1.

Terry has a Type 1 Diabetes mellitus, which is an autoimmune disease of the pancreas in
which the insulin-producing β-cells of the pancreas are selectively destroyed, resulting in an
absolute insulin deficiency. There is currently no cure and type 1 diabetics have an absolute life-
long requirement for daily insulin injections to survive but due to Terry’s decision of not taking
the insulin dose, she developed an acute complication of diabetes which is Diabetic
Ketoacidosis. It evolves over a period of less than 24 hours and results directly from insulin
deficiency. Extremely elevated blood glucose levels or hyperglycemia can lead to signs and
symptoms of Diabetic Ketoacidosis such as osmotic diuresis and tachycardia, while volume
depletion can result in hypotension.
2. Normal Saline solution is recommended for Terry’s dehydration. The initial priority in
the treatment of diabetic ketoacidosis is the restoration of extra-cellular fluid volume through
the intravenous administration of a normal saline (0.9 percent sodium chloride) solution. Normal
Saline solution helps by restoring water levels in the body and in the treatment of symptoms
such as lightheadedness and other dehydration related symptoms. Saline solution is
specially formulated to match the electrolytes present in blood plasma, therefore, causing
less of an osmotic effect compared to other intravenous fluids. It also contains sodium and
chloride ions as electrolytes which are important because they help balance the amount of water
in the body and balance the body's acid or base (pH) level. It is important to provide normal saline
solution for the patient and through the intravenous route for faster rehydration because during
periods of dehydration, blood sugar tend to rise. High blood sugar may lead to insulin
resistance and further blood sugar elevation happens. Normal saline solution is also good for
Terry’s low blood pressure because it can replace blood volume, which then improves the
patient’s blood pressure.

3. The Renin-Angiotensin-Aldosterone System (RAAS) is a hormone system

within the body that is essential for the regulation of blood pressure and fluid
balance.  It is composed of three major compounds: renin, angiotensin II, and aldosterone. These
three act to elevate arterial pressure in response to decreased renal blood pressure, decreased salt
delivery to the distal convoluted tubule, and/or beta-agonism. It is activated because through these
mechanisms, the body can elevate the blood pressure in a prolonged manner. Renin's primary
function is to eventually cause an increase in blood pressure, leading to restoration of perfusion
pressure in the kidneys. Meaning when low blood pressure occurs in the patient’s body, it
stimulate the sympathetic nervous system to increase renin production, which results in increased
conversion of angiotensinogen to angiotensin I, and so the cycle continues.

4. Terry’s abnormal breathing pattern is caused by diabetic ketoacidosis, a serious

complication of her type 1 diabetes. Tachypnea can be caused by an excess of acid in the
body or a decrease in a base in the body such as disruption in the acid-base balance of the
body. When the body senses that the blood is too acidic (metabolic acidosis), it blows off
carbon dioxide out of the lung in an attempt to rid the body of acid. In an attempt to expel carbon
dioxide, which is an acidic compound in blood, the body starts to breathe faster and shallow and
that explains why Terry have experienced tachypnea.

5. (insert notebook) Based on the table of acid base disturbances, the given result is concluded to be
UNCOMPENSATED METABOLIC ACIDOSIS.
6. If the body produces little or no insulin like Terry who has type 1 diabetes  she may
have rapid, deep breathing, fast heart rate and a weak pulse. It is becoming increasingly
apparent that diabetes impacts the electrical conduction system in the heart, resulting in atrial
fibrillation, and ventricular arrhythmias. Cardiac dysrhythmia may occur secondary to severe
hypokalemia and/or acidosis either initially or as a result of therapy in patients with DKA.

7. One of the most severe complications of diabetes, diabetic ketoacidosis (DKA), results

from insulin deficiency and is a medical emergency that is frequently encountered in
the emergency department. Serum potassium should be closely monitored during DKA treatment.
Insulin administration and correction of acidemia and hyperosmolality drive potassium intracellularly,
resulting in hypokalemia that may lead to arrhythmias and cardiac arrest. Patient’s vital signs should
also be monitored closely and frequently. Blood glucose should be evaluated every one to two
hours until the patient is stable, and the blood urea nitrogen, serum creatinine,
sodium, potassium, and bicarbonate levels should be monitored every two to six hours
depending on the severity of DKA.

8. To avoid complications related to rapid infusion it is important to monitor fluid balance and

electrolytes closely. Regular assessment for complications such as cerebral edema
and fluid overload is vital. Replacing of fluid loss, decreasing serum blood glucose, 
reversing acidosis and ketosis, correcting electrolyte imbalances and identifying
underlying causes are the main priorities of care. Fluid replacement alone reduces
hyperglycaemia and acidosis and increases tissue perfusion whilst being necessary to
correct the electrolyte imbalance that has occurred.

Studies have demonstrated that a high volume of fluid replacement in a short time
initially will have a positive effect on treatment outcomes, though care must be taken
to ensure adequate assessment of the patient for such treatment. 13 It is vital that an
accurate fluid balance chart is maintained at all times during care of the patient with
DKA.

Ncp

https://www.scribd.com/doc/36049963/NCP-for-Diabetes
https://nurseslabs.com/diabetes-mellitus-nursing-care-plans/
https://www.nursebuff.com/nursing-care-plan-for-diabetes/