Betty Cooper, 25-y/o-female, is admitted to the emergency department with decreasing

level of
consciousness. She is 98lbs and stands at 5ft. She has a history of diabetes mellitus since she
was
9 years of age. A physical assessment and laboratory data reveal the following:
➢ Dry skin, poor turgor > Serum glucose = 504mg/dl
➢ RR = 40cpm, rapid and deep & labored > Serum Na = 130 mEq/L
➢ HR = 118bpm, weak pulse > Serum K = 5 mEq/L
➢ Temp = 98°F > Serum Cl = 108 mEq/L
➢ BP = 110/70 mmHg > BUN = 74.68 mg/dL
➢ ABG: pH = 7.15; HCO3; 13mEq/L; pCO2 = 35 mEq/L

1. Calculate Betty’s serum osmolality.

FORMULA: Serum osmolality = (2Na) + (serum glucose / 18) + (BUN / 2.8)

= (2)(130 mEq/L) + (504mg/dl / 18) + (74.68 mg/dL / 2.8)

= 260 mEq/L + 28 mg/dl + 26.67 mg/dL

= 314.67 mOsm/ kg

2. What type of diabetes mellitus does Betty possibly have? Why?

There's a chance Betty has Type 1 Diabetes. Compared to type 2 diabetes, type 1 diabetes is
substantially more prevalent in children and young people. Juvenile diabetes, also known as type
1 diabetes in children, develops when the pancreas is unable to generate insulin. High blood
sugar levels can arise if there is insufficient insulin to allow sugar to go from the blood into the
cells. Type 1 diabetes can strike anyone at any age, from infancy to old life. In contrast, Type 2
is more prevalent in adults.

Betty Cooper's serum glucose was 504 mg/dl when she arrived at the emergency hospital;
normal blood sugar levels are less than 100 mg/dL after fasting for at least eight hours. Two
hours after eating, they are less than 140 mg/dL. Due to her normal weight, Betty is also less
likely to get type 1 diabetes than she is type 2, where being overweight or obese is a major risk
factor.

3. Which complication of diabetes mellitus does Xia possibly have, diabetic

ketoacidosis or
hyperglycemic hyperosmolar state? Why?

It's possible that Betty Copper has diabetic ketoacidosis (DKA). DKA is more likely to occur in
those with Type 1 DM. Based on the existence of ketoacidosis and the level of hyperglycemia,
DKA and HHS differ clinically from one another. According to the test findings, DKA is the
condition she is most likely to have. Results like: can demonstrate this.

By way of comparison, Betty Cooper has a potentially fatal condition known as diabetic
ketoacidosis, which affects patients with diabetes. It happens when the body begins to break
down fat at an excessively rapid rate. The fat is converted by the liver into a fuel called ketones,
which makes the blood acidic.

4. What is the 1st priority nursing management and medical management? Why?

Airway, breathing, and circulation are the top nursing priorities in an emergency. Patients with
DKA require rapid evaluation of their airway, breathing, and circulation. A diminished degree of
awareness might result in a compromised airway and breathing problems. Significant fluid loss
from the osmotic diuresis might result in severe dehydration and circulatory collapse.
Additionally, serious electrolyte imbalances greatly raise the danger of cardiac arrhythmias,
which can be fatal. Betty Cooper's admission to the emergency room while experiencing a loss of
consciousness demonstrates why airway, breathing, and circulation should be the first priority for
nursing management.

In terms of medical care, fluid replenishment and resuscitation should come first before insulin
administration. Fluid resuscitation is necessary because osmotic diuresis results in a significant
fluid loss. It is crucial! In cases of severe DKA, the amount of fluid that needs to be replaced
corresponds frequently to the amount of fluid lost (around six to ten liters). In the first eight
hours, half of the fluid resuscitation volume is immediately replenished; the remaining half is
given during the next sixteen hours.

In addition, fluid resuscitation independently lowers blood glucose levels, increases renal
perfusion (improving glucose excretion via the urine), increases tissue perfusion (facilitating
insulin mobilization), and decreases intravascular osmolality (minimizing fluid transfer from the
interstitial to the intravascular space). Following this, potassium levels must be treated due to the
body's increased ketones levels. Therefore, potassium levels must be carefully checked and  K+
is typically infused intravenously as needed to replace. The replacement of Betty's insulin comes
last. As glucose may be absorbed as an energy source, decreasing hyperglycemia and halting the
pathophysiology of gluconeogenesis, replacing insulin is the cornerstone of treating DKA.