4400 DKA quiz

Question 1

main cause of DKA

Answer 1

insulin deficiency

Question 2

what are two compensatory mechanisms with ketone accumulation (acidosis)

Answer 2

vomiting & kussmaul resps

to restore acid-base balance by expelling HCl & CO2

Question 3

what is the negative consequence of the compensatory mechanisms for acidosis?

Answer 3

contributes to dehydration

Question 4

common presenting symptoms of DKA

Answer 4

kussmaul resps; nausea/vomiting/anorexia; abdominal pain; reduced urine output; signs of dehydration; tachycardia; change in LOC; possible loss of BP (late sign)

Question 5

why do some adolescents omit use of insulin?

Answer 5

binge eating/extreme dieting

omiting insulin>hyperglycemia>glycosuria> can consume more calories without gaining weight

Question 6

what are some important teaching points re: DKA for secondary prevention?

Answer 6

• frequent self-monitoring of blood glucose and ketones
• raise awareness of the consequences of insulin omission
• possibility of delivery failure

Question 7

what is the primary way DKA is managed? how? why?

Answer 7

fluid resusitation with normal saline to start

this treats dehydration and enhances urine output which allows better elimination of ketones and glucose

Question 8

once rehydrated, how would you adjust the IV fluid therapy?

Answer 8

give 0.45 sodium chloride

Question 9

when someone is on IV fluid therapy - what is important to monitor & document?

Answer 9

strict I & O

Question 10

why is contiuous electrocardiographic monitoring necessary for children with DKA?

Answer 10

changes in the QRS complex provide important clues concerning hyperkalaemia and hypokalaemia

Question 11

what happens to blood glucose levels during fluid resusitation?

Answer 11

tends to fall rapidly so hourly BG testing

Question 12

what other therapy is introduced 1-2 hours after fluid replacement therapy?

Answer 12

Continuous intravenous insulin infusion, required to normalize blood glucose by facilitating its entry into cells - stops ketogenesis & reverses acidosis

Question 13

what conditions should there be to switch to sub q insulin?

Answer 13

BG normalizes
oral intake of fluids est.
ketoacidosis no longer cause for concern

Question 14

what is one cause of ketoacidosis that you may not think of right away?

Answer 14

infection!

Question 15

what is a complication of DKA?

Answer 15

cerebral edema

Question 16

Warning signs of cerebral edema

Answer 16

Headache; Return of vomiting; Behavioural changes; change in LOC; elev. BP and lower pulse; lower O2 sat

Question 17

what are interventions re: cerebral edema

Answer 17

slow down pace of IV fluid resusitation even further
admin of cerebral diuretic Mannitol
Hypertonic saline if mannitol doesn’t have desired effect
Intubation may be required to protect the airway and support ventilation

Question 18

monitoring of pt. re: cerebral edema

Answer 18

HOURLY:

vital signs; neuro; strict I&O; BG; urinary ketones; electrocardiogram