History of Present Problem: Diana Humphries is a 45-year-old woman…

History of Present Problem: Diana Humphries is a 45-year-old woman with chronic kidney disease stage III and diabetes mellitus type1 who checks
her blood sugar daily, or whenever she feels like it. She has been feeling increasingly nauseated the past 12 hours. She has
had a harsh, productive cough of yellow sputum the past three days. She checked her blood glucose before going to bed
last night and it was 382, but then she fell asleep early and missed her bedtime dose of glargine (Lantus) insulin. When
she awoke this morning, she had generalized abdominal pain and continued to feel nauseated and had a large emesis. Her
glucometer was unable to read her blood glucose because it was too high. She took 10 units of lispro (Humalog) insulin
this morning. Her nausea has increased all morning and she has been unable to eat or keep anything down despite having
an increased thirst and appetite. She also has had increased frequency of urination. When her lunchtime glucometer gave
no reading because it was too high and out of range, she called 9-1-1 to be evaluated in the emergency department (ED).

Personal/Social History: Diana has been inconsistently compliant with her medical/diabetic regimen due to her struggles with anxiety and
depression that have worsened since her mother died three months ago. She considers 200 a good blood sugar reading.
She is divorced with no children and has been homeless and has lived in a shelter off and on the past month. She is on
Social Security disability because of complications related to diabetes. At one point during the intake interview, she
expressed to the nurse, “I’m going to die anyway, why does all this matter?”
1. How did you use clinical judgment? Use at least 2 of the prompts listed on journal
instructions and include the prompts below.
2. How did you experiences impact your learning or nursing practice? My previous experience is Nursing assistance
3. What is your SMART goal for your next clinical experience? What course outcome does
the goal meet?