NRSG370 - Mr. Brad Taylor Case Study - Nursing Assessment

NRSG370: Mr. Brad Taylor Case Study,  Nursing Assessment Answer

Assessment Task:

NRSG370 Assessment Task 3: Case Study – High Dependency
Mr. Brad Taylor
Mr. Brad Taylor is a 28-year-old man admitted to the High Dependency Unit (HDU) of a large metropolitan hospital. Brad was brought in via the Emergency Department by his mother and girlfriend, following a 2-day history of generally feeling unwell, vomiting, polydipsia, and malaise. He is also recovering from a very mild cold. You are the nurse caring for Brad in HDU 24 hours post his hospital admission.

History: T1DM for 10 years, and ICU admission for DKA 5 years ago otherwise well, uneventful appendicectomy 5 years ago. Non-smoker, social drinker, NKDA. Lives with girlfriend, works full time.
Medications: Humalog 8 -16 u/s PC, Lantis 28u/s nocte
On admission in HDU:

•  Vital signs: SpO2 98% on RA, HR 125bpm, RR 35 (Kussmaul type with acetone smell), Temp 37.3° Celsius, BP 100/60; GCS 14/15 PEARL, pain 3/10 central abdomen.
•  Physical assessment: restless, c/o thirst and nausea with intermittent vomiting. Abdo is lax, chest is clear, skin is dry.
•  Urine output 25ml/hr

Investigations:

•  BGL 26.1 mmol/l
•  Ketones high on finger prick
•  Urinalysis: Ketones +++, Glucose ++, Micro haematuria.
•  FBE: mildly elevated WCC and haematocrit, otherwise NAD

 Urea & Electrolytes: Sodium 150mmol/l, Potassium 3.3mmol/l, Calcium normal range, Magnesium & Phosphorus mildly low.n   C-Reactive Protein: Mildly elevated
 Blood Cultures: Nil growth after 1 day  Troponin: Within normal limits  Chest XRAY: Clear  Arterial Blood Gas (ABG): pH 7.15, PaO2 105, PaCO2 35, HCO3 14

Interventions:

 18g cannula in Left Cubital fossa, with 4hourly Dextrose (5%) alternating with Hartmanns Solution 1L bag insitu (with supplemental KCL in bags)
 20g Cannula Right Cubital fossa with Insulin infusion commenced 50u/s Actrapid in
50mls of NSaline (1u/ml) at 4mls/hr
Normal ABG ranges: pH 7.35-7.45, PaO2 85-90, PaCO2 35-45, HCO3 22-26