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PRESENTED BY: SIMI M PAUL PEDIA WARD DEMOGRAFIC DATA Name : case no: 4 MR no : 157203 Diagnosis : DKA (Diabetic ketoacidosis) Age : 13 years Gender : Female Date of admission: 09/10/2012 Date of discharge: 11/10/2012 Physical Assessment General Assessment a) Chief complaint: Vomiting, Drowsiness, Polyuria, Lethargic b) Skin : Dehydrated , look lethargic c) Head and neck : No deformities found d) Thorax: Normally symmetrical in size e) Cardiovascular : No Deformities found f) Genitourinary: Polyuria, g) Gastrointestinal: vomiting, nausea ,abdominal pain h) Musculoskeletal: No deformities found i) Neurologically: No deformities found PATIENT HISTORY PASTMEDICAL HISTORY Known case of DKA since 3 yrs.She is on insulin treatment (insulin humolog 22 unit TID ) PRESENT MEDICAL HISTORY Now the patient is admitted with the complaint of polyuria, polydipsia, vomiting and drowsiness TOPIC PRESENTATION DEFINITION It is a disorder of glucose intolerance caused by deficiency in insulin production and action resulting in hyperglycemia and abnormal carbohydrate , protein and fat metabolism . ANATOMY AND PHYSIOLOGY PANCREAS The pancreas is a pale gray gland weighing about 60 grams. It is about 12 to 15 cm long and is situated in the epigastric and left hypochondriac region of the abdominal cavity .it consist of a broad head and a body and a narrow tail. The head lies in the curve of the duodenum. The body behind the stomach and the tail lies in front of the left kidney and just reaches the spleen. The pancreas both exocrine and endocrine gland EXOCRINE GLAND It consists of large number of lobules made up of small alveoli the walls of which consist of secretary cells .each lobules is drained by a tiny duct and these unite eventually to form the pancreatic duct , which extends the whole length of the gland opens in to the duodenum . FUNCTION The function of exocrine pancreas is to produce pancreatic juice containing enzymes that digest carbohydrates, proteins and fats ENDOCRINE PANCREAS Distributed throughout the gland are groups of specialized cells called the pancreatic islets .The islets have no ducts so the hormones diffuse directly in to the blood. The function of the endocrine pancreas is to secrete the hormones insulin and glucagon , which are principally concerned with control of blood glucose levels. ETIOLOGY Hereditary Genetics Obesity PATHOPHYSIOLOGY Insulin deficiency Free fatty acids Ketone bodies in the liver Causes metabolic acidosis Increased secretion of glucagon, catecholamine's, Serum cortisol. Hyperglycemia DKA SIGNS AND SYMPTOMS BOOK BASED Polyuria PATIEND MANIFESTED Polyuria Polydipsia Polydipsia Fatigue, malaise and drowsiness drowsiness Anorexia, nausea , vomiting vomiting Abdominal pain abdominal pain INTERVENTION Restoring fluid and electrolyte balance. Promoting rest and conserving energy Promoting frequent monitoring of blood glucose level Promoting family knowledge Monitoring and preventing complication TREATMENT BOOK BASED PATIONT TREATMENT INSULIN THERAPY INSULIN THERAPY Eg: Human insilin R Human misted Eg: Injection human insulin R IV infusion SUPPORTIVE MEASENCE : IV therapy, electrolyte replacement COMPLICATION Cerebral edema Extended Hyperglycemia Microvascular complication. Retinopathy Nephropathy PRIORITIZATION OF NURSING PROBLEMS Altered fluid volume deficit related to severe dehydration Activity intolerance related to poor glucose control. Altered electrolyte imbalance related to vomiting Risk for impaired skin integrity related to decreased sensation and circulation to lower extremities Ineffective coping related to chronic disease and complex self-care regimen. ASSESSMENT NURSING DIAGNOSIS PLANNING IMPLEMENTTATION RATIONALE EVALUATION Subjective : Patient mother complaints of increase number of vomiting Objective : Vomiting more than 5 times per day a) Dry skin b) Cracked lips Altered fluid volume deficit related to active fluid loss. With in 12 hrs of nursing intervention patient will. •Hydrated • No vomiting a) Encourage oral intake of fluid. b) Administer IV fluid( 5 % Dextrose in 1/2 ns + 5ml KCL at 85ml /hour) c) provide calm and quiet environment. d) monitor intake and output chart e) provide DM diet . a ) Helps to promote hydration b) Helps to provide fluid , calories and electrolytes. C) To maintain electrolyte imbalance d) will determine if out put exceeds input E) Helps to decreed blood glucose level After 12 hrs of nursing interventio n the goal was partially met ASSESSMENT NURSING DIAGNOSIS PLANNING IMPLEMENTTATION RATIONALE EVALUATION a) To determin e the correct amount of insulin injection b) Helps to decrease blood glucose level c) Provide relaxatio n After 24 hrs patient blood glucose level decreased. Subjective : Mother complaints patients experience fatigue and drowsiness Objective : Increase blood glucose level Activity intolerance related to poor glucose control Within 24 hrs Patient blood glucose level gradually decrease and back to normal range a) Monitor blood glucose level every 1 hourly b) Administer proper medication's c) Provide calm and quiet environment d) Monitor urine ketone NURING HEALTH TEACHING Encourage the mother to monitor blood sugar properly Demonstrate and teach the mother how to give insulin properly Educate the mother regarding proper preparation of diabetic diet Teach about the signs and symptoms of DKA CONCLUSION Patient relieved from signs and symptoms of DKA and maintains blood glucose level in normal range Discharge medications :- Insulin Humalog 22 units 3 times daily BIBLIOGRAPHY Lippincott manual of Nursing practice 9th edition . Ross and Wilson , anatomy and physiology in health and illness 9th edition . THANK YOU!!!!!!!