A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include fasting blood glucose of 120mg/dl, temperature of 101ºF, pulse of 88 bpm, respirations of 22 bpm, and a BP of 140/84 mmHg. Which finding would be of most concern to the nurse?
A. Pulse
B. Blood pressure
C. Respiration
D. Temperature
Correct Answer: D. Temperature
An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis. Due to the possibility of an infectious trigger for DKA, the patient may be febrile or hypothermic. If there is a superimposed infection that triggered the episode of DKA, the patient may have other infectious symptoms like fever, cough, or other urinary symptoms.
Option A: The pulse rate of 88 bpm is normal. On examination, vital signs typically reveal tachycardia and tachypnea. Supraventricular tachycardia (SVT) can occur as a complication of diabetic ketoacidosis in the absence of underlying heart disease, and the risk is increased by the electrolyte, acid-base, and fluid balance disturbances, as in the previous case reports.
Option B: A blood pressure of 140/84 mmHg is hypertensive. Blood pressure may also vary, though hypotension is possible and indicative of a more severe disease process. Insulin is known to decrease the catecholamine-induced production of these 2 potent vasodilators. Severe insulin deficiency as seen in DKA thus leads to increased production of PGI2 and PGE2, which leads to vasodilation and hypotension.
Option C: Respirations of 22 bpm are normal. Kussmaul’s breathing, which is labored, deep, and tachypneic, may occur in clients with DKA. Some providers may appreciate a fruity scent to the patient’s breath, indicative of the presence of acetone.
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