The patient with emphysema comes to the emergency department with difficulty breathing. What finding should the nurse anticipate during data collection? Select all that apply

A. Acetone breath, characterized by a fruity or acetone-like odor on the patient's breath, is a classic sign of DKA. In addition, Kussmaul respirations, which are deep and labored breathing patterns, can occur as the body attempts to compensate for metabolic acidosis in DKA.
C. Nausea and vomiting are common symptoms of DKA and can occur due to metabolic acidosis, electrolyte imbalances, and gastrointestinal disturbances associated with the condition.
F. Tachycardia and hypotension are signs of hemodynamic instability, which can occur in severe cases of DKA due to dehydration, electrolyte imbalances, and the systemic effects of metabolic acidosis.
G. Turning off an insulin pump can lead to insulin deficiency, which is a precipitating factor for DKA, particularly in patients with type 1 diabetes who rely on continuous insulin therapy. This finding is consistent with the development of DKA.
B. Blurred vision and headache can be symptoms of DKA, although they are not specific to this condition. Elevated blood glucose levels and dehydration associated with DKA can lead to osmotic diuresis and subsequent fluid shifts, which may manifest as headache and visual disturbances.

D. A history of type 1 diabetes mellitus (DM) predisposes the patient to DKA but the history of appendix removal at age 7 is not directly relevant to the current presentation of DKA.
E. Alcohol ingestion can contribute to the development of DKA by inhibiting gluconeogenesis and promoting ketoacidosis, particularly if the patient is not consuming adequate carbohydrates and insulin. However, it is not a direct sign of DKA.

B. Severe upper abdominal pain is a hallmark symptom of gastrointestinal perforation. Perforation can lead to the leakage of gastric contents into the peritoneal cavity, causing intense, sharp pain in the upper abdomen. The pain may be sudden and severe and can radiate to the back or shoulders.
A. Bradycardia, or a slow heart rate, is not typically associated with gastrointestinal perforation. Instead, tachycardia (rapid heart rate) is more commonly observed due to the body's response to shock or inflammation caused by perforation.

C. Hyperactive bowel sounds are more commonly associated with conditions such as gastroenteritis or bowel obstruction. In the case of gastrointestinal perforation, bowel sounds may initially be normal but can eventually become absent due to peritoneal irritation and subsequent paralytic ileus.
D. Epigastric fullness may be present in peptic ulcer disease but is not a specific manifestation of gastrointestinal perforation. Perforation is more likely to present with severe, acute pain rather than a sensation of fullness.