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You are working in an outpatient clinic when a mother brings in her 20-year-old daughter, Connie, who has type 1 diabetes mellitus (DM) and has just returned from a trip to Mexico. She has had a 3-day fever and diarrhea with nausea and vomiting. She has been unable to eat and has tolerated only sips of fluid. Because she was unable to eat, she did not take her insulin as directed. You note Connie is unsteady, so you take her to the examining room in a wheelchair. While helping her onto the examination table, you note her skin is warm and flushed. Her respirations are deep and rapid, and her breath is fruity and sweet smelling. Connie is drowsy and unable to answer your questions. Her mother states, “She kept telling me she’s so thirsty, but she can’t keep anything down.”

 

Connie’s mother tells you the following:

“Blood glucose monitor has been reading ‘high.'”
“C.J. has had sips of ginger ale, but that’s all.”
“She has been vomiting about every other time she drinks.”
“When she first got home, she went [voided] a lot, but yesterday she hardly went at all, and I don’t think she has gone today.”
“She went to bed early last night, and I could hardly wake her up this morning. That’s why I brought her in.”

Vital Signs
BP 90/50 mm Hg

HR 124 bpm

RR 36 even and deep

Temp 38.5 C Tympanic

 

Stat Laboratory Test Results
Glucose:  37.6 mmol/L

K+ 6.3 mmol/L

pH 7.26, Pao2 94, PaCO2 23, HCO3 18

 

Orders

1000 mL NS over 2 hours STAT
Start Insulin infusion – see Order Set below
20 units of Humulin R insulin subQ now
CBC q6 hr, blood cultures × 2 sites; C&S; stool for ova and parasites, Clostridium difficile toxin, serum lactate, ketone, and osmolality; ABGs on room air
Insert Foley Catheter and send urine sample for C&S and Micro.
Clear Liquid Diet as tolerated
Bed Rest
VS every 2 hours and as needed for Insulin Infusion Order Set.

Case Progress

 

 

Connie receives fluid resuscitation and sliding-scale insulin drip via infusion pump. After several hours, her latest laboratory findings are as shown in the chart.

 

 

Next Lab Findings

Case Study Outcome

 

Connie continues to improve and is discharged from the hospital 3 days later. Her mother and she agree to attend an outpatient class offered by the diabetes education department to assist Connie with better managing her diabetes.

 

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what i need help with is below:

 

Evaluation:
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.

 

What will you do: Measuring the degree to which goals/outcomes have been achieved and identifying factors that positively or negatively influence  goal achievement

 

Why will you do it: To determine whether to continue, modify, or terminate the plan of care.

Collaborate with client and relate nursing actions to client outcomes. Determine if goals/outcomes have been met/achieved. If not, re-evaluate:

Data – did you collect enough/correct data?
Diagnosis – did you analyze the data accurately?
Etiology – is it accurate?
Outcome – patient centered, measurable and realistic?
Interventions – realistic and doable?
Revise/modify the care plan as indicated?

 

SCIENCE
HEALTH SCIENCE
NURSING
NRSG MISC

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