Problem: The Patient with Diabetes Mellitus The patient is a 48-year-old unconscious woman admitted to the ED. She has a known history of type 1 diabetes mellitus. Her daughter accompanies her and tells the staff that her mother has had the "flu" and has been unable to eat or drink very much. The daughter is uncertain whether her mother has taken her insulin in the past 24 hours. The patient's vital signs are temperature 101.8 F (38.7o C); pulse 120, weak and irregular; respiration 22, deep, and fruity odor; and blood pressure 80/42 mm Hg. Blood specimens and arterial blood gases are drawn and an IV infusion begun.
1. Based on this patient's history, give the probable changes in laboratory results for serum glucose, serum osmolarity, serum acetone, BUN, arterial pH, and arterial PCO2. What medical emergency do these data indicate?
2. What type of IV solutions should the nurse be prepared to administer to this patient? What drugs should the nurse be prepared to give? Explain your answers.
3. The patient is placed on continuous cardiac monitoring. What is the rationale for this intervention?
4. During the first 24 hours, what complications should the nurse monitor for in this patient? Why?