Mr. Daniel Hughes
Mr. Daniel Hughes is a 28-year-old man admitted to the High Dependency unit (HDU) of a large metropolitan hospital. Daniel was brought in via the Emergency Department early this morning by his mother and girlfriend, following a 2-day history of generally feeling unwell, vomiting, polydipsia and malaise. He is also recovering from a very mild cold. You are the nurse caring for Daniel in HDU 24 hours post his hospital admission.
History: T1DM for 10 years, and ICU admission for DKA 5 years ago otherwise well, uneventful appendicectomy 5 years ago. Non-smoker, social drinker, NKDA. Lives with girlfriend, works full time.
Medications: Humalog 8 -16 u/s PC, Lantis 28u/s nocte
On admission in HDU:
· Vital signs: SpO2 98% on RA, HR 125bpm, RR 35 (Kussmaul type with acetone smell), Temp 37.3° Celsius, BP 100/60; GCS 14/15 PEARL, pain 3/10 central abdomen.
· Physical assessment: restless, c/o thirst and nausea with intermittent vomiting. Abdo is lax, chest is clear, skin in dry.
· Urine output 0.25ml/hr
· BGL 26.1 mmol/l
· Ketones high on finger prick
· Urinalysis: Ketones +++, Glucose ++, Micro haematuria.
· FBE: mildly elevated WCC and haematocrit, otherwise NAD
· Urea & Electrolytes: Sodium 150mmol/l, Potassium 3.3mmol/l, Calcium normal range, Magnesium & Phosphorus mildly low.
· C-Reactive Protein: Mildly elevated
· Blood Cultures: Nil growth after 1 day
· Troponin: Within normal limits
· Chest XRAY: Clear
· Arterial Blood Gas (ABG): pH 7.15, PaO2 105, PaCO2 35, HCO3 14
· 18g cannula in Left Cubital fossa, with 4hourly Dextrose (5%) alternating with Hartmanns Solution 1L bag insitu (with supplemental KCL in bags)
· 20g Cannula Right Cubital fossa with Insulin infusion commenced 50u/s Actrapid in 50mls of NSaline (1u/ml) at 4mls/hr
Normal ABG ranges: pH 7.35-7.45, PaO2 85-90, PaCO2 35-45, HCO3 22-26
Above is my case study information, could you please help me to identify and prioritise at least three (3) nursing problems/issues based on these information, and establish goals for priority of nursing care related to the nursing problem/issues identified.