Type 1 Diabetes Mellitus Type
I/DKA
UNFOLDING Reasoning
Jack Anderson, 9 years old
Primary Concept
Glucose Regulation
Interrelated Concepts (In order of emphasis)
● Fluid and Electrolyte Balance
● Acid-Base Balance
● Clinical Judgment
● Patient Education
● Communication
● Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
✔ Management of Care 17-23% ✔
✔ Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✔
Psychosocial Integrity 6-12% ✔
Physiological Integrity
✔ Basic Care and Comfort 6-12% ✔
✔ Pharmacological and Parenteral Therapies 12-18% ✔
,✔ Reduction of Risk Potential 9-15% ✔
✔ Physiological Adaptation 11-17% ✔
, History of Present Problem:
Jack Anderson is a 9-year-old boy who presents to the emergency department because he has been more sleepy and his
breathing is “not normal;” it is deeper and faster, according to his parents. Jack was sick with a respiratory virus two
weeks ago but has since recovered. Jack began feeling more tired a few days ago when he started to complain of
abdominal pain, headache, muscle aches, and consistently being hungry and thirsty. He is urinating more frequently
during the day and at night. His mother reports a normal full-term pregnancy and Jack has been healthy with no known
medical conditions.
Personal/Social History:
Jack lives with both parents and two siblings; a younger sister four years old and a 12-year-old brother. Both parents
work as middle school teachers in the community. Jack is in the 4th grade and earns above-average marks. He is
physically active and plays soccer on the school team.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
He's more sleepy Fatigue is a common symptom and can result from high blood sugar levels
His breathing is "not normal" it's deeper and faster Kussmaul breathing is rapid or labored breathing, a symptom of DKA
Was sick with a respiratory virus 2 weeks ago Lack of insulin or insulin resistance helping convert food to energy causes
increased hunger and thirst
Always hungry and thirsty
RELEVANT Data from Social History: Clinical Significance:
Has a support system from family Shows he will get the care he needs with his support system
Physically active, plays soccer Being active can lead to hypoglycemia once he manages his diabetes
I/DKA
UNFOLDING Reasoning
Jack Anderson, 9 years old
Primary Concept
Glucose Regulation
Interrelated Concepts (In order of emphasis)
● Fluid and Electrolyte Balance
● Acid-Base Balance
● Clinical Judgment
● Patient Education
● Communication
● Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
✔ Management of Care 17-23% ✔
✔ Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✔
Psychosocial Integrity 6-12% ✔
Physiological Integrity
✔ Basic Care and Comfort 6-12% ✔
✔ Pharmacological and Parenteral Therapies 12-18% ✔
,✔ Reduction of Risk Potential 9-15% ✔
✔ Physiological Adaptation 11-17% ✔
, History of Present Problem:
Jack Anderson is a 9-year-old boy who presents to the emergency department because he has been more sleepy and his
breathing is “not normal;” it is deeper and faster, according to his parents. Jack was sick with a respiratory virus two
weeks ago but has since recovered. Jack began feeling more tired a few days ago when he started to complain of
abdominal pain, headache, muscle aches, and consistently being hungry and thirsty. He is urinating more frequently
during the day and at night. His mother reports a normal full-term pregnancy and Jack has been healthy with no known
medical conditions.
Personal/Social History:
Jack lives with both parents and two siblings; a younger sister four years old and a 12-year-old brother. Both parents
work as middle school teachers in the community. Jack is in the 4th grade and earns above-average marks. He is
physically active and plays soccer on the school team.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
He's more sleepy Fatigue is a common symptom and can result from high blood sugar levels
His breathing is "not normal" it's deeper and faster Kussmaul breathing is rapid or labored breathing, a symptom of DKA
Was sick with a respiratory virus 2 weeks ago Lack of insulin or insulin resistance helping convert food to energy causes
increased hunger and thirst
Always hungry and thirsty
RELEVANT Data from Social History: Clinical Significance:
Has a support system from family Shows he will get the care he needs with his support system
Physically active, plays soccer Being active can lead to hypoglycemia once he manages his diabetes
