Case Study Question 5 A 12-year-old boy is brought to the em…

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Cаse Study Questiоn 5 A 12-yeаr-оld bоy is brought to the emergency depаrtment by his mother. She reports he has been extremely thirsty, urinating frequently, and more tired than usual over the past two weeks. He has lost 8 pounds in the last month despite having an increased appetite. Today he developed abdominal pain and vomiting. Past Medical History: No significant past medical history. Vaccines up to date. Family History: Aunt with autoimmune disease Nursing Notes: 1000 Client is lethargic but arousable. Mucous membranes are dry. Delayed capillary refill. Fruity odor on breath. Respirations are deep and rapid. Vital Signs: Time 1005 Blood Pressure 98/60 Heart Rate 124 bpm Respiration Rate 30/min Temperature 99.1°F (37.3°C) Pulse Oximeter 98% on room air Laboratory Results Basic Metabolic Panel (BMP): Lab Value Results Time 1015 Range Blood glucose 486 mg/dL 70–110 mg/dL Sodium 132 mEq/L 136-145 mEq/L Potassium 5.6 mEq/L 3.4-4.7 mEq/L Chloride 96 mEq/L 90-110 mEq/L Blood Urea Nitrogen (BUN) 28 mg/dL 5-18 mg/dL Creatinine 1.2 mg/dL 0.4-1 mg/dL Arterial Blood Gas (ABG): Lab Value Result Time 1015 Range pH 7.25 7.35-7.45 PCO₂ 28 mm Hg 35-45 mm Hg HCO₃⁻ 15 mEq/L 22-26 mEq/L PO₂ 96 mm Hg 80-100 mm Hg SaO₂: 98 % 95-100 % Urinalysis: Lab Value Result Time 1015 Range Appearance Clear Clear Color Yellow Yellow Specific gravity 1.032 1.005-1.03 Glucose 4+ None Ketones Large None Protein Trace None pH 5 4.6-8 Nitrates None None WBCs 0-2 0-5 RBCs 0-2 0-3 The provider has seen the client and has placed the following orders: Provider orders: 500mL 0.9% normal saline bolus Continusous IV insulin infusion at 0.1unit/kg/hr Cardiac monitoring Frequent blood glucose checks Oxygen via nasal cannula to keep oxygen saturation 95% or greater Repeat blood work ABG and BMP in 4 hours Question 5: Which order should the nurse implement first?

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