Nursing

Title of Assignment:

Module 06 Written Assignment – Diabetes Case Study

Purpose of Assignment:

Complications from endocrine disorders can result in wide systemic effects. Analyzing disorders related to the endocrine system can be complex.  Consideration of an endocrine case study will help the student learn the complexities of understanding the pathophysiology of an endocrine disorder.

Course Competency(s):

• Determine pathophysiologic alterations that affect the reproductive and endocrine systems

Content:

Using the case study below, prepare a 2-3 page paper.

Diabetes Case Study

A 21-year old female (A.M.) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since she’s been ill and unable to keep any food down. She’s only tolerated sips of water and juices. Since she’s also been unable to eat, she hasn’t taken any insulin as directed. While helping A.M. from the lobby to the examining room you note that she’s unsteady, her skin is warm and flushed, and that she’s drowsy. You also note that she’s breathing rapidly and smell a slight sweet/fruity odor. A.M. has a challenge answering questions but keeps asking for water to drink.

You get more information from A.M. and learn the following:

• She had some readings on her glucometer which were reading ‘high’
• She vomits almost every time she takes in fluid
• She hasn’t voided for a day but voided a great deal the day before
• She’s been sleeping long hours and finally woke up this morning and decided to seek care

Current labs and vital signs:

1. What is the disorder and its pathophysiology that you expect the health care provider to diagnose and treat?

2. Describe the etiology of the disorder A.M. is experiencing.

3. Identify and describe the clinical manifestations of the disorder A.M. is experiencing.

4. Identify and describe the expected treatment options for A.M. based on the disorder and clinical manifestations.

Instructions:

Summarize the questions above and formulate what may be happening with A.M. and the expected treatments to improve her condition.

Use at least one scholarly source to support your findings. Examples of scholarly sources include academic journals, textbooks, reference texts, and CINAHL nursing guides. Be sure to cite your sources in-text and on a References page using APA format.

Case study adapted from:

Harding, M.M. & Snyder, J.S. (2015). Winningham’s critical thinking cases in nursing: Medical-surgical, pediatric, maternity, and psychiatric. https://ebookcentral.proquest.com/lib/ras/detail.action?docID=2072336.

ANSWER

A.M Diabetic ketoacidosis

With reference to the condition of A.M, the healthcare provider should diagnose and treat Diabetic ketoacidosis. Diabetes ketoacidosis is a severe complication of type 1 diabetes. It develops when the body lacks adequate insulin to let the sugar in the cells to be utilized for energy. Diabetic Ketoacidosis is life threatening problem that starts with the body breaks down fat at a faster rate (Rees et al., 2019). Insulin deficiency leads the body to process amino acids and triglycerides rather than glucose for energy. The body shifts to burning of fatty acids that generate acidic ketones. The decrease in peripheral cell use and ketone production leads to metabolic acidosis which eventually results to ketoacidosis. A.M has diabetic ketoacidosis which is present in myriad symptoms such as deep breathing, fruity smelling breath, flushed face, dry mouth and skin, feeling very tired and nausea and vomiting.

Diabetic Ketoacidosis can be caused by eating poorly, missing insulin dose and feeling stressed. Increased counter regulatory hormones and insulin deficiency leads to the release of fatty acids that circulate into the body (Nyenwe and Kitabchi, 2016). Diabetic ketoacidosis when comparative or absolute insulin shortage deters the ability of glucose to go into cells to be utilized as metabolic fuel. With regard to this, the lover rapidly breaks down fat into ketones that are utilized as a source of fuel. The over production of Ketones leads to buildup in the blood and urine which leads to diabetic ketoacidosis.

The clinical manifestations of diabetic ketoacidosis include vomiting, nausea and pain. The high levels of ketones that have accumulated in the body increase the levels of potassium and sodium in the body become depleted causes vomiting and nausea (Rees et al., 2019). The abdominal pains are discomforts that occur anywhere between the pelvis and the ribs. Other clinical manifestations include increased urination and thirst.

Fluid replacement, insulin therapy and electrolyte replacement are effective treatment options for A.M based on the disorder and clinical manifestations. The therapeutic objectives of diabetic ketoacidosis comprise of tissues perfusion, improving circulatory volume, serum osmolality towards normal level, reducing the blood glucose, clearing ketones from serum and ensuring urination at steady rates.

References

Nyenwe, E. A., & Kitabchi, A. E. (2016). The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism, 65(4), 507-521.

Rees, C. J., Cantor, R. M., Pollack Jr, C. V., & Blanck, J. F. (2019). Diabetic ketoacidosis. In Differential Diagnosis of Cardiopulmonary Disease (pp. 355-377). Springer, Cham.