7. After Jessica has received 2L of intravenous fluids and her blood glucose lev

Question

7. After Jessica has received 2L of intravenous fluids and her blood glucose level decreases 240 mg/dL, the health care provider prescribes adding 5% dextrose to her intravenous solution. Should you question this prescription? Why or why not? 8. What other medical management interventions would you expect to be prescribed to facilitate Jessica’s recovery? 5 THE NERVOUS AND ENDOCRINE SYSTEMS Jessica is a ISyear-old high school student who lives with her parents and younger brother Jonathan (11 years old) in a middle-class meighborhood. Both ME and Mrs. Morris work in the commmunity where they live. Jessica has had diabetes mellitus type I insulin dependent diabetes mellitus (IDDM) since the age of 7 which has been well controlled with morning and evening injections of NPH Humulin insulin, diet, and exercise. Jessica has been staying up later in the evenings studying for her end-of-year (EOY) exams, and is also the pitcher on her school's softball team, which is playing in the semifinals. Her heavy schedule has contributed to changes in her eating and sleeping hahits Client Profile Case Study Jessica developed a cough, nasal congestion, and a low grade temperature 3 days ago, b told her parents she felt well enough to ga to school and didn't want to miss any of her classes or softhall practice. Today Jessica felt worse, so her mother called Jessica's pediatrician, Dr. Sheila Jones, who told Mrs. Morris to bring jessica into her office. Dr. Jones recommended that Mrs. Morris take Jessica to the emer gency department of the hospital, at which point she noted that Jessica's pulse and respirations were elevated, her breath had a fuity odor, and her capillary blood sungar level vwas elevated. At the emergency department,Jessica's diagnostic sest find- ings are as follows: Chemistry profile: glucose, 480 mg/dL sodium, 130 mEq/L chloride. 79 mEq/L and potassium, 3.3 mEq/L Arterial blood gases pH, 7. 19; Paco 25 mm Ho: HCO 10 mEq/L: Pao 92 mm Hg; oxygen saturation, 97% Questions 1. Discuss your impressions about the above sination, 2. How do you explain the abnormal values of the health care provider prescribes adding 5% dextrose to her intravenous solution. Should you Jessica's arterial blood gases? question this prescription? Why or why not? 3. What data indicate that Jessica's lungs are 8. What other medical management interventions o compensate for her present condition? Wouid you expect to be prescribed to facilitate 4. What factors place Jessica at risk for diabetic ketoacidosis (DKA)? 5. What other data would be helpful to determine whether she has developed other complications of either her DKA or her flu-like symptoms? 6. What medical management should you be pre- pared to initiate for Jessica? 7 After Jessica has received 2 L of intravenous fluids and her blood glucose level decreases 240 mg/d Jessica's recovery 9. Discuss the potential complications for Jessica if she is not compliant with her medical regimern when she goes home. 10. In collaboration with the health care provider, what referrals might you obtain prior to Jessica's discharge? 11. What are the teaching priorities for Jessica and her parents prior to discharge

Explanation / Answer

7. Jessica's lab values and PH shows the diabetic ketoacidosis. People with type 1 diabetes are at high risk of diabetic ketoacidosis. DKA is forms of acids in the blood when the blood sugar level is high for a long time. After receiving of IV fluids, her blood glucose level dropped too rapidly to 240mg/dL. Dropping of blood glucose too rapidly may cause a fluid shift which results in brain damage. So the health care provider advised adding 5% dextrose in IV fluid. Simultaneously, insulin drip can be continued to clear the ketones otherwise patient may develop insulin resistance.

8. Medical Management:

Rehydration: Fluids should be administered intravenously to enhance the excretion of glucose by the kidneys. Also, fluid replacement is necessary for the compensation of losses due to polyuria, vomiting, and hyperventilation.

Restoring the electrolytes: Jessica's has low potassium levels due to loss of potassium from the intracellular to extracellular shift. Insulin administration enhances the shift of potassium from the extracellular fluid into intracellular. Additionally, potassium replacement if required, to prevent dysrhythmias. Adequate salts to maintain normal sodium levels.

Reversing Acidosis: Acidosis can be reversed with an adequate amount of intravenous fluid and with the administration of insulin infusion slowly.

11.Teaching priorities for Jessica and her parents:

Related Questions

Navigate

• Browse (All)
• Browse 7
• Subjects

---

---

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.