Working Outpatient Clinic Question & Answer Guide (With Explanation)

Understanding this question requires applying core subject principles.

What This Question Is About

This question relates to working outpatient clinic and requires a structured academic response.

How to Approach This Question

Break the problem into smaller parts and analyze each logically.

Key Explanation

This topic involves working outpatient clinic. A strong answer should include explanation, application, and examples.

Original Question

You are working in an outpatient clinic when a mother brings in her 17-year-old daughter, C.J., who has type 1 diabetes mellitus (DM) and has just returned from a trip to Mexico. She has had a 3-day fever and diarrhea with nausea and vomiting. She has been unable to eat and has tolerated only sips of fluid. Because she was unable to eat, she did not take her insulin as directed. You note C.J. is unsteady, so you take her to the examining room in a wheelchair. While helping her onto the examination table, you note her skin is warm and flushed. Her respirations are deep and rapid, and her breath is fruity and sweet smelling. C.J. is drowsy and unable to answer your questions. Her mother states, “She kept telling me she’s so thirsty, but she can’t keep anything down.” 1. List 5 pieces of additional information you need to obtain from C.J.’s mother. 2. Describe the pathophysiology of diabetic ketoacidosis (DKA). CASE STUDY PROGRESS C.J.’s mother tells you the following: “Blood glucose monitor has been reading ‘high.'” “C.J. has had sips of ginger ale, but that’s all.” “She has been vomiting about every other time she drinks.” “When she first got home, she went [voided] a lot, but yesterday she hardly went at all, and I don’t think she has gone today.” “She went to bed early last night, and I could hardly wake her up this morning. That’s why I brought her in.” Vital Signs Blood pressure 90/50 mm Hg Heart rate 124 beats/min Respiratory rate 36 and deep Temperature 101.3° F (38.5° C) (tympanic) Laboratory Test Values Glucose 677 mg/dL (37.6 mmol/L) Potassium 6.3 mEq/L (6.3 mmol/L) 3. Interpret C.J.’s VS and laboratory results, relating them to the pathophysiology. 4. Explain the reason for C.J.’s other presenting signs and symptoms. The decision is made to transport C.J. by ambulance to the local emergency department (ED). 5. After assessing C.J., the ED resident on call writes the following orders. Review each order. Mark an A if the order is appropriate; mark an I if inappropriate. For each order you mark as I, explain why it is inappropriate, and correct the order. ____ 1000 mL lactated Ringer’s IV stat ____ 36 units NPH (Humulin N) and 20 units regular (Humulin R) insulin subQ now ____ CBC with differential; CMP; blood cultures × 2 sites; clean-catch urine for UA and C&S; stool for ova and parasites, Clostridium difficile toxin, and C&S; serum lactate, ketone, and osmolality; ABGs on room air ____ 1800-calorie, carbohydrate-controlled diet ____ Bed rest ____Acetaminophen 650 mg rectal suppository q4h as needed ____Furosemide 60 mg IV push now ____Urinary output every hour ____VS every shift 6. List 4 other collaborative interventions that C.J. needs and the reason for using each. 7. Which ABG results would you expect to see in C.J.? Why? pH 7.40, Pao2 88, PaCO2 34, HCO3 23 pH 7.48, Pao2 90, PaCO2 30, HCO3 28 pH 7.27, Pao2 90, PaCO2 50, HCO3 20 pH 7.26, Pao2 94, PaCO2 23, HCO3 18 CASE STUDY PROGRESS All orders have been corrected and therapies started. C.J. receives fluid resuscitation and insulin drip via infusion pump. After several hours, her latest laboratory findings are as shown in the chart. Laboratory Test Results Na 149 meq/L (149 mmol/L) K 3.0 meq/L (3.0 mmol/L) Cl 119 meq/L (119 mmol/L) Total CO2 21 meq/L (21 mmol/L) BUN 12 mg/dL (4.28 mmol/L) Creatinine 1.2 mg/dL (106 mcmol/L) Glucose 298 mg/dL (17 mmol/L) 8. Based on C.J.’s laboratory results, what changes in her IV fluids would you anticipate, and why? 9.When providing care for a patient with DKA, there are several nursing interventions that need to be done. List at least 5 things that should be monitored and frequency of that monitoring. C.J. asks when her IV insulin will be turned off. What would be an appropriate response by the nurse? 11. C.J. asks when she can start eating. What would be an appropriate response by the nurse? 12.C.J.’s insulin is at 195 and her insulin drip is discontinued and is moved to the floor where she receives dinner. Her insulin orders are the following: Check BGS before meals. For glucose greater than 150- for every 20 above 150, give 1 unit of Humalog. For every 8 gms of carbs she eats, give 1 unit of Humalog. Before dinner C.J.’s BGS is 345. She eats 23 gms of carbs. Calculate how much insulin you will give her. What other type of insulin do you think will be ordered for C.J? When will this be given? Before C.J. goes home, the diabetic nurse educator is scheduled to meet with her. List 7-10 things that would be important for the nurse educator to teach C.J. and her mom.

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