Mrs. S is a 28-year-old patient, with a 12-year history of type I diabetes mellitus. Her husband states that she has had a bad cold for several days. Yesterday she stayed in bed and slept all day. She was too ill to check her blood sugar, and since she was not really eating, she did not take her insulin. This morning, she was not able to stand up and vomited twice. A Gram stain of Mrs. Ss blood contains gram-positive cocci in clusters. Her admission vital signs are: BP = 90/60; HR = 118 bpm (sinus tachycardia); RR = 32/min; T = 102.3 F; O2 sat via pulse oximetry = 96%. Her serum glucose is 398 mg/dl, and she is positive for serum ketones. She is admitted with a diagnosis of DKA. Her baseline ABGs on 2 L of oxygen are: pH = 7.25; PCO2 = 28; HCO3 = 14; PaO2 = 92; O2 sat = 96%. Her respirations are deep, rapid, and labored. She has bronchial breath sounds in the right axillary area. There is bilateral chest expansion and no evidence of cyanosis. A regular insulin bolus is given and a regular insulin drip is initiated. Mrs. Ss IV fluids are infusing at 800 ml/hr. Her vital signs after 2 hours in the unit are: BP = 120/70; HR = 78 bpm (normal sinus rhythm); RR = 22/min; O2 sat = 100%. Her serum glucose is 250 mg/dl and serum potassium is 4.0 mEq/L. She is more alert and is feeling hungry. 1. What is insulins function in the body? What is the most significant basic defect in the development of DKA? 2. What is the cause of Ms. S experiencing DKA? Describe the pathophysiologic rationale for your answer. 3. List the classic signs and symptoms of DKA. Which signs and symptoms did Ms. S experience? What are the pathophysiologic causes of these signs and symptoms? 4. What is an anion gap? Why is the anion gap important to follow in the treatment of DKA? 5. What acid base disturbance is Ms. S experiencing? What compensatory mechanisms are in effect at this time? 6. What is the primary nursing diagnosis for Ms. S.? What are the goals for treatment (both independent and collaborative)? What interventions are imperative to initiate immediately? What interventions are important within the next 12-24 hours? 7. What are potential lab abnormalities for a patient in DKA? 8. What nursing considerations are important in planning Ms. Ss discharge? Grading Rubric for Case Study 4 / Week 7 All questions addressed with complete answers that are organized, clear and concise to include: 1. Described the function of insulin and the defect in the development of DKA. 2. Discussed the cause of Ms. Ss DKA including the pathophysiology. 3. Lists the classic signs and symptoms of DKA. 4. Defined an anion gap and the importance following the treatment of DKA. 5. Described the acid base disturbance is Ms. Ss situation including compensatory mechanisms. 6. Primary nursing diagnosis and goals for treatment. 7. Potential lab abnormalities for a patient in DKA. 8. Nursing considerations in planning Ms. Ss discharge.

