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The client is a 23-year-old African American male with type-1 diabetes who has not been taking his insulin as prescribed or adhering to a diabetic diet. The client presented to the emergency department with complaints of lethargy, abdominal pain, nausea, and malaise.
Vital signs:
· Temperature: 98.6 F
· Pulse: 110 beats/minute
· Respirations: 32 breaths/minute
· Blood pressure: 90/60 mm Hg
· Oxygen saturation: 96% on room air
Laboratory results:
· Serum glucose: 400 mg/dL (on arrival at the emergency department)
· Serum sodium (Na+): 125 mEq/L
· Serum potassium (K+): 6.5 mEq/L
· Serum chloride (Cl): 120 mEq/L
· Blood urea nitrogen (BUN): 39 mg/dl
· Serum creatinine (Cr): 1.7 mg/dl
· Urinalysis – positive for ketones
Arterial blood gas (ABG) results:
· pH: 7.30
· PaCO2: 33 mm Hg
· PaO2: 95 mm Hg
· HCO3: 19 mEq/L
The client is admitted to the intensive care unit, and you are the nurse assigned to the client. Reply to the following questions:
1. Based on an interpretation of the ABG results, what acid-base imbalance is occurring?
2. What nursing assessment findings are expected?
3. Describe strategies for safe, effective multidimensional nursing care of the client. Include rationale to support the strategies identified.