‫المملكة العربية السعودية‬

KINGDOM OF SAUDI ARABIA

‫وزارة التعليم العالي‬
Ministry of Higher Education
‫جامـعـة حـائل‬
University of Hail
‫كلية التمريض‬
College of Nursing

Case Study A
Susan Khaled is a 25 years old (Saudi, student and single ) who was known to have
type 1 diabetes 5 years ago, she was admitted to the acute medical ward
accompanied by her Mother, following a home visit as she was feeling very unwell on
Monday 17/2/2021 with file number 54764. She had completed immunization with no
history of childhood and mental diseases. In addition, she admits that she has bad
habits diet. In addition, she was admitted to the Hospital one year ago for
appendectomy. Susan gave a history of four episodes of vomiting accompanied by
abdominal pain over the past 24 hours. She was not tolerating food or fluid at present
although she complained of thirst. Capillary blood glucose level 30.7 mmol/L. ABG
reveals evidence of acidosis .Susan was prescribed 50 units of soluble insulin
(Actrapid) made up to 50 mL to be administered as a continuous fixed rate IV
infusion via an infusion pump(Prescribed rate 0.1 unit/kg/hr = 6 mL/hr) .Also Susan
was commenced on the following fluid replacement :

1 liter 0.9% sodium chloride over 1 hour

Physical examination

Review of body system revealed the following:

 Respiratory rate: 26 breaths/minute (rapid and shallow)

 Blood pressure: 100/65 mmHg
 Pulse: 105 beats per minute (regular)
 Temperature 36.5oC
 Oxygen saturations: 96% on room air
 She was orientated and able to respond to questions although she was
quite lethargic.
 She was well developed and nourished.
 On examination, dry mucous membranes were apparent
 Chest X-ray revealed no obvious abnormalities.
 Abdominal examination revealed diffuse abdominal pain – pain score
6/10 constant, non-radiating, with no aggravating or relieving factors.
 Susan’s height is 157 cm and weighs 60 kg.

Furthermore, doctor requested CBC for the patient and the result shows at the below
table:

Urinalysis was positive for ketones +++, glucose ++++ with evidence of possible
Infection.
Test name Result

WBCs 8.40

RBCs 3.81

HGB 11.1

HCT 33.3

MCV 87.3

MCH 29.2

MCHC 33.4

RDW 13

PLT 354

• NOTE: WRITE NA IF DATA NOT AVAILABLE.