Diabetic Ketoacidosis (DKA) Flashcards
Definition DKA
Life threatening complications of DM >>> No insulin, fat burning(ketones) = hyperglycemia-ketosis - acidosis
What are a very acidic
Ketones
What happens when body cannot tolerate excessive ketones?
PH start drop less than 7.35 start entering into metabolic acidosis
When entering metabolic acidosis
When PH less than 7.35
Causes of DKA
- المريض ما بيكون عارف انو مريض بالسكري
- مريض السكري ما بيوكل او عمل سكيب على موعد وجبة معينه فا بيبدا يجوع فا بيبلش الجسم يحرق بالدهون فا الدهون بتطلق الketones
sign and symptoms of DKA
Polyuria»_space;> dehydration
Ketone in blood»_space;> blood PH less than 7.35»> metabolic acidosis»> acetone breath
Weight loss
# All these symptoms happen suddenly |
Kussmaul breathing
Kussmaul breathing
Rapid, deep breathing because metabolic acidosis
Nursing interventions for DKA
Education > teaching pt how to prevent + warnings signs
Tell the patient they need monitor their glucose and urine ketones 24h when they’re sick
Notify if blood glucose >300mg/dl
Excessive urination + thirst +
+ نشوف البوتاسيوم ليفل علشان cerebral edema + correct acid-base imbalance
Pharmacological Goal (DKA)
علاج الجفاف + خفض السكر لو كان عالي + نشوف البوتاسيوم ليفل علشان cerebral edema + correct acid-base imbalance
Administration i.v fluid for DKA
Start out 0.9% normal saline isotonic they depending on severity of dehydration
5% dextrose half-normal saline whenever glucose level is reading 250-300mg/dl
شو نوع الانسلين الي بينعطى لمريض الDKA؟
Regular insulin iv
Only insulin that can be given IV is ?
Regular insulin
قبل ما تبدا في اعطاء الانسلين لمريض DKA شو بتعمل
Monitor potassium level
لازم البوتاسيم يكون في مريض الDKA اكثر من
3.3
وانت بتعطي المريض الانسلين بدك تراقبوا كل
15 minutes
Which of the following is not a sign or symptom of Diabetic Ketoacidosis? Positive Ketones in the urine Oliguria Polydipsia Abdominal Pain
Oliguria
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?
Start the IV fluids and administer the insulin bolus and drip as ordered
Hold the insulin and notify the doctor of the potassium level of 2.5
Hold IV fluids and administer insulin as ordered
Recheck the glucose level
Hold the insulin and notify the doctor of the potassium level of 2.5
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.
Which patient is MOST likely to develop Diabetic Ketoacidosis?
A 25 year old female newly diagnosed with Cushing’s Disease taking glucocorticoids.
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.
A 35 year old female newly diagnosed with Type 2 diabetes.
None of the options are correct.
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.
Which of the following statements are INCORRECT about Diabetic Ketoacidoisis?
Extreme Hyperglycemia that presents with blood glucose >600 mg/dL
Ketones are present in the urine
Metabolic acidosis is present with Kussmaul breathing
Potassium levels should be at least 3.3 or higher during treatment of DKA with insulin therapy
Extreme Hyperglycemia that presents with blood glucose >600 mg/dL
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
T
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?
Patient complains of thirst.
Patient has a potassium level of 2.3
Patient’s skin and mucous membranes are dry.
Patient is nauseous.
Patient has a potassium level of 2.3
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.
What type of insulin do you expect the doctor to order for treatment of DKA? IV Novolog IV Levemir IV NPH IV Regular Insulin
iv Regular Insulin
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?
“I should not be alarmed if ketones are present in my urine because this is expected during illness.”
“It is normal for my blood sugar to be 250-350 mg/dL while I’m sick.”
“I will hold off taking my insulin while I’m sick.”
“It is important I check my blood glucose every 3-4 hours when I’m sick and consume liquids.”
“It is important I check my blood glucose every 3-4 hours when I’m sick and consume liquids.”
