DKA

Question 1

What is diabetic ketoacidosis?

Answer 1

A life threatening complication of type 1 DM that develops when a severe insulin deficiency occurs.

It is caused by an absence or inadequate amount of insulin

Question 2

What are the main clinical manifestations?

Answer 2

-hyperglycemia
-dehydration (increase levels of creatinine, BUN, and hematocrit)
-ketosis
-acidosis
-blood sugar between 250-800

Kaplan:
1. Headache, drowsiness, coma, stupor
2. Hypotension, tachycardia
3. Skin warm and dry, dry mucous membranes, elevated temp
4. Polyuria progressing to oliguria, polydipsia, and polyphagia
5. Kussmaul respirations (rapid and deep)
6. Fruity odor breath

In book:
-the 3 main clinical features are:
-hyperglycemia
-dehydration and electrolyte loss
-acidosis

Question 3

What are the nursing interventions for DKA?

Answer 3

1. Restore blood volume, so .9% normal saline or .45% NaCl
2. Regular insulin administration (short or rapid acting insulin)
3. Correct electrolyte imbalances (Potassium level may be elevated d/t dehydration and acidosis), so administer potassium as soon as urine output is good
4. Monitor K+ levels closely after administration because K+ levels will decrease and K+ replacement may be required
5. Cardiac monitor in place d/t abnormal K+ levels
6. Monitor pt closely for signs of increased intracranial pressure (if blood glucose level falls too far or too fast before the brain has time to equilibrate, water is pulled from the blood to the cerebrospinal fluid and the brain, causing cerebral edema, and increased intracranial pressure), so once when blood sugars are decreased to about 250, can prepare it fluids containing dextrose

Question 4

What is the management/treatments part 2?

Answer 4

1. Put pt on telemetry
2. Get an IV access
3. Rehydration:
   -patients with DKA are dehydrated d/t polyuria, hyperventilation, diarrhea, and vomiting. Rehydration is important for maintaining tissue perfusion
4. Assess blood sugar levels
5. Reverse acidosis with insulin, which inhibits fat breakdown, ending ketone production and acid buildup
   5.Restoring electrolytes:
   -The major electrolyte of concern during treatment of DKA is potassium. The initial plasma concentration of potassium may be low, normal, or high, but more often than not, tends to be high (hyperkalemia) from disruption of the cellular sodium-potassium pump (in the face of acidosis). Therefore, the serum potassium level must be monitored frequently