Melissa Stewart management plan

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Melissa Stewart management plan 5’1, 41 kg, BMI 17 Primary Diagnosis: severe diabetic ketoacidosis 2/2 new onset type 1 diabetes mellitus Status/Condition: guarded Code Status: full Allergie... s: NKDA, no known food allergies Admit to Unit: pediatric intensive care Activity Level: bedrest with bathroom privileges Diet: NPO IVF: initiate 0.9% NS bolus (1000cc) x2L then 0.9% NS at 500 cc/hr x 4 hrs then 0.9% NS + 40 MMOL/L KCl @ 200 cc/hr if hypokalemic Critical Drips: Start regular insulin infusion at 4 units/hr. SEE ATTACHED DKA management guideline (adapted from the Johnson & Johnson Institute) Respiratory: 2-4 l/min o2 via nasal cannula or simple face mask, titrate to keep o2 sat > 92%; May us non-rebreather at 10 L/min for acidosis Medications: Tylenol 650 mg po q 4-6 hours prn, mild pain, headache, temp >101.5, not to exceed 4gm in 24 hours Zofran 4mg IV q 6-8 hours PRN for nausea Fluzone quadrivalent 0.5 ml IM x1, (encouraged), parent may decline Once anion gap is <= 12, may initiate “sliding scale” with Aspart as follows: Sliding Scale Insulin with Aspart q TID PRN in addition to the 4 units Aspart scheduled with meals and HS as follows and Glucose Aspart 121-150 mg/dl none 151-199 mg/dl 3 units sq 200-250 mg/dl 5 units sq 251-300 mg/dl 7 units sq 301-350 mg/dl 9 units sq 351-400 mg/dl. 12 units sq and call ACNP or MD If glucose < 70, give D50W IVP x1 or 4 oz. juice; re-check glucose in 15 minutes; may repeat if glucose remains < 70. Start diabetic, carbohydrate-controlled, TID with 3 sna [Show More]

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