Medical/Surgical UTI/DKA

Scenario Description

Patient has been admitted to the Medical/Surgical unit from the ED with diagnosis of UTI and DKA. The participant will be given a brief report from the nursing staff in the ED and the ED paperwork/EHR. The participant should administer ordered IV antibiotics (initially Bactrim ordered but participant needs to catch that this is an allergy (sulfa), contact the MD, and obtain a new order for Ceftriaxone IV). Participant should also have an order for a urine culture, which they should obtain and send to the lab prior to initiating the IV antibiotics. Participant should be administering and monitoring a regular insulin drip and IVFs to manage the DKA while monitoring frequent lab values (ABGs, CMP, UA, etc.), which are reported to the MD and orders change as patient improves (labs should initially show dehydration, hyperglycemia, metabolic acidosis, urine with +leukocytes/ nitrites/ protein/ ketones) that improve at case resolution. The participant should do complete history and physical assessment of the patient and frequent monitoring of patient/labs/IV site/vital signs until DKA improves. Once stable, extensive patient education on smoking cessation, compliance with office visits and medications, nutrition, exercise/weight control, medication side effects/use, etc. should be given to the patient and family member by the participant, as well as, referral to social worker/case management for financial resources. The participant should be able to interpret that the UTI was the main factor in the development of hyperglycemia and, thus, the DKA.