A young adult client with a history of type 1 diabetes mellitus is admitted to the critica… — NCLEX-RN

A young adult client with a history of type 1 diabetes mellitus is admitted to the critical care unit with severe lethargy, a fruity breath odor, and deep, rapid respirations at $32\text{/min}$ . Current vital signs reveal a heart rate of $128\text{/min}$ and a blood pressure of $88/54\text{ mm Hg}$ . Laboratory data show a blood glucose level of $580\text{ mg/dL}$ and a serum potassium of $5.2\text{ mEq/L}$ . An arterial blood gas (ABG) analysis indicates a $\text{pH}$ of $7.15$ , $\text{PaCO}_2$ of $26\text{ mm Hg}$ , $\text{PaO}_2$ of $96\text{ mm Hg}$ , and $\text{HCO}_3^-$ of $9\text{ mEq/L}$ . What is the nurse's priority intervention?

Rapidly infuse a large volume of an isotonic saline solution.Answer
B
Begin a continuous intravenous drip of short-acting insulin.
C
Apply a non-rebreather mask to manage the tachypnea and hyperventilation.
D
Prepare to administer an intravenous alkaline solution to reverse the acidemia.

Answer

The correct answer is to rapidly infuse a large volume of an isotonic saline solution to treat the underlying hypovolemic shock.

The client is exhibiting signs of severe hypovolemic shock (hypotension, tachycardia) caused by the massive osmotic diuresis associated with DKA. The absolute highest priority in this scenario is to stabilize the cardiovascular system and restore organ perfusion by rapidly administering isotonic intravenous fluids. Once intravascular volume is stabilized, insulin therapy can be safely initiated.

Step-by-Step Solution

Analyze the clinical presentation and diagnostic data.

The client has extreme hyperglycemia, acidemia, Kussmaul respirations, tachycardia, and hypotension.

Identifying these classic signs confirms a diagnosis of severe Diabetic Ketoacidosis (DKA) complicated by hypovolemic shock.

Interpret the arterial blood gas (ABG) results.

The ABG reveals a primary metabolic acidosis (low bicarbonate and pH) with partial respiratory compensation (low carbon dioxide) and adequate oxygenation.

Understanding the acid-base balance confirms that the hyperventilation is a necessary compensatory mechanism, not a respiratory deficit.

Evaluate the hemodynamic status to determine immediate life threats.

The blood pressure of

88/54\text{ mm Hg}

and heart rate of

128\text{/min}

indicate severe volume depletion resulting from glucose-induced osmotic diuresis.

Recognizing signs of shock dictates that restoring circulatory volume takes precedence over all other therapies.

Prioritize nursing interventions based on physiological needs.

Aggressive fluid resuscitation with isotonic crystalloids is identified as the first action.

Intravascular volume must be restored before administering insulin to prevent fatal cardiovascular collapse and severe intracellular shifts of fluid and electrolytes.

Key Concept

In the management of Diabetic Ketoacidosis (DKA) with hypovolemia, immediate aggressive fluid resuscitation is required prior to continuous insulin therapy to prevent cardiovascular collapse.

Estimated Time:1m 30s

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