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Disease Process Precipitating Factors Nursing Diagnosis

Signs & Symptoms  Nursing Interventions  Medical Diagnosis

Predisposing Factors Medical Management  Diagnostic tests results

Precipitating Factors 

Predisposing Factors

Stopped taking insulin

Type 1 Diabetes Miletus

Symptoms of anorexia
Race: Caucasian
Vomiting for the past 72
Age: 47
hours

Temp:  38.3 

Tylenol 975mg po q4h prn

Vomiting; nausea

Inadequate insulin Missed insulin dose  Infection/stress Morphine 5mg IV q4h prn
Abdominal pain 

(for acute pain)

Decreased appetite 

Glucose remains in
blood, NOT utilized by Excess secretion of
glycogen and WBC: 14x10^9/L
muscle, fat cells 
counterregulatory
hormones

Body tries to ↑ blood

Blood glucose level : 28 Increased lipolysis of
glucose to ↑ cell glucose Hyperglycemia 
mmol/L adipose tissue 
absorption

Triggers feelings of
hunger
Ketogenesis
Glycogenesis  &
gluconeogensis by the
Polyphagia liver 
↑ ketone bodies Ketouria

Urine glucose: +4 

Glucose filtration is greater
Glucosuria
Urine ketone: + than reabsorption Metabolic acidosis

Ineffective Breathing Pattern r/t

Kussmaul
Orthostatic hypotension Blowing off CO2 to offset deep, fast breathing as a
Polyuria Promotes osmotic diuresis respiration (RR:
(100/60 mmHg) acidosis compensatory mechanism of
26) 
Tachycardia (120BPM) metabolic acidosis
Slightly decreased LOC
Lethargy; weakness Fruity-smelling
Diaphoresis Breathing off ketones
Severe Dehydration breath
 Poor skin turgor
Sunken eyes 
Dimenhydrinate 25-50mg
Polydipsia (excessive Fluid volume deficit r/t  ↓ ECF volume concentrates Abdominal pain,
Disrupts enteric nervous po/IM/IV q4-6 prn
thirst) increased urination and ketone bodies, exacerbates nausea and
system Prochlorperazine 5-10mg
Decreased urine output vomiting acidosis  vomiting
  IV q8h prn

Imbalanced nutrition: Less than

body requirements r/t body’s
Diabetic Ketoacidosis (DKA)
inability to use glucose AEB
nausea and vomiting

Check vital signs q4h 

Administer fluid as indicated: Isotonic solution (0.9% Check blood glucose q4h, call physician if blood sugar is > 7
NaCl). mmol/L 

Administer succeeding IV therapy: Hypotonic solution Check renal function/urine output

such as 0.45% normal saline. Listen to lungs for rales and crackles

Add dextrose to IV fluid when serum blood glucose level Assess mental status

is less than 250 mg/dL in DKA Look for signs of infection  

Administer IV potassium and other electrolytes as Administer fluids as ordered 

indicated. Repeat electrolytes, phosphate q4h

Administer bicarbonate as indicated. (If pH <7.0, give 1 Urinalysis q24h; check urine culture 

amp sodium bicarbonate IV push then call MD) Ask the patient to wear an ID bracelet signifying that he has
DKA episode 

Administer an IV bolus dose of regular insulin, followed

Encourage a healthy diet when NPO order is withdrawn and as
by a continuous infusion of regular insulin. tolerated 

Administer antibiotics as indicated. Educate on the importance of compliance with diabetic

medications 

Educate on the importance of follow-up