Question

An older client with a history of Type 1 diabetes has not felt well the past few days and arrives at the clinic with abdominal cramping and vomiting. The client is lethargic, moderately confused, and cannot remember when taking the last dose of insulin or eating. Which action should the nurse implement first?

a. Administer the client's usual dose of insulin.
b. Obtain a serum potassium level.
c. Assess pupillary response to light.
d. Start an intravenous infusion of normal saline.

Answer 1

For a Type 1 diabetic patient presenting with lethargy and vomiting, the initial nursing action should be to start an intravenous infusion of normal saline to address dehydration and stabilize the patient.

Step-by-step explanation:

The action a nurse should implement first for a client with a history of Type 1 diabetes, who is lethargic and vomiting, is d. Start an intravenous infusion of normal saline.

This initial response is critical as the client may be experiencing diabetic ketoacidosis, a potentially life-threatening complication of diabetes characterized by dehydration, electrolyte imbalance, and acidosis. Administering an intravenous infusion of normal saline would help to address dehydration and assist in stabilizing the patient before further treatment. It is important not to administer insulin without knowing the patient's current blood glucose levels.

In addition, hypoglycemia due to too much insulin could exacerbate the patient's condition, and hypokalemia could occur due to insulin therapy. Therefore, it is essential to rehydrate the patient first and manage electrolyte imbalances before any additional treatments are considered.