Case Analysis- Case Study of an Acute Life-Threatening Condition

Word Count

There is a word limit of 1000 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10%-word count. If you exceed the word count by 10% (1100 words) the marker will stop marking.

Aim of assessment

The aim of this assessment is to enable students to:

  1. Demonstrate knowledge by analysing the information provided in the case
  2. Apply the clinical information provided in the case study and describe this clinical information within a pathophysiological and patient focused framework.
  3. Discuss nursing strategies and evidence-based rationales to manage a patient with diabetic
  4. Discuss the pharmacological interventions related to the management of a patient with diabetic ketoacidosis.

Details

You are to answer all questions related to the case study provided. Your answers must be directly related to the clinical manifestations that your patient presents with. You must submit your work with a minimum of six references from the past five years with at least two references from the resources provided in the vUWS site including peer-reviewed journal articles, textbook material or other appropriate evidence-based resources.

Case study

Mrs Sandra Mirza is a 24-year-old lady presenting to the emergency department at 1900hrs with nausea, vomiting, malaise for 2 days. Decreased oral intake. Vague historian. Denies urinary or bowel symptoms. Denies cough, chest pains or fevers. Currently breastfeeding 4 months old infant. Husband reports patient has history of Type I Diabetes, variable insulin compliance- not measured BGL for last 2-3 weeks, and not taking insulin regularly for the last 2-3 weeks as patient is trying ‘home remedies.’ Non-Medicare, BUPA health insurance.

Past Medical History:

Type I Diabetes, ?nil community follow-up

Lower Segment Caesarean Section-postpartum 4 months

Current Medications: Inj Levimur 4U nocte, Inj Novarapid 3U TDS, Ferograd 1 tablet daily

Nursing Assessment at 2000hrs:

  1. Patent, own
  • RR-37/mt, SPO2-99% on 2L NP. Spontaneous, fruity odour breath, some increased work of breathing, chest clear, good air entry B/L, no adventitious lung sounds.
  • Heart Rate Regular- 145/mt, tachycardic. BP- 90/58 mmHg. Capillary Refill Time 3 sec, heart sounds dual no murmur.
  1. GCS-14/15 E4V4M6, anxious and distressed +
  2. Dry mucous membrane +++

Abdo: soft and non-tender, bowel sounds present, IVCx2 Rand L antecubital fossa in situ, IVCx1 L arm.

  1. IVF fluids in progress, Nil by mouth, ice
  2. BSL- 7 mmol/L (on arrival BGL- Hi), Ketones- 7.9 mmol/L

Venous blood gas at 1930 hrs pH- 6.83 Weight: 56 kg

Lab Results:

Result Reference Range
Sodium 139 mmol/L 135-147 mmol/L
Potassium 4.4 mmol/L 3.5-5.2 mmol/L
Chloride 107 mmol/L 95-107 mmol/L
Magnesium 0.88 mmol/L 0.8-1.10 mmol/L
Phosphate 1.54 mmol/L 0.75-1.50 mmol/L
Haemoglobin 145 g/L 120-140 g/L
White blood cells 16.0x10^9/L 4.0-11.0x10^9/L
Neutrophils 11.0x10^9/L 2.0-7.5x10^9/L
Platelets 468x10^9/L 150-400x10^9/L
C Reactive Protein (CRP) 7 mg/L <3mg/L

 Arterial blood gas analysis (at 2200hrs)

Result Reference Range
pH 7.05 7.35-7.45
PaO2 139 mmHg 80-100 mmHg
PaCO2 9 mmHg 35-45 mmHg
HCO3- 2 mmol/L 22-26 mmol/L
SpO2 98% >95%
BE -27.9 mmol/L -2 to +2 mmol/L
Lactate 3.0 mmol/L 0.5-1.6mmol/L
GFR >90 mL/min/m2 ≥ 90mL/min/m2

 Clinical Impression: DKA, precipitant likely noncompliance with insulin+? viral illness

Plan:

  • Transfer to ICU within 1 hour
  • Chase urine and blood culture results
  • Continue current Normal Saline infusion
  • Continue DKA protocol: Continue current insulin (Actrapid) infusion at 5u/hr Hourly BGLs, ketones,

2-hourly VBGs,

Potassium replacement as per protocol.

  • ECG
  • IDC to be inserted
  • Nurse manager to organise bed boarding for baby
  • Endocrine review

Question 1 (600 words)

Explain the pathophysiology leading to all the clinical manifestations with which Mrs Mirza presents.

Please use information from diagnostic results where relevant.

Question 2 (400 words)

Mrs. Mirza has been prescribed the below two interventions.

  • Briefly explain/provide rationale why each of these two (both) interventions are prescribed for Mrs Mirza using pathophysiological linking and appropriate evidence
  • Discuss briefly the specific mechanism of action of the medication and relate the medication to the underlying pathophysiology
  • Describe briefly the impact of not performing the interventions
  • Insulin replacement
  • Replace Potassium as per protocol

Submission

Refer to Section 2.5 of the Learning Guide- General Submission Requirements Submit your assessment through Turnitin

Format

All assignments are to be typed

Typing must be according to the following format: 3 cm left and right margins, double spaced.

Font: Arial or Times New Roman Font size: 12pt

See further submission requirements below

Submission Requirements

  1. Electronic copy Students are to submit an electronic copy of the assessment. Students are not required to submit the original hard copy of their assessment on campus
  2. Submit your assessment electronically through the Turnitin link on the unit vUWS
  3. Students are to upload the assessment with the following title: Surname_Firstname_assessment title
  4. Your assessment must be submitted in .doc, docx
  5. This assessment is marked online; no paper copy will be accepted. Marks, comments and the marking criteria will be released If you do not receive your marked assessment when all others have been returned, it is your responsibility to contact the Subject Coordinator for assistance.

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