UNFOLDING Reasoning Simulation
Diabetic Ketoacidosis (DKA)
Introduction
In this unfolding case study that simulates the complexities of clinical practice, you will assume the role of a
nurse in the emergency department. You will use a holistic approach to provide safe care by making correct
clinical judgments for a patient with diabetic ketoacidosis. You will need to apply essential knowledge to notice
and interpret the most important assessment findings and lab values to properly establish care priorities and
recognize a developing complication before it needlessly progresses.
Preparation for Care Activity
Recognizing Clinical Relationships
Review the medical history and home medications of this patient. For each home medication, identify the
pharm. classification and expected outcome for this patient is its most common side effect (SE). Finally, draw a
line to determine which medication treats what condition.
Medical History
 Chronic Kidney
disease stage III
(diabetic
nephropathy)
 Iron deficiency anemia
 Diabetes mellitus type
1 since age 12
Home Medications
1. Aspirin 81mg PO
daily
2. Lisinopril 10 mg
PO daily
Pharm.
Classification
NSAID
prevent blood clots
and stroke, reduce BP
nausea, dyspepsia
reduced blood
pressure
headache, dizziness,
dry cough
3. Labetalol 200 mg
PO bid
Beta Blocker
decreased
peripheral vascular
resistance, reduced
blood pressure
orthostatic
hypotension, fatigue,
weakness
4. Simvastatin 40 mg
PO HS
HMG-CoA
reductase inhibitor
decreased LDL and
triglycerides, slight
increase in HDL
headache, abdominal
pain/cramps,
constipation
5. Glargine insulin 50
units SQ at HS
Long Acting Insulin
Blood glucose levels
will be within normal
range
Rapid Acting
Insulin
Blood glucose levels
will be within normal
range
 Hypertension
 Coronary artery disease
Common SE
ACE Inhibitors
 Diabetic retinopathy
 Hyperlipidemia
Expected Outcome
6. Lispro insulin SQ
sliding scale AC
and HS
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