Diabetic Ketoacidosis (DKA)

Question 1

Definition DKA

Answer 1

Life threatening complications of DM >>> No insulin,
 fat burning(ketones) = hyperglycemia-ketosis - acidosis

Question 2

What are a very acidic

Answer 2

Ketones

Question 3

What happens when body cannot tolerate excessive ketones?

Answer 3

PH start drop less than 7.35 start entering into metabolic acidosis

Question 4

When entering metabolic acidosis

Answer 4

When PH less than 7.35

Question 5

Causes of DKA

Answer 5

• 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

Question 6

sign and symptoms of DKA

Answer 6

Polyuria&raquo_space;> dehydration

Ketone in blood&raquo_space;> blood PH less than 7.35»> metabolic acidosis»> acetone breath

Weight loss
# All these symptoms happen suddenly |
Kussmaul breathing

Question 7

Kussmaul breathing

Answer 7

Rapid, deep breathing because metabolic acidosis

Question 8

Nursing interventions for DKA

Answer 8

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

Question 9

Pharmacological Goal (DKA)

Answer 9

علاج الجفاف + خفض السكر لو كان عالي + نشوف البوتاسيوم ليفل علشان cerebral edema + correct acid-base imbalance

Question 10

Administration i.v fluid for DKA

Answer 10

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

Question 11

شو نوع الانسلين الي بينعطى لمريض الDKA؟

Answer 11

Regular insulin iv

Question 12

Only insulin that can be given IV is ?

Answer 12

Regular insulin

Question 13

قبل ما تبدا في اعطاء الانسلين لمريض DKA شو بتعمل

Answer 13

Monitor potassium level

Question 14

لازم البوتاسيم يكون في مريض الDKA اكثر من

Answer 14

3.3

Question 15

وانت بتعطي المريض الانسلين بدك تراقبوا كل

Answer 15

15 minutes

Question 16

Which of the following is not a sign or symptom of Diabetic Ketoacidosis?
Positive Ketones in the urine
Oliguria 
Polydipsia
Abdominal Pain

Answer 16

Oliguria

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

Question 17

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

Answer 17

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.

Question 18

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.

Answer 18

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.

Question 19

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

Answer 19

Extreme Hyperglycemia that presents with blood glucose >600 mg/dL

Question 20

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

Answer 20

T

Question 21

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.

Answer 21

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.

Question 22

What type of insulin do you expect the doctor to order for treatment of DKA?
IV Novolog
IV Levemir
IV NPH
IV Regular Insulin

Answer 22

iv Regular Insulin

Question 23

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.”

Answer 23

“It is important I check my blood glucose every 3-4 hours when I’m sick and consume liquids.”