Jerry Thomas is a 26-year-old Type I Diabetic. He was originally diagnosed at the age of 14, and currently manages his disease with an intensive regimen of insulin injections. Jerry is employed as a schoolteacher and soccer coach. He presents today with a 2-day history of vomiting and diarrhea. He has been closely monitoring his blood glucoses, and is using regular insulin for high blood glucose levels. He has only been able to tolerate liquids such as Gatorade, but today he is unable to even tolerate that, and comes to the clinic for evaluation of possible Diabetic Ketoacidosis (DKA).
Describe the pathophysiology of DKA and why it occurs in patients with Type I Diabetes Mellitus.
Based upon the diagnosis of DKA, what assessment findings does the nurse correlate to this disorder?
The physician orders a complete metabolic panel, and Jerry’s blood glucose is 425. Other lab values include a serum sodium of 152, serum potassium of 3.0, and BUN of 64. What is your assessment of these results?
Explain why it is important for Jerry to continue to take his insulin even though his oral intake is decreased.
Formulate three nursing diagnoses based on actual problems for this client.
Based on the nursing diagnoses you created, provide at least three interventions for each (do not include “assessment” statements-these must be interventions you will actually do) .
A lack of insulin causes the body to utilise triglycerides and amino acids as fuel instead of glucose. Unrestricted lipolysis causes an increase in serum levels of glycerol and free fatty acids, and muscle catabolism causes an increase in alanine levels. Hepatic gluconeogenesis, which is triggered by the excess glucagon that comes along with insulin insufficiency, uses glycerol and alanine as a substrate. also promotes the production of ketones from free fatty acids in the mitochondria. In the absence of insulin, ketogenesis continues even though insulin ordinarily prevents the passage of free fatty acid derivatives into the mitochondrial matrix. Acetoacetic acid and beta-hydroxybutyric acid, the two main ketoacids generated, are potent organic acids that induce metabolic acidosis.
d by Vittola: ‘not always lawful to execute all combatants…we must take account… scale of the injury inflicted by the enemy.’ This is further supported by Frowe approach, which is a lot more moral than Vittola’s view but implies the same agendas: ‘can’t be punished simply for fighting.’ This means one cannot simply punish another because they have been a combatant. They must be treated as humanely as possible. However, the situation is escalated if killing them can lead to peace and security, within the interests of all parties.
Overall, jus in bello suggests in wars, harm can only be used against combatants, never against the innocent. But in the end, the aim is to establish peace and security within the commonwealth. As Vittola’s conclusion: ‘the pursuit of justice for which he fights and the defence of his homeland’ is what nations should be fighting for in wars (Begby et al (2006b), Page 332). Thus, although today’s world has developed, we can see not much different from the modernist accounts on warfare and the traditionists, giving another section of the theory of the just war. Nevertheless, we can still conclude that there cannot be one definitive theory of the just war theory because of its normativity.
Finally, jus post bellum suggests that the actions we should take after a war (Frowe (2010), Page 208).
Firstly, Vittola argues after a war, it is the responsibility of the leader to judge what to do with the enemy (Begby et al (2006b), Page 332).. Again, proportionality is emphasised. For example, the Versailles treaty imposed after the First World War is questionably too harsh, as it was not all Germany’s fault for the war. This is supported by Frowe, who expresses two views in jus post bellum: Minimalism and Maximalism, which are very differing views. Minimalists suggest a more lenient approach while maximalist, supporting the above example, provides a harsher approach, punishing the enemy both economically and politically