Complex Care: DKA

What is the recommended glucose level of start Dextrose in order to prevent hypoglycemia

250mg/dL

A patient comes to the emergency department with a complaint of nausea, vomiting, and abdominal pain. She is a type 1 diabetic. Four days earlier, she reduced her insulin dose due to flu symptoms and decreased nutritional intake. The nurse performs an assessment of the patient that reveals poor skin turgor, dry mucous membranes, kussmaul respirations, and fruity breath odor. The nurse prioritizes which of the following interventions? Select all that apply. A. Fluid replacement B. IV Regular Insulin C. chest x-ray and bronchoscopy D. Monitor electrolytes and blood glucose levels closely during therapy

A. Fluid replacement B. IV Regular Insulin D. Monitor electrolytes and blood glucose levels closely during therapy

A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis. What is the initial intervention the nurse should expect the primary healthcare provider to prescribe for this client? A. Intravenous (IV) fluids B. Potassium C. NPH insulin (Novolin N) D. Sodium polystyrene sulfonate (Kayexalate)

A. Intravenous (IV) fluids IV fluids are given to combat dehydration in ketoacidosis and to keep an IV line open for administration of medications. After electrolyte levels are evaluated, potassium may be added along with insulin. In acidosis, potassium ions initially shift from the intracellular to extracellular compartment, resulting in hyperkalemia; as acidosis is corrected, hypokalemia may occur, and then potassium may be administered. NPH insulin is an intermediate-acting insulin; rapid-acting insulin is indicated in an emergency. Sodium polystyrene sulfonate is not indicated; abnormally high serum potassium levels will revert once dehydration is corrected.

After assessing a client, a nurse concludes that the client may be experiencing hyperglycemia. Which clinical findings commonly associated with hyperglycemia support the nurse's conclusion? Select all that apply. A. Polyuria B. Polydipsia C. Polyphagia D. Polyphrasia E. Polydysplasia

A. Polyuria B. Polydipsia C. Polyphagia Polyuria is excessive urination associated with osmotic diuresis. Polydipsia is excessive thirst associated with hyperglycemia; thirst is the response to osmotic diuresis and glycosuria. Polyphagia is associated with the catabolic state induced by insulin deficiency. Polyphrasia is excessive talking associated with mental illness, not hyperglycemia. Polydysplasia is related to multiple developmental abnormalities and is unrelated to hyperglycemia.

If the Potassium levels are falling after giving the patient Insulin with DKA, the treatment would be considered adequate or inadequate

Adequate

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? A. Abnormal P waves and depressed T waves B. Peaked T waves and widened QRS complexes C. Abnormal Q waves and prolonged ST segments D. Peaked P waves and an increased number of T waves

B. Peaked T waves and widened QRS complexes Potassium is the principal intracellular cation, and during ketoacidosis it moves out of cells into the extracellular compartment to replace potassium lost as a result of glucose-induced osmotic diuresis; overstimulation of the cardiac muscle results. The T wave is depressed in hypokalemia. Initially, the QT segment is short, and as the potassium level rises, the QRS complex widens. P waves are abnormal because the PR interval may be prolonged and the P wave may be lost; however, the T wave is peaked, not depressed. The ST segment becomes depressed. The PR interval is prolonged, and the P wave may be lost. QRS complexes and thus T waves become irregular, and the rate does not necessarily change.

A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe? A. NPH insulin B. Inhaled insulin C. Regular insulin D. Insulin glargine

C. Regular insulin

Which condition is a result of insulin deficiency and glucagon excess leads to the promotion of lipolysis, increase FFA delivery to the liver where they are converted to free fatty Acyl CoA ketones

Diabetic Ketoacidosis

If a patient with a history of Type I Diabetes presents with the signs/syptoms of rapid onset, glucose level of 340mg/dL, POLYURIA, POLYDISPIA, weight loss, voimting, abdominal pain, EXCESSIVE DEHYDRATION, dry skin, drink muscus membrane, tachycardia, weakness, FRUITY BREATH, neurological deficit & KUSSMAUL RESPIRATIONS, the nurse would expect which condition.......

Diabetic Ketoacidosis (DKA)

If a patient has an ABG of pH: 7.16 PCO2: 27 PO2: 106 Sat: 96%; Anion Gap of 20 & BG: 496mg/dL

Diabetic Ketoacidosis (DKA) & Metabolic Acidosis

Diabetic Ketoacidosis (DKA) Nursing Interventions: 1. Aggressive Hydration (e.g. Fluids)-->2. Insulin Infusion to correct gluocse & acidosis (e.g. bolus)-->3. Glucose < 300mg/dL, begin dextrose-->4. Urine output, start potassium-->5. correct electrolytes abnormailites-->6. protect airway if altered mental status

Diabetic Ketoacidosis (DKA) Nursing Interventions: 1. Aggressive Hydration (e.g. Fluids)-->2. Insulin Infusion to correct gluocse & acidosis (e.g. bolus)-->3. Glucose < 300mg/dL, begin dextrose-->4. Urine output, start potassium-->5. correct electrolytes abnormailites-->6. protect airway if altered mental status

A patient with Diabetic Ketoacidosis (DKA) would have.......dehydration

Excessive

What is the main breath smell for Diabetic Ketoacidosis (DKA).....

Fruity Breath

What is the glucose levels of Diabetic Ketoacidosis (DKA).....

Glucose Levels > 300mg/dL

At what Potassium should be stated in order to continue or give an Insulin Bolus

Greater than 3.3mE1/L

If the Potassium levels are NOT falling after giving the patient Insulin with DKA, the treatment would be considered adequate or inadequate

Inadequate

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

Increase (normal range: 12-15mEq/L)

What is the rationale for administration of potassium supplement when a patient is on insulin therapy

Insulin drives Potassium back into the cell

What type of respirations would present for a patient with Diabetic Ketoacidosis (DKA).....

Kussmaul Respirations

What Diabetic Ketoacidosis complication is a result of ketones exerting in a strong osmotic effect with volume and electrolyte depletion (e.g. urinary ketones also promote excretion of positvely ​charged ions)

Osmotic Diuresis

What type of urine would the patient have with Diabetic Ketoacidosis (DKA)

Postive Urine Ketones

Why give the patient Dextrose after an Insulin Bolus

Prevent Hypoglycemia

The onset of Diabetic Ketoacidosis (DKA) is.....

Rapid

Which Diabetic Population usually present with Diabetic Ketoacidosis (DKA)

Type I

Can Type II Diabetic Patients present with Diabetic Ketoacidosis (DKA) if under exterme stress

Yes