On arrival to the ER he was weak, a&ox 4,
diaphoretic.
Vitals were as follows: HR 48, BP 100/76, Temp 98.9, 02 99%, RR 28, Pain 0/10
EKG showed a bradycardic rhythm with peaked T-waves and widened QRS
Orders are as follows
STAT: 10mg Albuterol INH , IV Insulin 10 units, 50 ml Dextrose 50% and 30ml
Calcium Gluconate 10%
Insulin drip: Sunits IV/HR until BS under 200, then transition to inpatient sliding scale
Labs are as follows
WBC 11; BG 890; K 7.2; Anion Gap 15; Serum bicarb 12; NA 160; Phosphate 5
When Hector was moved to the ICU with an admission diagnosis of DKA his EKG
was normal sinus rhythm. Admission orders were as follows:
• Endocrinology consult
• Diet- ADA
• Insulin sliding scale
• NS 50ml/hr continuous
• Strict I&0
Insert Foley Catheter
Hectors past medical history is as follows- laceration to spleen, asthma (ProAir 90mcg
2 puffs PRN SOB q2h), seasonal allergies (Benadryl 50mg qhs PRN allergic
reaction), diabetes (Lantus 20 units qhs), IBS (benty1 20mg qhs PRN diarrhea)
1). Assessment: What are the identified abnormal findings:
- List S&S= (Signs and symptoms, i.e., Abnormal Subjective and Objective Assessment Findings/lab results, etc.
2).
Analysis/Hypothesis: What is the cause of the patients problem that must be prioritized at this time?
- Evaluate the Hypothesis = (Signs and symptoms, i.e., Abnormal Subjective and Objective Assessment Findings/lab results, etc.)
3). Planning (Patient goals focus on resolving the problem), Must be SMART goals Generate Solutions
Develops a list of actions to address the priority hypothesis. The student nurse then selects the appropriate action from the list and carries out the action. TIME OUT!! The desired outcome must meet criteria to be accurate. The outcome must be specific, realistic, measurable, and include a time frame for completion. Does the action verb describe the patient’s behavior to be evaluated? Can the outcome be used in the evaluation step of the nursing process to measure the patient’s response to the nursing interventions listed below?
Pt. will (verbalize, demonstrate, be able to, increase & maintain, or decrease & maintain)?
4). Implementation (Specific nursing interventions that were performed during your shift): Take Action
Sorts the hypotheses (probable client needs, concerns, problems) in order (based on their evaluation in various dimensions) and carries out the action(s) to address the hypothesis/hypotheses with highest priority.
Must contain the following: Assess {observe, auscultate, palpate, percuss}; Monitor; Prepare, administer; Collaborate w/ specific multi-disciplinary team; & teach, i.e., VERBS
1._____________________________________________________________________________________
2.____________________________________________________________________________________
3._____________________________________________________________________________________
4. ____________________________________________________________________________________
5). Evaluation (What was the outcome: Did you meet your desired goal?) TIME OUT!! Re-Assess the Patient: Do your interventions address further monitoring of the patient’s response to your interventions and to the achievement of the desired outcome? Are qualifiers: when, how, amount, time, and frequency used? Is the focus of the action’s verb on the nurse
Goal; Met or Not met or partially met and how to revise.)
Goal: □ Met Goal: □ Not Met Goal: □ Partially Met Goal: □ Unable to Assess
How to Revise: __________________________________________________________________________
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