DKA- Diabetic Ketoacidosis

The nurse is assessing a client diagnosed with type 2 diabetes mellitus for symptoms associated with diabetic ketoacidosis. Which of the following will the nurse most likely assess in this client? (Select all that apply.) 1. Dehydration 2. Fruity breath odor 3. Hypertension 4. Bradycardia 5. Kussmaul breathing 6. Abdominal pain

1, 2, 5, 6 The client diagnosed with diabetic ketoacidosis will experience dehydration, fruity breath odor, Kussmaul respirations, and abdominal pain. The client will also have hypotension and not hypertension. The clients heart rate will be tachycardic and not bradycardic

The nurse would anticipate laboratory values from a patient in ketoacidosis to reveal: a. increased blood urea nitrogen (BUN). b. normal or decreased CO2. c. increased arterial pH. d. decreased glucose.

A. Diabetic ketoacidosis results when the body attempts to metabolize protein and fats, which results in high BUN readings. The CO2 should be normal or low depending on the effectiveness of Kussmauls respirations. The arterial pH will be low, and there will be high glucose, which the diabetic patient cannot use.

A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first? a. Infuse 1 liter of normal saline per hour. b. Give sodium bicarbonate 50 mEq IV push. c. Administer regular insulin 10 U by IV push. d. Start a regular insulin infusion at 0.1 units/kg/hr.

A. The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be done after the infusion of normal saline is initiated

A nurse is reviewing the laboratory results of a client in the emergency department with diabetic ketoacidosis (DKA). Which laboratory result would the nurse expect to note? A. Creatinine 1.0 mg/dL B. Serum bicarbonate of 12 mEq/L Correct C. Blood urea nitrogen (BUN) of 15 mg/dL D. Negative results on urinary ketone testing

B.

A nurse is reviewing the laboratory values of a client who has diabetic ketoacidosis. The nurse should understand that which of the following laboratory values is consistent with diabetic ketoacidosis?

Bicarbonate level 12 mEq/L The client who has diabetic ketoacidosis should have a bicarbonate level less than 15 mEq/L because the client has an increased production of counter-regulatory hormones that lead to metabolic acidosis.

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? a. Infuse dextrose 50% by slow IV push. b. Administer 1 mg glucagon subcutaneously. c. Obtain a glucose reading using a finger stick. d. Have the patient drink 4 ounces of orange juice

C. The patients clinical manifestations are consistent with hypoglycemia and the initial action should be to check the patients glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon or dextrose 50% might be given if the patients symptoms become worse or if the patient is unconscious.

The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action should the nurse take? a. Give the prescribed PRN lorazepam (Ativan). b. Start the prescribed PRN oxygen at 2 to 4 L/min. c. Administer the prescribed normal saline bolus and insulin. d. Encourage the patient to take deep, slow breaths with guided imagery.

C. The rapid, deep (Kussmaul) respirations indicate a metabolic acidosis and the need for correction of the acidosis with a saline bolus to prevent hypovolemia followed by insulin administration to allow glucose to reenter the cells. Oxygen therapy is not indicated because there is no indication that the increased respiratory rate is related to hypoxemia. The respiratory pattern is compensatory, and the patient will not be able to slow the respiratory rate. Lorazepam administration will slow the respiratory rate and increase the level of acidosis

A patient at home with type 1 diabetes has a glucose level of 324 mg/dL. It is usually less than 150 mg/dL. What should the patient do first? a. Call the physician. b. Have a glass of orange juice. c. Check the urine for ketones and drink water. d. Exercise and recheck glucose level in 2 hours

c. Patients with type 1 diabetes are at risk of ketoacidosis when blood glucose is out of control. Hydration is important. Checking the urine for ketones can help determine if ketoacidosis is developing. B. Orange juice will further increase blood glucose. A. The physician should be contacted if it remains high or if ketones are present. D. Exercise is not recommended when glucose is high.

A diabetic patient calls the clinic complaining of having a flu bug. The nurse tells him to take his regular dose of insulin. What else should the nurse tell the patient? A) Make sure to stick to your normal diet. B) Try to eat small amounts of carbs, if possible. C) Ensure that you check your blood glucose every hour. D) For now, check your urine for ketones every 8 hours.

B. For prevention of DKA related to illness, the patient should attempt to consume frequent small portions of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours.

An unresponsive patient with type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemic syndrome (HHS). The nurse will anticipate the need to a. give a bolus of 50% dextrose. b. insert a large-bore IV catheter. c. initiate oxygen by nasal cannula. d. administer glargine (Lantus) insulin.

b. HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires oxygen. Dextrose solutions will increase the patients blood glucose and would be contraindicated.

