Diabetic Ketoacidosis

What is the recommended glucose level of start Dextrose in order to prevent hypoglycemia 250mg/dL 300mg/dl 110mg/dl 275mg/dl

250mg/dL

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level was 950 mg/dL. A continuous intravenous infusion of short-acting insulin is initiated, along with intravenous rehydration with normal saline. The serum glucose level is now 240 mg/dL. The nurse would next prepare to administer which item? 1.Ampule of 50% dextrose 2.NPH insulin subcutaneously 3.Intravenous fluids containing dextrose 4.Phenytoin (Dilantin) for the prevention of seizures

3.Intravenous fluids containing dextrose During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL, the infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. Fifty percent dextrose is used to treat hypoglycemia. NPH insulin is not used to treat DKA. Phenytoin (Dilantin) is not a usual treatment measure for DKA.

Which of the following statements are INCORRECT about Diabetic Ketoacidoisis?* A. Extreme Hyperglycemia that presents with blood glucose >600 mg/dL B. Ketones are present in the urine C. Metabolic acidosis is present with Kussmaul breathing D. Potassium levels should be at least 3.3 or higher during treatment of DKA with insulin therapy

A Extreme Hyperglycemia that presents with blood glucose >600 mg/dL is present only in Hyperglycemic Hyperosmolar Nonketotic Syndrome.

Diabetic ketoacidosis, aspirin toxicity, and renal failure are examples of the causes of ___________________.* A. High anion gap metabolic acidosis B. Normal anion gap metabolic acidosis C. Low anion gap metabolic acidosis D. Normal anion gap respiratory acidosis

A. High anion gap metabolic acidosis

A patient is in high anion gap metabolic acidosis due to diabetic ketoacidosis. Which of the following signs and symptoms would you expect to see in this patient?* A. Kussmaul's respirations B. Glucose 110 C. Hypoventilation D. Neuro-excitability

A. Kussmaul's respirations anion gap/normal anion gap difference in serum levels between cations and anions (electrolytes, Cl, HCO2, Na, etc)normal anion gap 10-14 mEq/L For this exam ANION GAP needs to be <12 to adjust treatment in DKA

Which patient is MOST likely to develop Diabetic Ketoacidosis?* A. A 25 year old female newly diagnosed with Cushing's Disease taking glucocorticoids. B. 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. C. A 35 year old female newly diagnosed with Type 2 diabetes. D. None of the options are correct.

B

You are providing care to a patient experiencing diabetic ketoacidosis. The patient is on an insulin drip and their current glucose level is 300. In addition to this, the patient also has 5% Dextrose 0.45% NS infusing in the right antecubital vein. Which of the following patient signs/symptoms causes concern?* A. Patient complains of thirst. B. Patient has a potassium level of 2.3 C. Patient's skin and mucous membranes are dry. D. Patient is nauseous.

B Insulin causes potassium to enter back into the cell; therefore removing it from the blood. If the potassium is already 2.3, the patient can bottom out their potassium level. Therefore, the patient needs potassium supplements which requires a doctor's order.

Which of the following is not a sign or symptom of Diabetic Ketoacidosis?* A. Positive Ketones in the urine B. Oliguria C. Polydipsia D. Abdominal Pain

B Oliguria means low urinary output....in DKA you have high urinary ouput (POLYURIA).

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. Which of the following is the most appropriate nursing intervention to perform next?* A. Start the IV fluids and administer the insulin bolus and drip as ordered B. Hold the insulin and notify the doctor of the potassium level of 2.5 C. Hold IV fluids and administer insulin as ordered D. Recheck the glucose level

B Remember when insulin is given it helps take potassium back into the cell which will cause potassium blood levels to fall. Insulin therapy is to be started only if the patient's potassium level is 3.3 or greater.

A patient diagnosed with diabetes mellitus is being discharged home and you are teaching them about preventing DKA. What statement by the patient demonstrates they understood your teaching about this condition?* A. "I should not be alarmed if ketones are present in my urine because this is expected during illness." B. "It is normal for my blood sugar to be 250-350 mg/dL while I'm sick." C. "I will hold off taking my insulin while I'm sick." D. "It is important I check my blood glucose every 3-4 hours when I'm sick and consume liquids."

D

What type of insulin do you expect the doctor to order for treatment of DKA?* A. IV Novolog B. IV Levemir C. IV NPH D. IV Regular Insulin

D this is the only one that can be used via IV

A patient with Diabetic Ketoacidosis (DKA) would have an increased or decreased Aion Gap

Increase (normal range: 12mEq/L) Increased anion gap= increased acidosis

True or False: When priming the tubing for an Insulin infusion it is best practice to waste 50cc to 100cc of insulin prior to starting the infusion because insulin absorbs into the plastic lining of the tubing.* True False

True

What is the rationale for administration of potassium supplement when a patient is on insulin therapy a. Potassium replaces losses incurred with diuresis. b. The patient has been in a long-term malnourished state. c. IV potassium renders the infused solution isotonic. d. Insulin drives the potassium back into the cells.

d. Insulin drives the potassium back into the cells. ANS: DLow serum potassium (hypokalemia) occurs as insulin promotes the return of potassium into the cell and metabolic acidosis is reversed. Replacement of potassium by administration of potassium chloride (KCl) begins as soon as the serum potassium falls below normal. Frequent verification of the serum potassium concentration is required for patients with DKA who are receiving fluid resuscitation and insulin therapy.