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Mrs. S is a 28-year-old patient, with a 12-year history of type I diabetes mellitus. Her husband states that she has had a bad cold for several days. Yesterday she stayed in bed and slept all day. She was too ill to check her blood sugar, and since she was not really eating, she did not take her insulin. This morning, she was not able to stand up and vomited twice. A Gram stain of Mrs. Ss blood contains gram-positive cocci in clusters. Her admission vital signs are: BP = 90/60; HR = 118 bpm (sinus tachycardia); RR = 32/min; T = 102.3 F; O2 sat via pulse oximetry = 96%. Her serum glucose is 398 mg/dl, and she is positive for serum ketones. She is admitted with a diagnosis of DKA. Her baseline ABGs on 2 L of oxygen are: pH = 7.25; PCO2 = 28; HCO3 = 14; PaO2 = 92; O2 sat = 96%. Her respirations are deep, rapid, and labored. She has bronchial breath sounds in the right axillary area. There is bilateral chest expansion and no evidence of cyanosis.
A regular insulin bolus is given and a regular insulin drip is initiated. Mrs. Ss IV fluids are infusing at 800 ml/hr. Her vital signs after 2 hours in the unit are: BP = 120/70; HR = 78 bpm (normal sinus rhythm); RR = 22/min; O2 sat = 100%. Her serum glucose is 250 mg/dl and serum potassium is 4.0 mEq/L. She is more alert and is feeling hungry.
1. What is insulins function in the body? What is the most significant basic defect in the development of DKA?
2. What is the cause of Ms. S experiencing DKA? Describe the pathophysiologic rationale for your answer.
3. List the classic signs and symptoms of DKA. Which signs and symptoms did Ms. S experience? What are the pathophysiologic causes of these signs and symptoms?
4. What is an anion gap? Why is the anion gap important to follow in the treatment of DKA?
5. What acid base disturbance is Ms. S experiencing? What compensatory mechanisms are in effect at this time?
6. What is the primary nursing diagnosis for Ms. S.? What are the goals for treatment (both independent and collaborative)? What interventions are imperative to initiate immediately? What interventions are important within the next 12-24 hours?
7. What are potential lab abnormalities for a patient in DKA?
8. What nursing considerations are important in planning Ms. Ss discharge? Grading Rubric for Case Study 4 / Week 7
All questions addressed with complete answers that are organized, clear and concise to include:
1. Described the function of insulin and the defect in the development of DKA.
2. Discussed the cause of Ms. Ss DKA including the pathophysiology.
3. Lists the classic signs and symptoms of DKA.
4. Defined an anion gap and the importance following the treatment of DKA.
5. Described the acid base disturbance is Ms. Ss situation including compensatory mechanisms.
6. Primary nursing diagnosis and goals for treatment.
7. Potential lab abnormalities for a patient in DKA.
8. Nursing considerations in planning Ms. Ss discharge.

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As societal-norms evolve, a variety of popular entertainment media (books, movies, TV shows, etc.) feature stories of characters who are a part of traditional and non-traditional family or relationship structures. Examples include but are not limited to: traditional families, cohabitation, single-parent households, blended families, same-sex couples, and grandparents as the primary care-givers for their grandchildren.

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In a 3-page paper, written in APA format using proper spelling/grammar, address the following:

  1. Describe a book, movie, or TV show that you are familiar with which features characters in families or personal relationships.
  2. Select at least two families/relationships from your chosen story and explain the relationship characteristics and dynamics between individuals.
  3. Apply terminology presented within the module when analyzing the relationships. Be sure to include APA citations for any resources you used as references.
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In a 3-page paper, written in APA format using proper spelling/grammar, research the topic of eating disorders and address the following:

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  1. Compare and contrast anorexia nervosa and bulimia nervosa.
  2. Who is more likely to suffer from anorexia nervosa and bulimia nervosa? Why?
  3. What are the causes contributing to anorexia nervosa?
  4. What are the consequences of eating disorders?
  5. How can one diagnose eating disorders?
  6. What are the treatment and support options for a person who has eating disorders?

Be sure to include APA citations for any resources you used as references.

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Research the Lean Start Up approach and consider the principles and methodology. Is it an approach you would consider? Why or why not? Be specific and offer explanations for your position along with citations.

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Before posting to the discussion board GO TO THE LEAN STARTUP website & CLICK HERE or VIEW THE ATTACHED FILE to review the information provided in the Website Reviews Folder for Week #8 on the Lean Start Up. Be sure to read about the Lean Start Up concept AND read the reviews, background and critiques of this theory to help you formulate an opinion. Use the sources provided for additional research.

File Link: The Lean Start Up

FOR CREDIT on the ASSIGNMENT ALL STEPS MUST BE FOLLOWED BELOW

DISCUSSION BOARD POSTING INSTRUCTIONS:

1. FIRST POST a complete response to ALL the questions in the discussion board.

2. Read your classmates or team members’ posts.

3. Reply to at least one post from your classmates or team member.

4. Rate your fellow classmates’ or team members’ posts.

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