Running head: DIABETES COMPLICATIONS 1

Diabetes complications case study

Vanesa Dusabe

Patty Hanks School of Nursing

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DIABETES COMPLICATIONS

Laboratory investigations

Mrs. Hernandez seems to be experiencing hyperglycemia. She reports being thirsty and needing

to urinate frequently, nausea and vomiting associated with hyperglycemia causing fluid to shift

to the extracellular spaces which leads to cellular dehydration and fluid depletion. Mrs.

Hernandez is also feeling fatigue, and she has a 5cm diabetic ulcer on her left great toe. Based on

her lab values and her fruity breath, I would say she is experiencing diabetic ketoacidosis. Her

blood glucose is elevated, higher than 250mg/dL, her arterial pH is lower than 7.35 (normal

7.35-7.45), which indicates acidosis & serum bicarbonate is very low both indicating metabolic

acidosis which is caused by the increase in free fatty acids in circulation, and urinalysis indicates

positive ketones. Her serum sodium, though in the normal range of 135-145mEq/L, it is a little

elevated, her serum Potassium is normal, and her white blood cell count is elevated. All the lab

values, along with the fruity breath odor caused by acidosis, indicate ketoacidosis.

Pathophysiology

Diabetic ketoacidosis results from a combination of insulin deficiency and noncompliance.

Insulin deficiency will stimulate counter-regulatory hormones which in term contributes to an

increased blood glucose and insulin resistance. Insulin deficiency and the counter-regulatory

hormones causes an alteration is glucose production, causes the body to breakdown adipose

tissue for the fatty acids as an alternative energy source, and increased production of ketones.

Impaired use of glucose leads to hyperglycemia. Metabolic acidosis results from an increase in

free fatty acids in the blood. Patient experiences dehydration or extreme thirst and electrolyte

imbalances because of hyperglycemia causing fluid and electrolytes to shift from the intracellular

to the extracellular spaces. Osmotic diuresis results from hyperglycemia and the elevated
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ketones. Patient experiences vomiting which causes further dehydration and electrolyte

imbalances.

Nursing diagnosis

Mrs. Hernandez is at risk for deficient fluid volume related to excessive gastric losses: Vomiting.

Restoration of fluids will help restore circulating volume, clear ketones, and correct electrolyte

imbalances.

Nursing interventions

The priority nursing care that should be provided is education on benefits of her adhering to her

prescribed medications and assessing her fluid volume. Mrs. Hernandez does not have an at

home glucose monitoring device. Without a glucose monitoring device, she is unable to monitor

her glucose, which leads to complications such as the foot ulcer. Nursing care that could be

implemented include collaborating with a social worker to help her get a glucose monitor and

educate her on how to use it. If she has family, they can be involved in her care making sure she

adheres to taking her medications and appropriate use of the glucose monitor. Other

interventions include diet modification, and wound care.

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Reference
Bonsall, L., MSN, RN, CRNP. (2012, August 15). LippincottNursingCenter. Retrieved March

06, 2017, from http://www.nursingcenter.com/ncblog/august-2012/lab-values-and-dka

M., V. L., & Bladh, M. L. (2016). Textbook of laboratory and diagnostic testing: practical

application at the bedside. Philadelphia, PA: F. A. Davis Company.

Nursing times. (2014, February 28). Management of diabetic ketoacidosis in adults. Retrieved

March 06, 2017, from https://www.nursingtimes.net/clinical-archive/diabetes/management-of-

diabetic-ketoacidosis-in-adults/5068489.article
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Grading Rubric Case Study

Please attach a copy of the grading rubric to the end of your paper. THANK YOU!!!

Content Possible ------------------- Points

Comments-----------
Points Received
----
Abnormal Values: 10
What do the labs indicate specific to this patient.
Normal Values: 5
What do the labs indicate specific to this patient
The relationship between the abnormal Signs & 30
Symptoms and lab values is clearly demonstrated.
**Must be specific**

Pathophysiology used to demonstrate connections

between lab results, manifestations and disease 20
process.

Nursing Care:
expected care to be given for exhibited s/s and 10
lab values
expected correction of lab values based on care 10
given
Patient education to prevent recurrence of
abnormal lab values 10
Mechanics (grammar, spelling, APA, etc.) 5
Total 100