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DIABETIC KETOACIDOSIS. 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
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DIABETIC KETOACIDOSIS 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 humolog22 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
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
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.
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 .