DKA

Question 1

what is dka

Answer 1

absence or inadequate amount of insulin resulting in abnormal metabolism of carbs, protein, and fat

Question 2

what are the 3 main features of dka

Answer 2

hyperglycemia
dehyration and electrolye loss
acidosis

Question 3

who is at higher risk for dka

Answer 3

type 1 diabetics

Question 4

what causes a severe lack of insulin

Answer 4

decreased or missed dose of insulin
illness/infection- increased stress
undiagnosed diabetes

Question 5

what are the primary symptoms of dka

Answer 5

polyuria
polydipsia
fatigue

Question 6

what is the onset of dka

Answer 6

rapid
<24 hrs

Question 7

hwat are some other symptoms of dka

Answer 7

decreased loc
blurred vision
weakness
headache
orthostatic hypotension
anorexia
n/v
abd pain
dry skin/mouth
hyperventilation (kussmaul resp)

Question 8

what is the bg range for dka

Answer 8

250-800

Question 9

are blood ketones high or low

Answer 9

high

Question 10

what does urinalysis show

Answer 10

positive ketones
glucose

Question 11

what does ABG show

Answer 11

metabolic acidosis
low ph and HCO3
resp compensation
low co2

Question 12

what do electrolyes show

Answer 12

sodium and potassium levels vary according to severity of dehydration

Question 13

is BUN/creatinine high or low

Answer 13

high

Question 14

is hct high or low

Answer 14

high

Question 15

why is potassium more likely to be high in pt with dka

Answer 15

disruption of sodium-potassium pump
exits cell d/t acidosis

Question 16

assessment findings with dka

Answer 16

neuro: low gcs, confusion, ketotic breath, headache
cardiac: tachy, hypotension, dehydration
resp: kussmaul breathing
musculoskeletal: leg cramps
GI: n/v, abd pain
GU: polydipsia an polyuria

Question 17

what might cardiac arrhythmias be present

Answer 17

increased potassium

Question 18

what must be corrected with dka

Answer 18

acidosis
dehydration
electrolyte imbalances
hyperglycemia

Question 19

inital tr4eatment of dka

Answer 19

iv fluid replacement- rapid infsuion of 0.9% NS- isotonic
IV reg insulin infusion- slow infusion rate (5 units/hr)

Question 20

what reverses the acidosis

Answer 20

insulin

Question 21

what considerations for dka pt recieving iv insulin

Answer 21

slow infusion
hourly bg monitoring
iv fluid w/ glucose when bg reaches 250-300
infusion must continue until subq insulin admin can be resumed

Question 22

what happens to potassium throughout treatment of dka

Answer 22

too high… to low
acidosis reversed
increased urination

Question 23

when should potassium replacement begin

Answer 23

once levels are normal

Question 24

when do you hold replacement

Answer 24

hyperkalemia or no urination

Question 25

pot complications of treatment

Answer 25

fluid overload
hypoglycemia
hypokalemia
cerebral edema

Question 26

nsg management

Answer 26

encourage oral fluid intake
monitor i/o
vs
labs
ecg
assessment
teach to avoid activities that increased ic pressure

Question 27

what are the sick day rules

Answer 27

take insulin/oral antidiabetic as usual
test bg and urine ketones every 3-4 hrs
report elevated glucose as specified or urine ketones to pcp
take supplemental doses or reg insulin every3-4 hrs if needed
substitute soft foods 6-8x per day if you cant follow usual meal plan
take liquids every 1/2 to 1 hour to prevent dehydration and to provide calories if v/d or fever persists
report n/v/d to pcp

Question 28

expected pt outcomes

Answer 28

achieves fluid and electrolye balance
demonstrates knowlegde ab dka
decreased anxiety
absence of complicatiosn