Discussion 7(1) : Ketoacidosis Essay

Leonard Mays, a 58 y.o., Caucasian, homeless man with long-standing insulin-treated type 2 diabetes has been diagnosed with right lower extremity cellulitis. He has taken a prescribed oral antibiotic for the past week but has not noticed much improvement. For the last 2 days, he has complained of intermittent fevers and chills, nausea with poor oral intake, and proximally spreading erythema over his right leg. On the evening of admission, a worker at the homeless shelter notices that he is markedly confused and calls 911. In the emergency room, he is oriented only to his name. The patient is tachypneic, breathing deeply at a rate of 24/min. He is febrile at 38.8°C. He is normotensive, but his heart rate is elevated at 112 bpm. On examination, this patient is a delirious, unkempt man with a fruity breath odor. His right lower extremity is markedly erythematous and exquisitely tender to palpation. Serum chemistries reveal glucose of 488 mg/dL, potassium of 3.7 mg/dL, and sodium of 132 m/dL. Urine dip-stick is grossly positive for ketones. In this discussion: Describe and discuss with your colleagues the pathophysiology of ketoacidosis in this diabetic patient. What is causing his altered mental status? Describe the pathogenetic mechanism of his respiratory pattern. Describe and discuss a plan of care for this patient during his first few days in the hospital. Describe a plan of care for him at discharge (he will likely be admitted to the “medical floor” of the homeless shelter, which has the services of an Nurse Practitioner three times per week and a registered nurse four times per week). Include plans for at least one population-focused intervention. Include citations from the text or the external literature in your discussions. Discussion 7(1) : Ketoacidosis Essay

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Diabetic ketoacidosis ( DKA) is a dynamic metabolic disease marked by ketoacidosis, hyperglycemia, and ketonuria. DKA typically develops as a consequence of an actual or conditional insulin deficit combined with a rise in contra-regulatory hormones including cortisol, glucagon, growth hormone, and epinephrine (Enondu et al., 2015). This form of hormonal dysfunction improves glycogenolysis, hepatic gluconeogenesis, and lipolysis. In the case study, Leonard suffers from a mental health disorder. This is caused by alow life quality shown by him being homeless. Poor glucose control and increased visits to the emergency room also impacts his mental health status.

The pathogenetic mechanism of his respiratory pattern

When ketones that are accumulated surpass the capacity of the body to extract them, they flow into the urine. Organic acids accumulation causes a candid clinical acidosis with a substantial drop in bicarbonate and pH serum level. This acidotic condition causes a Kussmaul respiratory pattern characterized by fast, shallow breathing and becomes deeper and labored as acidosis becomes more severe (de Moraes and Surani, 2019). The client registers a deep breathing pattern shown by a drop in sodium and potassium levels. The presence of ketones in his urine also explains his respiratory pattern. Discussion 7(1) : Ketoacidosis Essay

Plan of Care

The clinical care plan for individuals with Diabetic Ketoacidosis involves the provision of details on the process and prognosis of illness, self-management and medical requirements, the assessment and support of cardiovascular, respiratory, renal and central nervous system (CNS) activity, the avoidance of diarrhea and the correction of hyperglycemia and its complications (Enondu et al., 2015). The nurse practitioner should monitor the client’s fluid intake to prevent dehydration. The nurse should also provide information to the individuals in the homeless shelter community on diabetes, symptoms, causes, and prevention measures.

References

Erondu, N., Desai, M., Ways, K., & Meininger, G. (2015). Diabetic ketoacidosis and related events in the canagliflozin type 2 diabetes clinical program. Diabetes care, 38(9), 1680-1686.

de Moraes, A. G., & Surani, S. (2019). Effects of diabetic ketoacidosis in the respiratory system. World Journal of Diabetes, 10(1), 16. Discussion 7(1) : Ketoacidosis Essay