The client is a 23-year-old African American male with type-1 diabetes who has not been taking his insulin as prescribed or adhering to a diabetic diet. The client presented to the emergency department with complaints of lethargy, abdominal pain, nausea, and malaise.

Vital signs:

· Temperature: 98.6 F

· Pulse: 110 beats/minute

· Respirations: 32 breaths/minute

· Blood pressure: 90/60 mm Hg

· Oxygen saturation: 96% on room air

Laboratory results:

· Serum glucose: 400 mg/dL (on arrival at the emergency department)

· Serum sodium (Na+): 125 mEq/L

· Serum potassium (K+): 6.5 mEq/L

· Serum chloride (Cl): 120 mEq/L

· Blood urea nitrogen (BUN): 39 mg/dl

· Serum creatinine (Cr): 1.7 mg/dl

· Urinalysis – positive for ketones

Arterial blood gas (ABG) results:

· pH: 7.30

· PaCO2: 33 mm Hg

· PaO2: 95 mm Hg

· HCO3: 19 mEq/L

The client is admitted to the intensive care unit, and you are the nurse assigned to the client. Reply to the following questions:

1. Based on an interpretation of the ABG results, what acid-base imbalance is occurring?

2. What nursing assessment findings are expected?

3. Describe strategies for safe, effective multidimensional nursing care of the client. Include rationale to support the strategies identified.

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