Symptoms of nausea-vomiting-diarrhea and fever

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Reference no: EM133848520

Question

A 21-year old female (A.M) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since she's been ill and unable to keep any food down. She's only tolerated sips of water and juices. Since she's also been unable to eat, she hasn't taken any insulin as directed. While helping A.M. from the lobby to the examining room you note that she's unsteady, note that her skin in warm and flushed and that she's drowsy. You also note that she's breathing rapidly and smell a slight sweet/fruity odor. A.M. has a challenge answering questions but keeps asking for water to drink.

You get more information from A.M. and learn

She had some readings on her glucometer which were reading 'high'
She vomits almost every time she takes in fluid
She hasn't voided for a day but voided a great deal the day before
She's been sleeping long hours and finally woke up this morning and decided to seek care

1. A.M. is likely suffering from:

2. What is the pathophysiology for the condition you believe A.M. has (etiology, pathogenesis, and clinical manifestations)?

3. Relate the etiology and clinical manifestations for the condition you identified for A.M. What caused this condition to occur for this specific patient, and why did it cause the clinical manifestations presented above?

4. The practitioner at the urgent care facility makes the decision that A.M. needs to go to the hospital by ambulance. Once at the Emergency Department (ED), the ED physician orders the following items. Which are questionable related to her condition and which are appropriate? Why?

1000 ml Lactated Ringer's (LR) IV stat

36 units NPH (Humulin N) and 20 units regular (Humulin R) insulin SQ now CBC with differential; CMP: blood cultures X2 sites; clean-catch urine for UA and C&S; stool for ova and parasites; Clostridium difficile toxin, and C&S; serum lactate; ketone; osmolality; ABGs on room air

1800 calorie, carbohydrate controlled diet

Bed rest

Acetaminophen (Tylenol) 650 mg orally Q4 hrs PRN

Furosemide (Lasix) 60 mg IV push now

Urinary output every hour

VS every shift

5. What are the expected treatments for this condition?

Reference no: EM133848520

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