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*Directions: Consider the following patient and answer the questions concisely but
completely in appropriate APA format. Please use 1” margins and 12 font, proper
grammar/spelling, write in paragraphs (do not number your responses), and do
NOT present in first person. Cite references correctly within the body of your paper
and provide title and reference pages. Please review the APA guidelines included in
the Canvas course.
*Seek out an appropriate evidence-based article on the web to support your
discussion of DKA. The article must be recent (no older than 5 years) and must be
from a nursing journal with at least one nurse author. Highlight the article in yellow
to indicate the portions applicable to your discussion and submit the highlighted
article with your paper.
Melanie, a 19 year-old female college student, was diagnosed with type 1 DM three
months ago and she describes her HPI as follows:
 Always had a ‘weight problem’ but approximately four months before
diagnosis she began slowly losing weight despite “eating more than I every
have in my life.”
 Also described increasing thirst leading to “too many trips to the bathroom”,
interrupting her ability to remain in class as expected.
 Diagnosed with type 1 DM after she had lost 18 pounds and was started on the
following insulin regimen: insulin glargine (Lantus) 35 units at bedtime;
insulin lispro (Humalog) sliding scale before each meal. Her meal plan
developed by the dietician included 1200 calories and 10 servings of
CHO/day with a suggestion of walking 30 minutes at least 3 days/week.
 Her presenting S&S quickly resolved, she had much more “energy to
exercise”, but she also noted a disturbing trend: not only had she stopped
losing weight but was actually gaining.
(1) Concisely explain the above HPI (start with what is type 1 DM) and beginning
treatment. May explain the above in ‘bullet’ format but write in paragraphs and
provide appropriate references.
Today, three months post-diagnosis, Melanie is brought to the Emergency Department
and DKA is suspected from the outset. The triage nurse learns that she gradually but
significantly decreased her insulin and CHO intake to “stop the weight gain” and for the
past two days “was back in the bathroom again because I was so thirsty.” Appears
somewhat confused when discussing rationale for her actions.
Admitting VS: 86/48, 136 and regular; 28, deep, and smelling ‘fruity’
Current blood glucose: 424 mg/dL and urine + for ketones
(2) Briefly explain the pathophysiology of DKA and why Melanie is demonstrating
such at this time. Also, explain her presenting VS, BG, and the fact that ketones
are present in her urine. Describe her expected fluid status in all 3 spaces.
(3) Presentation confirms the diagnosis of DKA: provide an expected ABG for
Melanie (complete interpretation and actual numbers) with rationale for each
value.
(4) Serum potassium will fluctuate in DKA: describe the rationale for the common
hypokalemia early in the process and then later hyperkalemia followed by a drop
again with treatment. Why must this be monitored closely?
(5) State the priority nursing diagnosis at this time.
(6) What orders do you expect from the physician to manage her BG/insulin and fluid
needs? Be specific and provide rationale to demonstrate your understanding of
initial DKA treatment. Do not simply copy isolated facts from your references.
And, why is it important to control the change in serum osmolality carefully
during initial therapy?
Melanie’s treatment is successful and she is ready for discharge 36 hours later. What
must she be taught prior to discharge to prevent a repeat of a potentially life-threatening
DKA episode in the future? Consider that she is a 19 year-old college student who has
had a life-long weight problem.

This is a discussion post for nursing. Use at least 3 references within current 5 years.  The state to use is Florida where I reside. 
Preparing the Discussion
Using the readings from this week as well as reliable outside resources to: 
Identify and describe practice barriers for all four APNs’ roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.
Identify forms of competition on the state and national level that interfere with APNs’ ability to practice independently.
Identify the specific lawmakers by name at the state level (i.e., key members of the state’s legislative branch and executive branch of government)
Discuss interest groups that exist at the state and national levels that influence APN policy.
Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.
A scholarly resource must be used for EACH discussion question each week.
Category Points % Description
DISCUSSION CONTENT
Practice Barriers 15 15% Provides relevant evidence of scholarly inquiry clearly stating how the evidence describes APN barriers to practice. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
Competition 15 15% Provides relevant evidence of scholarly inquiry clearly stating the forms of competition to APN practice. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
Key Law Makers 15 15% Provides relevant evidence of scholarly inquiry in identifying law makers at the state level. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
Interest Groups 15 15% Provides relevant evidence of scholarly inquiry at identifying interest groups at the state and national level. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
Methods to Influence Change 15 15%
Provides relevant evidence of scholarly inquiry of methods used to influence a change to eliminate barriers.
Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
75 75%
Total CONTENT Points = 75 pts
DISCUSSION FORMAT
Interactive Dialogue 20 20%
4 Required Elements:
Responds a minimum of two other posts to peers and/or faculty in the threaded discussion; 
Responses to peer/faculty are substantive (adds importance, depth, and meaningfulness to the discussion)
Responds to all direct questions from faculty (if no question asked directly, student responded to questions posed to the entire class)
Summarizes what was learned from the lesson, readings, and other student posts for the week. The summary could be included in one of the three minimum posts.
Grammar, Syntax, Spelling, & Punctuation 5 5% Grammar, syntax, spelling, and punctuation are accurate.
25 25%
Total FORMAT Points = 25 pts
100 100%
DISCUSSION TOTAL = 100 pts