The nurse should observe the patient for symptoms of ketoacidosis when: a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids b. glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss. c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. d. the patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy

c. When insulin is insufficient and glucose cannot be used for cellular energy, the body uses stored fats to meet energy needs. Free fatty acids from stored triglycerides are metabolized in the liver in such large quantities that ketones are formed. Ketones are acidic and alter the pH of the blood, causing acidosis. Osmotic diuresis from the elimination of both glucose and ketones in the urine causes dehydration, not ketosis. The loss of bicarbonate and skipping a meal after insulin administration do not cause ketosis

A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase of treatment? A) Monitoring the patient for dysrhythmias B) Maintaining and monitoring the patients fluid balance C) Assessing the patients level of consciousness D) Assessing the patient for signs and symptoms of venous thromboembolism

B. In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.

The nurse is caring for a patient who was hospitalized with ketosis. The nurse recognizes that the patient correctly understands the phenomenon when she reports what about the condition? a. I had taken too much insulin to decrease my bodys levels of glucose. b. The condition resulted when my body tried to break down and use my stores of fats. c. When my blood glucose goes over 150 mg/dL, I am at risk for this condition. d. I was exercising too much and had too sharp reductions in my blood glucose level.

B. Persons with type 1 diabetes are more prone to a serious complication, ketosis, associated with an excess production of ketone bodies, leading to ketoacidosis (metabolic acidosis). When the glucose level gets too high the body attempts to metabolize fats for energy, and the result is a buildup of ketone bodies.

What are manifestations of diabetic ketoacidosis (DKA) (select all that apply)? a. Thirst b. Ketonuria c. Dehydration d. Metabolic acidosis e. Kussmaul respirations f. Sweet, fruity breath odor

a, b, c, d, e, f In DKA, thirst occurs to replace fluid used to eliminate ketones in the urine in trying to decrease the blood glucose and ketonemia. The metabolic acidosis leads to the Kussmaul respirations trying to decrease the acid in the system. The sweet, fruity breath odor is from acetone. Thirst and dehydration are found with both DKA and hyperosmolar hyperglycemic syndrome (HHS).

30. A patient is diagnosed with diabetic ketoacidosis (DKA). Which manifestations should the nurse expect to observe in this patient? (Select all that apply.) a. Dehydration b. Hypertension c. Flulike symptoms d. Kussmauls respirations e. Cheyne-Stokes respirations f. Edema associated with fluid overload

a, c, d, The body attempts to compensate for acidosis by deepening respirations, thereby blowing off excess carbon dioxide. The deep, sighing respiratory pattern is called Kussmauls respirations. F. With such high blood glucose and the accompanying polyuria, the body becomes dehydrated very quickly. B. Tachycardia, hypotension, and shock can result. Acidosis also causes potassium to leave the cells and accumulate in the blood (hyperkalemia). Potassium is then lost in large amounts in the urine. The combination of dehydration, potassium imbalance, and acidosis causes the patient to develop flulike symptoms, including abdominal pain and vomiting. The patient loses consciousness and death occurs if DKA is not treated. E. Cheyne-Stokes respirations are not associated with diabetes.

A 27-year-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first? a. Place the patient on a cardiac monitor. b. Administer IV potassium supplements. c. Obtain urine glucose and ketone levels. d. Start an insulin infusion at 0.1 units/kg/hr.

a. Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring because insulin infusion will further decrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage the patients care

Priority Decision: The nurse is assessing a newly admitted patient with diabetes. Which observation should be addressed as the priority by the nurse? a. Bilateral numbness of both hands b. Stage II pressure ulcer on the right heel c. Rapid respirations with deep inspiration d. Areas of lumps and dents on the abdomen

c. Rapid deep respirations (kussmaul breathing) are symptoms of diabetic ketoacidosis (DKA), so this is the priority of care. Stage II pressure ulcers and bilateral numbness are chronic complications of diabetes. The lumps and dents on the abdomen indicate the patient has lipodystrophy and may need to learn about site rotation of insulin injections

A patient is experiencing rapid deep breathing, fruity odor, lethargy, and weight loss. Laboratory results include a blood glucose of 720 mg/dL. Which symptom should indicate to the nurse that the patient has type 1 diabetes mellitus? a. Thirst b. Hunger c. Lethargy d. Fruity odor

d. Fruity odor occurs with ketoacidosis in type 1 diabetes, which is very rare in type 2. A. B. C. The symptoms can occur in either type 1 or type 2 diabetes mellitus.