Unit 2 (sem 4) DKA
A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? 1 Nervousness and tachycardia 2 Erythema toxicum rash and pruritus 3 Diaphoresis and altered mental state 4 Deep respirations and fruity odor to the breath
Deep respirations and fruity odor to the breath Rationale Deep respirations and a fruity odor to the breath are classic signs of DKA, because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine; this causes clinical findings such as nervousness, tachycardia, palpitations, sweating, tremors, and hunger. Erythema toxicum rash and pruritus are unrelated to diabetes; they indicate a hypersensitivity reaction. Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine.
Why does the nurse teach the parents of a young child with type 1 diabetes how to test the child's urine at home during periods of stress or illness, even though blood glucose testing is being done four times a day? 1 Urine should be tested for acetone during illness and when the blood glucose level is increased. 2 Blood glucose testing before meals and at bedtime may be stopped once the child is stabilized on insulin. 3 Urine testing remains the most accurate way to check for a high glucose level if double-voided specimens are used. 4 The short-term glucose level is more accurately reflected in a urine specimen than in a blood specimen, especially in children.
Urine should be tested for acetone during illness and when the blood glucose level is increased. Rationale Urine testing is primarily helpful in detecting ketones, which are most likely to be present during illness and hyperglycemia. Because of the complexity of the diabetic regimen and the variety of factors that influence the serum glucose level (e.g., food ingested, exercise, medications, and the stresses of growth and development), serum glucose levels in children can fluctuate; therefore the serum glucose level should be checked before meals and at bedtime. Blood, not urine, is the best specimen with which to determine the glucose level.
A school-aged child with type 1 diabetes is admitted to the pediatric unit in ketoacidosis. What sign of ketoacidosis does the nurse expect to identify when assessing the child? 1 Sweating 2 Hyperpnea 3 Bradycardia 4 Hypertension
Hypernea Rationale
A 15-year-old adolescent who has type 1 diabetes mellitus is admitted to the pediatric intensive care unit in ketoacidosis with a blood glucose level of 170 mg/dL (9.4 mmol/L). The adolescent has a history of fluctuating blood glucose readings and difficulty adhering to the therapeutic regimen. A continuous insulin infusion is started. What adverse reaction to the infusion is most important for the nurse to monitor? 1 Hypokalemia 2 Hypovolemia 3 Hypernatremia 4 Hypercalcemia
Hypokalemia Rationale Insulin moves potassium into the cells along with glucose, thus lowering the serum potassium level. Insulin does not lead to a reduced blood volume. Insulin does not directly alter the sodium levels. Insulin does not affect the calcium levels.
Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis? 1 Monitoring for signs of hypoglycemia resulting from treatment 2 Withholding glucose in any form until the situation is corrected 3 Giving fruit juices, broth, and milk as soon as the client is able to take fluids orally 4 Regulating insulin dosage according to the amount of ketones found in the client's urine
Monitoring for signs of hypoglycemia resulting from treatment Rationale During treatment for acidosis, hypoglycemia may develop; careful observation for this complication should be made by the nurse. Withholding all glucose may cause insulin coma. Whole milk and fruit juices are high in carbohydrates, which are contraindicated immediately following ketoacidosis. The regulation of insulin depends on the prescription for coverage; the prescription usually depends on the client's blood glucose level rather than ketones in the urine.
The nurse caring for a client with diabetic ketoacidosis (DKA) can expect to implement which intervention? 1 Intravenous administration of regular insulin 2 Administer insulin glargine subcutaneously at hour of sleep 3 Maintain nothing prescribed orally (NPO) status 4 Intravenous administration of 10% dextrose
Intravenous administration of regular insulin Rationale 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.
A newborn whose mother has type 1 diabetes has been receiving a continuous infusion of fluids with glucose. What should the nurse do when there is a prescription to discontinue the infusion? 1 Gradually decrease the rate. 2 Observe for metabolic alkalosis. 3 Withhold oral feedings for several hours. 4 Perform glucometer readings every hour
Gradually decrease the rate Rationale A gradual decrease in the administration of intravenous glucose is necessary to prevent a hypoglycemic reaction. Metabolic alkalosis will not occur with discontinuation of the glucose; it occurs with excessive amounts of bicarbonate. Withholding oral feedings when an intravenous infusion of glucose is discontinued may result in hypoglycemia. It is not necessary to perform frequent glucometer readings because hypoglycemia is unlikely to occur when the glucose infusion rate is decreased gradually and feedings are instituted.
An unconscious 16-year-old adolescent with type 1 diabetes is brought to the emergency department. The blood glucose level is 742 mg/dL (41.2 mmol/L). What finding does the nurse expect during the initial assessment? 1 Pyrexia 2 Hyperpnea 3 Bradycardia 4 Hypertension
Hyperpnea Rationale Rapid breathing is an attempt by the respiratory system to eliminate excess carbon dioxide; it is a characteristic compensatory mechanism for correcting metabolic acidosis. An increase in temperature will occur if an infection is present; it is not a response to hyperglycemia. Tachycardia, not bradycardia, results from the hypovolemia of dehydration. Hypotension, not hypertension, may result from the decreased vascular volume associated with hyperglycemia.
An adolescent with a history of type 1 diabetes is admitted in ketoacidosis. What does the nurse suspect as a precipitating cause of this episode of ketoacidosis? 1 Infection 2 Increased exercise 3 Recent weight loss 4 Overdose of insulin
Infection Rationale The stress of an infection increases the body's metabolism; the presence of glucocorticoids results in hyperglycemia. Exercise causes a decrease in insulin needs that results in hypoglycemia, not hyperglycemia and ketoacidosis. Rapid weight loss causes a decrease in insulin needs that results in hypoglycemia, not hyperglycemia and ketoacidosis. Excessive insulin results in hypoglycemia, not hyperglycemia and ketoacidosis.
The nurse is providing teaching to a client who recently has been diagnosed with type 1 diabetes. The nurse reinforces the importance of monitoring for ketoacidosis. What are the signs and symptoms of ketoacidosis? Select all that apply. 1 Confusion 2 Hyperactivity 3 Excessive thirst 4 Fruity-scented breath 5 Decreased urinary output
Confusion, excessive thirst, fruity-scented breath Rationale Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. Diabetic ketoacidosis is a serious complication of diabetes that occurs when the body produces high levels of ketones (blood acids). Diabetic ketoacidosis develops when the body is unable to produce enough insulin. Without enough insulin, the body begins to break down fat as an alternative fuel. This process produces a buildup of ketones (toxic acids) in the bloodstream, eventually leading to diabetic ketoacidosis if untreated. Signs and symptoms include excessive thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion. Frequent urination, not decreased urination, is a symptom. Weakness or fatigue, not hyperactivity, is a symptom.
The nurse is testing newborns' heel blood for the level of glucose. Which newborn does the nurse anticipate will experience hypoglycemia? Select all that apply. 1 Preterm infant 2 Infant with Down syndrome 3 Small-for-gestational-age infant 4 Large-for-gestational-age infant 5 Appropriate-for-gestational-age infant
Preterm infant Small for gestational age Large for gestational age Rationale Preterm infants have low glycogen stores. Small-for-gestational-age infants also have low glycogen stores. Large-for-gestational-age infants are prone to hyperinsulinemia; often they are born to mothers who have diabetes, meaning that they are exposed to a high circulating glucose level while in utero. After prolonged exposure to a high glucose level, hyperplasia of the pancreas occurs, resulting in hyperinsulinemia. Infants with Down syndrome are not at risk for hypoglycemia but are at risk for congenital cardiac defects. Appropriate-for-gestational-age infants are not at risk for hypoglycemia.
