presented by: simi m paul pedia ward. demografic data name : case no: 4 mr no : 157203 diagnosis :...
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DEMOGRAFIC DATA Name : case no: 4MR no : 157203Diagnosis : DKA (Diabetic ketoacidosis)Age : 13 yearsGender : FemaleDate of admission: 09/10/2012 Date of discharge: 11/10/2012
Physical Assessment
General Assessment
a) Chief complaint: Vomiting, Drowsiness, Polyuria, Lethargic
b) Skin : Dehydrated , look lethargicc) Head and neck : No deformities foundd) Thorax: Normally symmetrical in sizee) Cardiovascular : No Deformities foundf) Genitourinary: Polyuria,g) Gastrointestinal: vomiting, nausea ,abdominal painh) Musculoskeletal: No deformities foundi) Neurologically: No deformities found
PATIENT HISTORYPASTMEDICAL HISTORY
Known case of DKA since 3 yrs.She is on insulin treatment (insulin humolog 22 unit TID )
PRESENT MEDICAL HISTORY
Now the patient is admitted with the complaint of polyuria, polydipsia, vomiting and drowsiness
TOPIC PRESENTATION
DEFINITION
It is a disorder of glucose intolerance caused by deficiency in insulin production and action resulting in hyperglycemia and abnormal carbohydrate , protein and fat metabolism .
The pancreas is a pale gray gland weighing about 60 grams. It is about 12 to 15 cm long and is situated in the epigastric and left hypochondriac region of the abdominal cavity .it consist of a broad head and a body and a narrow tail. The head lies in the curve of the duodenum. The body behind the stomach and the tail lies in front of the left kidney and just reaches the spleen.
The pancreas both exocrine and endocrine gland
EXOCRINE GLAND
It consists of large number of lobules made up of small alveoli the walls of which consist of secretary cells .each lobules is drained by a tiny duct and these unite eventually to form the pancreatic duct , which extends the whole length of the gland opens in to the duodenum .
FUNCTION
The function of exocrine pancreas is to produce pancreatic juice containing enzymes that digest carbohydrates, proteins and fats
ENDOCRINE PANCREAS
Distributed throughout the gland are groups of specialized cells called the pancreatic islets .The islets have no ducts so the hormones diffuse directly in to the blood.
The function of the endocrine pancreas is to secrete the hormones insulin and glucagon , which are principally concerned with control of blood glucose levels.
PATHOPHYSIOLOGY
Insulin deficiency
Free fatty acids
Ketone bodies in the liver
Causes metabolic acidosis Increased secretion of glucagon, catecholamine's,
Serum cortisol.
Hyperglycemia
DKA
SIGNS AND SYMPTOMS
BOOK BASED PATIEND MANIFESTED
Polyuria
Polyuria
Polydipsia Polydipsia
Fatigue, malaise and drowsiness drowsiness
Anorexia, nausea , vomiting vomiting
Abdominal pain abdominal pain
INTERVENTION
Restoring fluid and electrolyte balance.
Promoting rest and conserving energy
Promoting frequent monitoring of blood glucose level
Promoting family knowledge
Monitoring and preventing complication
BOOK BASED PATIONT TREATMENT
INSULIN THERAPY INSULIN THERAPY
Eg: Human insilin RHuman misted
Eg:Injection human insulin R IV infusion
SUPPORTIVE MEASENCE :
IV therapy, electrolyte replacement
TREATMENT
COMPLICATION
Cerebral edema
Extended Hyperglycemia
Microvascular complication.
Retinopathy
Nephropathy
PRIORITIZATION OF NURSING PROBLEMS
Altered fluid volume deficit related to severe dehydration
Activity intolerance related to poor glucose control.
Altered electrolyte imbalance related to vomiting
Risk for impaired skin integrity related to decreased sensation and circulation to lower extremities
Ineffective coping related to chronic disease and complex self-care regimen.
ASSESSMENT
NURSING DIAGNOSI
S PLANNING IMPLEMENTTATI
ON RATIONALEEVALUATI
ON
Subjective :
Patient mother complaints of increase number of vomiting Objective : Vomiting more than 5 times per day a) Dry skin b) Cracked lips
Altered fluid volume deficit related to active fluid loss.
With in 12 hrs of nursing intervention patient will. •Hydrated • No vomiting
a) Encourage oral intake of fluid.
b) Administer IV fluid( 5 % Dextrose in 1/2 ns + 5ml KCL at 85ml /hour)
c) provide calm and quiet environment.
d) monitor intake and output chart
e) provide DM diet .
a ) Helps to promote hydration
b) Helps to provide fluid , calories and electrolytes.
C) To maintain electrolyte imbalance
d) will determine if out put exceeds input
E) Helps to decreed blood glucose level
After 12 hrs of nursing intervention the goal was partially met
ASSESSMENTNURSING
DIAGNOSIS PLANNING IMPLEMENTTATIO
N RATIONALEEVALUATIO
N
Subjective : Mother complaints patients experience fatigue and drowsiness
Objective :
Increase blood glucose level
Activity intolerance related to poor glucose control
Within 24 hrs Patient blood glucose level gradually decrease and back to normal range
a) Monitor blood glucose level every 1 hourly
b) Administer proper medication's
c) Provide calm and quiet environment
d) Monitor urine ketone
a) To determine the correct amount of insulin injection
b) Helps to decrease blood glucose level
c) Provide relaxation
After 24 hrs patient blood glucose level decreased.
NURING HEALTH TEACHING
Encourage the mother to monitor blood sugar properly
Demonstrate and teach the mother how to give insulin properly
Educate the mother regarding proper preparation of diabetic diet
Teach about the signs and symptoms of DKA
CONCLUSION
Patient relieved from signs and symptoms of DKA and maintains blood glucose level in normal range
Discharge medications :- Insulin Humalog 22 units 3 times daily
BIBLIOGRAPHY
Lippincott manual of Nursing practice 9th edition .
Ross and Wilson , anatomy and physiology in health and illness 9th edition .