Week 5 Simulation: Nursing Management of DKA

Question 1

Collaborative management of DKA includes what 5 things?

Answer 1

Fluid therapy, insulin therapy, correction of electrolytes, correction of acidosis, and treatment of the precipitating cause

Question 2

Fluid therapy replacement based on estimated losses

Answer 2

-100ml/kg of weight.
-During first 8 hours, pt. receives approx. one 1/2 of total fluid replacement.
-Usually use .9 normal saline
EX: pt weight 75kg=7,500 mL first 24 hours
-FIrst hour flow rates=1,000ml/hr
-Hours 2-8 (7 hours)=500ml/hr
-Hours 9-24 (16 hours)=200ml/hr=3,200mL

Question 3

inulin therapy for DKA

Answer 3

• Standard bolus dose is 0.15 u/kg

- Insulin infusions are often started at 0.1u/kg/hr

Question 4

How to give a bolus?

Answer 4

-May be administered undiluted, up to 20 units over 1 minute

Question 5

How to start insulin IV infusion?

Answer 5

• insulin IV infusion should be diluted in 0.45 or 0.9 NS
• prior to initiating the IV infusion, waste 25-50mL through the new IV tubing because insulin adheres to the IV tubing
• Measure BG hourly
• When BG reaches 250-300 mg/dL, the rate of administration of insulin is either stopped or transitioned to SQ or decreased by half to 0.05u/kg/hr until signs of acidosis have resolved

Question 6

Serum potassium in DKA may be?

Answer 6

High, normal, or low

Question 7

Potassium no no’s

Answer 7

• Never give IV push or in any concentrated form.
• Never add potassium to an IV that is infusing. After adding potassium to an IV bag, invert it several times to ensure even distribution of potassium solution

Question 8

Potassium administration IV

Answer 8

• If possible, infuse into a central vein to prevent pain at the IV site and phlebitis
• Monitor ECG of pts exceeding 10meq/hr
• Given IV 10meq/hr or a high dose of 20-40meq/hr and diluted to 10-20 meq per 100mL of solution.

Question 9

Bicarb therapy in DKA

Answer 9

• reserved for those pts with severe acidosis with a pH of less than 7.0.
• often mixed in an IV solution of water or .45NS. It is then administered slowly over 1 hour

Question 10

If sodium levels are low,then?

Answer 10

Seizure precautions are appropriate

Question 11

Most common cause of DKA?

Answer 11

Infection. Nurse should culture potential sites of infection and wait to administer antibiotics until after cultures have been obtained

Question 12

Atlanta Multiplier Method for insulin

Answer 12

atlanta multiplier method

starting rate units/hour = (BG - 60) x .02