Case Study Project



Case Study and Its Significance

Mrs. Smith, 51 years old obese female from a local suburb of Logan. Since last two days before she is was suffering from vomiting, abdominal pain, persistent diarrhoea and headache at home. On her visit to GP she was treated for dehydration, but after two days the patient condition deteriorated and ambulance was called to take her to the hospital. The patient vitals noted by the paramedics on her arrival were heart beat 120 beats/minute, blood pressure 89/60 mmHg, Ketotic breath, Kussmaul breathing and respiratory rate 28 breaths/minute. Blood glucose level was recorded to be 26mmol and Glasgow coma scale was 12. The emergency treatment given to the patient was fluid resuscitation with 1 litre intravenous sodium chloride. After the patient was stabilized in the emergency department she was shifted to the medical ward for close monitoring. Patient is a known diabetic type 2 patient, also had transient ischemic attack and now diagnosed with Diabetic Ketoacidosis.

The case study is a significant case with respect to nursing care as the management of DKA requires good nursing care and they can play a major role in the critical handling of the patient, sound physical assessment and proper time management of the disease and treatment. Therefore for standard patient care the nurses must have a clear understanding of the disease, pathophysiology, clinical presentation, treatment and the role they can play is the disease management and patient care.

The two clinical priorities are:

Dehydration, because patients suffering from DKA often suffer from severe dehydration and there are chances of hypovolemic shock.

Hyperglycemia, as brain only utilizes glucose to drive energy, therefore it is very important that glucose enters into the cells and blood glucose levels are controlled.

Acute Management of Diabetic Ketoacidosis in Type 2 DM - The Role of the Nurse

An Overview of Diabetic Ketoacidosis

Diabetic ketoacidosis also known as DKA is considered to be a hallmark of life threatening complications that occurs in patients with Type 1 diabetes. DKA is said to be rare in type 2 Diabetes. Recent researches made to examine the prevalence of DKA in patients have showed that DKA is prevailing in Type 2 Diabetes (Fishbein & Palumbo, n.d). The leading causes of the progression of DKA in both Type 1 and 2 Diabetes is due to inadequate insulin treatment or non adherence to therapy. It is also followed by new onset of diabetes in patients. Acute illness, stress, depression and drugs can also lead to DKA in diabetic patients. According to retrospective view, 47% patients with Type 1 diabetes were diagnosed with DKA while 26 % patients with Type 2 diabetes were diagnosed with DKA. Rest 27% patients were newly diagnosed diabetic patients (Lin et.al 2010).

Diabetic ketoacidosis is defined as uncontrolled diabetes. It is typified by hyperglycemia, a high anion gap acidosis, and presence of ketone bodies in the blood and urine. The main reason of its occurrence in type 2 diabetic patient is severe stress, and in type 1 patient it occurs ...