What are ELEVEN (11) S&S of DKA?
- Polyuria
- Polydipsia
- Polyphasia
- Weight loss
- Vomiting
- ABD pain
- Dehydration
- Weakness
- Altered mental status
- Shock
- Coma
What is the MOST COMMON precipitating FACTOR for developing DKA?
Infection
DKA results from a combination of _____________ and _____________.
- Insulin deficiency
2. ⬆️ counterregulatory hormone release
What are FIVE (5) indicators that the patient consistently demonstrates EXPECTED OUTCOME of CONTROLLED BS?
- Maintain BS within target range 🌡🎚
- Adjust insulin doses to match eating patterns 🍽 and times of illness 🤒
- Maintains easily digestible liquid diet containing carbs + salt 🥛
- Describes correct procedure for urine ketone testing
- Describes when to seek help 🚨 from health care provider 👩🏽⚕️
The ONSET of DKA is __________.
Sudden
Precipitating FACTORS of DKA include infection, stress and ____________.
Inadequate insulin dose
What FIVE (5) things are PRIORITY ASSESSMENTS for DKA patient?
- Airway 😗💨
- LOC 🙇🏾♀️
- Hydration 💧
- Electrolytes
- Blood Glucose Level 🌡
True or False: skin turgor can be used to assess hydration status in older adults.
FALSE, d/t loss of elasticity and dryness from aging, skin turgor is an UNRELIABLE sign of dehydration in older adults.
What are the TWO (2) main GOALS of FLUID THERAPY?
- Restore volume
2. Maintain perfusion to the brain 🙇🏾♀️, heart ❤️ and kidneys
What would be your (5) ASSESSMENT findings in a patient wit POOR KIDNEY FUNCTION and EXCESS FLUID volume?
- Edema;
Around the eyes 👀
In the limbs 🖐🏾💪🏽👣 - ABD girth
- ⬆️ BP
- Jugular Distention
- Orthostatic hypostension
What does ORTHOSTATIC HYPOTENSION INDICATE?
Volume depletion
Typical IV INFUSION rates for the FIRST HOUR of FLUID THERAPY start at ____ to ____ mL/kg/hr.
15-20 mL/kg/hr
HYPOTONIC fluids are generally INFUSED at what RATE following the initial fluid bolus?
4-14 mL/kg/hr
When BLOOD GLUCOSE reaches 250 give __________________.
5% dextrose in 0.45% NS
5% DEXTROSE in 0.45% NS prevents ________ and ________.
Cerebral Edema
Hypoglycemia
During the first 24 hours of treatment the patient needs roughly ____ to ____ L of fluids to replace volume deficit and ongoing losses.
6-10 L
During fluid replacement the nurse should monitor for ____________.
Fluid overload
What is the GOAL of INSULIN THERAPY?
Lower serum glucose by about 50-75 mg/dL/hr
What would be a CONTRADICTION of CONTINUOUS IV INSULIN infusion?
DKA is mild
What are laboratory signs that the DKA has RESOLVED?
- Blood glucose < 200
- HCO3 < 18
- pH > 7.3
- Anion Gap < 12
What is the NORMAL RANGE for ANION GAP?
7-9
What are EIGHT (8) ASSESSMENT FINDINGS of HYPOKALEMIA?
- Fatigue 😴
- Malaise
- Confusion
- Muscle Weakness 💪🏽
- Shallow Respirations
- ABD Distention/ paralytic ileus
- Hypotension
- Weak Pulse
What is a common CAUSE of DEATH with the TREATMENT of DKA?
Hypokalemia
The nurse is educating a patient with DM proper blood glucose management and how to avoid DKA from occurring when ill. What will the nurse inform the pt to do when exhibiting symptoms of N/V, anorexia and blood glucose levels exceeding 250 mg/dL?
Check blood glucose levels every 4-6 hours.
