INTRODUCTION

Juanabeth a 65-year-old retired teacher of Tuguegarao City was rushed to the hospital because
of complain of stomach upset. Upon interview she mentioned to have passage of soft stool for
3x with slight bloody appearance. She mentioned also about feeling nauseated. Her daughter
who accompanied her to the hospital mentioned that prior to bringing Juanabeth to the ER she
experienced fainting and cold to touch. The daughter also mentioned that her mother was on
maintenance medicine for almost 5 years now. She had tremors, sweating and very weak. Initial
vital signs were taken by the ER nurse with BP 90/50, HR 116, RR 30, and temp 35.8. Laboratory
Exam were done. And the doctor on duty made her orders. As the nurse caring for Juanabeth,
what do you think is happening to her? How will you manage her condition?
CHART DATA
Name: Juanabeth
Age: 65
Address: Tuguegarao City
Civil Status: Single
Religion: Born Again Christian
Occupation: Retired Teacher
Weight: 80 kgs
Height: 5’2”

Doctor’s Order

 Hook to O2 therapy at 2-3 LMP via nasal cannula

Start IV therapy with D5W 500ccx 24 hours
HGT now-result 50mg/dl
D5050 1 vial 30 minutes until stable.
 Vital Signs
 Juanabeth was able to have a good conversation with the physician and nurses:
 HISTORY
-Juanabeth was diagnosed to have DM type 2 when she was 50 years old. She was given
Diamicron 60 mg/tab OD.
-A known hypertensive with a maintenance dose of Pritor plus 40 mg OD and Lacipil 2 mg OD
-She has undergone a coronary angioplasty at St. Luke’s Medical Center last April 2018
-2 days prior admission, she complained of headache and difficulty falling asleep.
 EMERGENCY ROOM:
-Hooked to O2 at 2-3 LMP via NC
-Given D5050 x 2 cycles.
 The doctor ordered for insulin coverage. Give Lantus 10 “u” in the morning, and in the evening
Actrapid 6 “u” in the evening if HGT is continuously abnormally high. Do not give if HGT is less
than 120mg/dl
 BLOOD GLUCOSE MONITORING:
- DAY 1: 6 AM+ 195 mg/dl; 11AM=167mg/dl;6PM+204mg/dl
- DAY 2: 6 AM+ 1146 mg/dl; 11AM=154mg/dl;6PM=161mg/dl
- DAY 3: 6 AM+ 171mg/dl; 11AM=198mg/dl; 6PM=189mg/dl

CUES

- 65 YRS. OLD
- COMPLAIN STOMACH UPSET
- SOFT STOOL FOR 3X WITH SLIGHT BLOODY APPEARANCE
- FEELING NAUSEATED
- FAINTING AND COLD TO TOUCH
- MAINTENANCE MEDICINE FOR ALMOST 5 YEARS
- TREMORS, SWEATING AND VERY WEAK
- BP=90/50, HR=116, RR=30, TEMP.=35.8-degree Celsius
- LAB EXAM
-Ultrasound abdomen- Normal
-FECALYSIS
Consistency: soft
Color: brown
Epithelial cells: 2
Pus cells: 2
Ova/parasite: None
pH:7.2
RBC:2