Scarlet Jones is a 15-year-old Caucasian female (90 kg) with poorly managed type 1 diabetes, who presented to the emergency department this morning with complaints of polyuria, polydipsia, nausea, and an elevated blood glucose level. Over the weekend, Scarlet snuck out of her bedroom window and caught her right hand on a piece of aluminum. She now has an infected 1.5 cm laceration on the dorsal aspect of her right hand. The triage nurse places Scarlet into an ER room and obtains vital signs: 3. What is your initial interpretation of Scarlet’s assessment? Does anything concern you? 4. What action will you expect the physician to take next, and why? You review the orders from the ER attending and proceed to complete them. First, you start an IV and draw blood for CBC with differential, comprehensive metabolic panel, calcium, magnesium, phosphorus, and beta hydroxybutyrate and send it for analysis. A blood culture, urine pregnancy test, and urinalysis are obtained and sent. One hour later the follow STAT lab results are available: Pediatric Diabetes Learning Activity 5. What is the significance of each of the lab results? Answer in full sentences with enough detail to clearly demonstrate understanding of each lab test. Be sure to relate your answers to diabetes; specifically, hyperglycemia vs. diabetic ketoacidosis (DKA). 6. What orders do you anticipate next? The pediatric nurse practitioner comes to assess Scarlet and states she will place several orders for Scarlet. You go to lunch and when you return you note the following orders have been entered: – 900 mL IV Bolus of 0.9NS to be given over one hour x1 – Clindamycin 900mg IVPB, to be infusion over 30 minutes, every 8 hours for 7 days – Ondansetron 6mg IV Push, every 8 hours prn nausea – Acetaminophen tabs 650mg po, every 4-6 hours prn for temperature elevation greater than 38.5C – Ibuprofen 600mg every 6 hours as needed for pain – Morphine 2mg every 2 hours as need for severe pain – Regular insulin 0.1 units/ kg/hr IV infusion – 0.9NS IV infusion, 130 mL/hr 7. Explain the rationale for each order. 8. Is the ordered amount of each medication safe for Scarlet? Explain how you determined this. 9. Did you anticipate any additional orders for Scarlet? 10. Discuss the order in which you will implement the medications/fluids and include the rationale.
