Daniel Hughes Mr. Daniel Hughes is a 28-year-old man admitted to the High Dependency unit (HDU) of a large metropolitan hospital.

Mr. Daniel Hughes is a 28-year-old man admitted to the High Dependency unit (HDU) of a large metropolitan hospital. Daniel was brought in via the Emergency Department early this morning by his mother and girlfriend, following a 2-day history of generally feeling unwell, vomiting, polydipsia and malaise. He is also recovering from a very mild cold. You are the nurse caring for Daniel in HDU 24 hours post his hospital admission.  

History: T1DM for 10 years, and ICU admission for DKA 5 years ago otherwise well, uneventful appendicectomy 5 years ago. Non-smoker, social drinker, NKDA. Lives with girlfriend, works full time.

Medications: Humalog 8 -16 u/s PC, Lantis 28u/s nocte

On admission in HDU:

·      Vital signs: SpO2 98% on RA, HR 125bpm, RR 35 (Kussmaul type with acetone smell), Temp 37.3° Celsius, BP 100/60; GCS 14/15 PEARL, pain 3/10 central abdomen.

·      Physical assessment: restless, c/o thirst and nausea with intermittent vomiting. Abdo is lax, chest is clear, skin in dry.

·      Urine output 0.25ml/hr

Investigations:

·      BGL 26.1 mmol/l

·      Ketones high on finger prick

·      Urinalysis: Ketones +++, Glucose ++, Micro haematuria.

·      FBE: mildly elevated WCC and haematocrit, otherwise NAD

·      Urea & Electrolytes: Sodium 150mmol/l, Potassium 3.3mmol/l, Calcium normal range, Magnesium & Phosphorus mildly low.

·      C-Reactive Protein: Mildly elevated

·      Blood Cultures: Nil growth after 1 day

·      Troponin: Within normal limits

·      Chest XRAY: Clear

·      Arterial Blood Gas (ABG): pH 7.15, PaO2 105, PaCO2 35, HCO3 14

Interventions:

·      18g cannula in Left Cubital fossa, with 4hourly Dextrose (5%) alternating with Hartmanns Solution 1L bag insitu (with supplemental KCL in bags)

·      20g Cannula Right Cubital fossa with Insulin infusion commenced 50u/s Actrapid in 50mls of NSaline (1u/ml) at 4mls/hr

Normal ABG ranges: pH 7.35-7.45, PaO2 85-90, PaCO2 35-45, HCO3 22-26

Above is my case study information, could you please help me to identify and prioritise at least three (3) nursing problems/issues based on these information, and establish goals for priority of nursing care related to the nursing problem/issues identified.

Thanks!