DKA Flashcards
what is dka
absence or inadequate amount of insulin resulting in abnormal metabolism of carbs, protein, and fat
what are the 3 main features of dka
hyperglycemia
dehyration and electrolye loss
acidosis
who is at higher risk for dka
type 1 diabetics
what causes a severe lack of insulin
decreased or missed dose of insulin
illness/infection- increased stress
undiagnosed diabetes
what are the primary symptoms of dka
polyuria
polydipsia
fatigue
what is the onset of dka
rapid
<24 hrs
hwat are some other symptoms of dka
decreased loc
blurred vision
weakness
headache
orthostatic hypotension
anorexia
n/v
abd pain
dry skin/mouth
hyperventilation (kussmaul resp)
what is the bg range for dka
250-800
are blood ketones high or low
high
what does urinalysis show
positive ketones
glucose
what does ABG show
metabolic acidosis
low ph and HCO3
resp compensation
low co2
what do electrolyes show
sodium and potassium levels vary according to severity of dehydration
is BUN/creatinine high or low
high
is hct high or low
high
why is potassium more likely to be high in pt with dka
disruption of sodium-potassium pump
exits cell d/t acidosis
assessment findings with dka
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
what might cardiac arrhythmias be present
increased potassium
what must be corrected with dka
acidosis
dehydration
electrolyte imbalances
hyperglycemia
inital tr4eatment of dka
iv fluid replacement- rapid infsuion of 0.9% NS- isotonic
IV reg insulin infusion- slow infusion rate (5 units/hr)
what reverses the acidosis
insulin
what considerations for dka pt recieving iv insulin
slow infusion
hourly bg monitoring
iv fluid w/ glucose when bg reaches 250-300
infusion must continue until subq insulin admin can be resumed
what happens to potassium throughout treatment of dka
too high… to low
acidosis reversed
increased urination
when should potassium replacement begin
once levels are normal
when do you hold replacement
hyperkalemia or no urination
pot complications of treatment
fluid overload
hypoglycemia
hypokalemia
cerebral edema
nsg management
encourage oral fluid intake
monitor i/o
vs
labs
ecg
assessment
teach to avoid activities that increased ic pressure
what are the sick day rules
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
expected pt outcomes
achieves fluid and electrolye balance
demonstrates knowlegde ab dka
decreased anxiety
absence of complicatiosn
