SCENARIO: ST, is a 23-year old man with a 10 year history of type 1 diabetes presents to the hospital Emergency Medical Department with symptoms of nausea, vomiting, myalgia, polydipsia, and polyuria for almost 2 days. 3 days ago, he went to a party and drank an excessive amount of alcohol. He woke up the next day and complains “sick to his stomach”. He vomited 6 times since then, and is unable to keep any food or drink down. He stopped taking insulin. Currently he has headache. He denies chest pain, cough, fever, upper respiratory symptoms, and abdominal pain.  ST has been hospitalized due to DKA. He was also diagnosed with depression for 3 years and allergic rhinitis for 5 years. He doesn’t have a family history of diabetes. His mother committed suicide. He smokes approximately 1/2 pack per day and drinks alcohol socially. He denies IV drug abuse. He works for his father. He stated that he does not follow a diabetic diet.   Medications:  Humulin 70/30 insulin, 30 U SC q AM Sertraline, 100 mg  PO q PM
 Fluticasone nasal spray, 2 sprays each nostril PRN  Loratidine, 10 mg PO daily
 Acetaminophen, 500 mg PO PRN for headache Allergies: Amoxicillin-causes rash   Physical Examination: GEN: Well-developed, well-nourished male 23-year-old in mild distress
 VS: Breathing is deep and labored with a fruity odor; BP 100/84, HR 120 (supine); BP 98/60, HR 140 (Sitting); RR 34; T 37.0'C;  Wt 58 kg (decreased 4 kg); Ht 178 cm HEENT: Dry tongue and mucous membranes
 CHEST: Clear to auscultation and percussion, no rales, wheezing, or rhonchi
 COR: Tachycardia, regular rhythm EXT: Poor skin turgor  NEURO: Alert and oriented x 3 ABD: Voluntary guarding secondary to nervousness, mildly tender, positive bowel sounds   Laboratory Examination Results on SI units (Conventional unit)  Na 130 (130) PO4 1.5 (4.8) Hct 0.457 (45.7) K 6.0 (6.0) Glu 30 (541) Hgb 152 (15.2) Cl 96 (96) ABG: pH 7.2 LKcs 14 x 109 HCO3 14 (14)         PCO2 26 BUN 14.2 (40)         Cr 141 (1.6)   Urinalysis: Trace protein, 4+ glucose,  + ketones, -nitrites  Chest radiography: No infiltrates
 ECG: WNL Blood cultures X 2: Pending Urine cultures: Pending Assessment and therapy justification for each problem   Health Care Problems Therapeutic Goal Therapeutic Recommendation Rationale

Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
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SCENARIO:

ST, is a 23-year old man with a 10 year history of type 1 diabetes presents to the hospital Emergency Medical Department with symptoms of nausea, vomiting, myalgia, polydipsia, and polyuria for almost 2 days. 3 days ago, he went to a party and drank an excessive amount of alcohol. He woke up the next day and complains “sick to his stomach”. He vomited 6 times since then, and is unable to keep any food or drink down. He stopped taking insulin. Currently he has headache. He denies chest pain, cough, fever, upper respiratory symptoms, and abdominal pain. 

ST has been hospitalized due to DKA. He was also diagnosed with depression for 3 years and allergic rhinitis for 5 years.

He doesn’t have a family history of diabetes. His mother committed suicide. He smokes approximately 1/2 pack per day and drinks alcohol socially. He denies IV drug abuse. He works for his father. He stated that he does not follow a diabetic diet.

 

Medications: 

Humulin 70/30 insulin, 30 U SC q AM

Sertraline, 100 mg  PO q PM


Fluticasone nasal spray, 2 sprays each nostril PRN 

Loratidine, 10 mg PO daily


Acetaminophen, 500 mg PO PRN for headache

Allergies: Amoxicillin-causes rash

 

Physical Examination:

GEN: Well-developed, well-nourished male 23-year-old in mild distress


VS: Breathing is deep and labored with a fruity odor; BP 100/84, HR 120 (supine); BP 98/60, HR 140 (Sitting); RR 34; T 37.0'C;  Wt 58 kg (decreased 4 kg); Ht 178 cm

HEENT: Dry tongue and mucous membranes


CHEST: Clear to auscultation and percussion, no rales, wheezing, or rhonchi


COR: Tachycardia, regular rhythm

EXT: Poor skin turgor 

NEURO: Alert and oriented x 3

ABD: Voluntary guarding secondary to nervousness, mildly tender, positive bowel sounds

 

Laboratory Examination Results on SI units (Conventional unit) 

Na

130 (130)

PO4

1.5 (4.8)

Hct

0.457 (45.7)

K

6.0 (6.0)

Glu

30 (541)

Hgb

152 (15.2)

Cl

96 (96)

ABG: pH

7.2

LKcs

14 x 109

HCO3

14 (14)

        PCO2

26

BUN

14.2 (40)

       

Cr

141 (1.6)

 

Urinalysis: Trace protein, 4+ glucose,  + ketones, -nitrites 

Chest radiography: No infiltrates


ECG: WNL

Blood cultures X 2: Pending

Urine cultures: Pending

Assessment and therapy justification for each problem

 

Health Care Problems

Therapeutic Goal

Therapeutic Recommendation

Rationale

       
       
       
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