28 hours ago · If you have DKA, you’ll be treated in the emergency room or admitted to the hospital. Your treatment will likely include: Replacing fluids you lost through frequent urination and to help dilute excess sugar in your blood. Replacing electrolytes (minerals in your body that help your nerves, muscles, heart, and brain work the way they should). Too little insulin can lower your electrolyte levels. >> Go To The Portal
As the nurse, you must know typical signs and symptoms of DKA, patient teaching, and expected medical treatments. Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) are both complication of diabetes mellitus, but there are differences between the two complications that you must know as a nurse.
Inhaled insulin has not been approved for management of diabetic ketoacidosis. The nurse is assessing the client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management?
DKA: Diabetic ketoacidosis; ICU: Intensive care unit; LOS: Length of stay; SD: Standard deviation. Additionally, no significant difference in mean number of episodes of hyperkalemia (0.56 vs0.43, P = 0.37), hypoglycemia (0.97 vs1.54, P = 0.18), or severe acidosis (0.04 vs0.20, P = 0.18) existed between the early and late nutrition groups.
* A patient is admitted with Diabetic Ketoacidosis. The physician orders intravenous fluids of 0.9% Normal Saline and 10 units of intravenous regular insulin IV bolus and then to start an insulin drip per protocol. The patient’s labs are the following: pH 7.25, Glucose 455, potassium 2.5.
Insulin Therapy Only short-acting insulin is used for correction of hyperglycemia. Subcutaneous absorption of insulin is reduced in DKA because of dehydration; therefore, using intravenous routes is preferable. SC use of the fast-acting insulin analog (lispro) has been tried in pediatric DKA (0.15 U/kg q2h).
Intravenous insulin acts rapidly and lasts for a very short duration in the body. To maintain the desired glucose levels in the blood, insulin is infused continuously with appropriate dosage titrations depending on the blood sugar level.
Introduction. Patients in DKA often require ICU admission for IV insulin therapy and constant monitoring, as blood glucose levels must be lowered slowly to avoid neurological damage and electrolytes must be closely monitored.
After initial stabilization of circulation, airway, and breathing as a priority, specific treatment of DKA requires correction of hyperglycemia with intravenous insulin, frequent monitoring, and replacement of electrolytes, mainly potassium, correction of hypovolemia with intravenous fluids, and correction of acidosis.
DKA is resolved when 1) plasma glucose is <200–250 mg/dL; 2) serum bicarbonate concentration is ≥15 mEq/L; 3) venous blood pH is >7.3; and 4) anion gap is ≤12. In general, resolution of hyperglycemia, normalization of bicarbonate level, and closure of anion gap is sufficient to stop insulin infusion.
Generally, to correct a high blood sugar, one unit of insulin is needed to drop the blood glucose by 50 mg/dl. This drop in blood sugar can range from 30-100 mg/dl or more, depending on individual insulin sensitivities, and other circumstances.
DKA can cause complications such as:Low levels of potassium (hypokalemia)Swelling inside the brain (cerebral edema)Fluid inside your lungs (pulmonary edema)Damage to your kidney or other organs from your fluid loss.
Normal saline (0.9% sodium chloride) is the most commonly used intravenous fluid in treating DKA, but it has a very high concentration of chloride and can lead to additional acid production when given in large volumes.
DKA is a well-known cause of hypokalemia caused by osmotic diuresis leading to a total body potassium deficiency of 3 to 6 mEq/kg. At presentation, potassium levels are typically “normal” due to the extracellular shift of potassium (K+) from insulin deficiency and acidosis.
Nursing Interventions of DKA Teach patient early signs and when to seek treatment: Monitor glucose and ketones during illness every 4 hours, especially if dealing with illness/infection. If vomiting and cannot eat food or drink liquids notify doctor (if can tolerate drink liquids every hour)
Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment.
What tests are used to diagnose diabetes-related ketoacidosis (DKA)?Blood glucose test.Ketone testing (through a urine or blood test).Arterial blood gas.Basic metabolic panel.Blood pressure check.Osmolality blood test.
This quiz on DKA ( Diabetic Ketoacidosis NCLEX Questions) will test you on how to care for the diabetic patient who is experiencing this condition. As the nurse, you must know typical signs and symptoms of DKA, patient teaching, and expected medical treatments.
D. Potassium levels should be at least 3.3 or higher during treatment of DKA with insulin therapy.
C. “It is important I check my blood glucose every 3-4 hours when I’m sick and consume liquids.”
A 36 year old male with diabetes mellitus who has been unable to eat the past 2 days due to a gastrointestinal illness and has been unable to take insulin. A 35 year old female newly diagnosed with Type 2 diabetes. None of the options are correct.
Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) are both complication of diabetes mellitus, but there are difference s between the two complications that you must know as a nurse . This endocrine teaching series will test your knowledge on how to differentiate between the two conditions, along with a video lecture.
The cardiac monitor shows the appearance of a U wave. What complication does the nurse suspect?
1.) A client admitted with DKA will have a blood glucose value greater than 250 and blood ketones. Intravenous (IV) administration of regular insulin is needed to rid the body of ketones and regulate blood glucose. Administration of insulin glargine is not going to reverse the ketoacidosis. The client will be allowed fluids to maintain hydration. Administration of 10% dextrose IV will increase the client's blood glucose.
1.) A client in diabetic ketoacidosis will have blood gas readings that indicate metabolic acidosis. The pH will be acidic (7.30), and the HCO 3 - will be low (20 mEq/L [20 mmol/L]). The normal pH is 7.35 to 7.45; CO 2 ranges from 35 to 45 mm Hg, and HCO 3 - ranges from 22 to 26 (22 to 26 mmol/L). A pH of 7.35 and a CO 2 of 47 mm Hg indicate respiratory acidosis. pH values of 7.46 and 7.50 represent alkalosis, not acidosis.
The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L (5 .4 mmol/L). What would the nurse expect to see on the ECG tracing monitor?
Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. "Insulin dosage will likely need to be increased during the second and third trimesters," "Episodes of hypoglycemia are more likely to occur during the first 3 months," and "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding" are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy.
Correct4) The bicarbonate-carbonic acid buffer system helps maintain the pH of body fluids; in metabolic acidosis, there is a decrease in bicarbonate because of an increase of metabolic acids. The pH is decreased. The PO 2 is not decreased in diabetic acidosis. The PCO 2 may be decreased by the body's attempt to eliminate CO 2 to compensate for a decreased pH.
1.) With diabetic ketoacidosis, serum lipid levels are high because of the increased breakdown of fat. Serum lipid levels can go so high that the serum appears opalescent and creamy. With diabetic ketoacidosis the hematocrit level generally is increased because of dehydration. The calcium level is unrelated to diabetic ketoacidosis. With diabetic ketoacidosis the blood urea nitrogen level generally is increased because of dehydration.