Category: Diet

DKA nursing interventions

DKA nursing interventions

Through thorough education and nursinf monitoring, nurses foster patient DKA nursing interventions and promote self-management, contributing to improved long-term diabetes control. Promoting Infection Control and Preventing Infection Infection is the most common predisposing factor for the development of a hyperglycemic crisis, which is DKA. Nursing Lung Assessment. DKA nursing interventions

DKA nursing interventions -

All of those types of things can increase the patient's insulin requirements. So when a patient's insulin requirements change, it might be difficult for them to keep up with their blood sugars and to keep them in a normal range. Other important factors that can influence this are lifestyle factors.

So, things like drinking too much alcohol and drug abuse. The desired outcome for a patient that's in DKA is number one, to maintain blood glucose level within the target range, and then two, to maintain normal fluid balance.

So, let's get started with our care plan by looking at the subjective data associated with DKA. Things that you're going to see with this patient is excessive thirst, nausea, abdominal pain, weakness and fatigue, shortness of breath, sometimes blurry vision and excessive urination.

So, the first P is polydipsia, which is excessive thirst. The second P is polyuria, which is excessive urination, and the third P is polyphagia, where you've got excessive hunger. For your objective patient with this, you're going to see vomiting, they may have fruity-scented breath, confusion, hyperglycemia, so the blood sugar level is usually greater than , high urine ketone levels and Kussmaul respirations, which is just deep-labored breathing that is often associated with metabolic acidosis.

Then, when you look further into the blood, you're going to see potentially even high ketone levels also, so you've got that high blood sugar level and a high ketone level as well, and with the metabolic acidosis that we mentioned, you're going to see an elevated anion gap. For your nursing interventions, obviously, probably the first and most important thing to be aware of is that you want to monitor blood glucose levels very closely and you may need to administer insulin as appropriate for that patient.

Again, the major problem the body is having is that it doesn't have that insulin that's going to allow the body to use the sugar for energy. So, you're getting those really high blood sugar levels and that is what's triggering the body to produce those ketones because it's not able to use them.

So when we give the body insulin, it can start to use the glucose for energy, and eventually the body will stop producing those ketones because it doesn't have to use the fat. Okay, your next intervention here and it's equally as important as the intervention we just talked about, is to monitor fluid and electrolytes very, very closely to prevent dehydration and complications such as hyponatremia.

So, a drop in sodium and hyperkalemia, those are really important to try and monitor, so that we can prevent those issues. You can also see changes in calcium and magnesium, but the most common ones are going to be related to sodium and potassium. Major, major issues can arise from electrolyte abnormalities.

The two most common ones that are really problematic are cerebral edema and cardiac arrhythmias, and really managing DKA is all about a balancing act.

So, it's keeping that patient hydrated, keeping electrolytes in balance, bringing ketones and blood sugar levels down to a normal level, and actually this can be really tricky for a lot of different reasons, but the key for us is that we're going to be monitoring it closely, so that we can balance it all and make sure that insulin doses, fluids, and additives can all be adjusted to maintain that balance.

Your next intervention here, is focused on finding out why we need to know again, why have this patient in DKA, remember a common cause is infection. So, you want to be looking for signs of infection so that we can treat it.

Remember, if the patient is sick, this is going to make their insulin needs go up, so we need to treat that infection so we can get their insulin level requirements back down to normal. Infections that may commonly cause this type of problem for a diabetic patient are things like pneumonia and a urinary tract infection.

Okay, the next one on our list for intervention, is you're going to be expecting to administer some medications and some fluids as appropriate and as prescribed.

Some things that you should be expecting to administer to these patients we've already said, are insulin, potassium, and antibiotics.

You also may be giving medications to help treat nausea and vomiting, so be on the lookout for that as well. Okay, so earlier on we mentioned complications up here like cerebral edema and hypokalemia, but these patients are also at risk for having sepsis and shock, so it's really important to look out for signs that the patient is becoming hypovolemic.

Remember, we're talking about maintaining that balance for this patient, so we want to keep a close eye on their vital signs in addition to those electrolytes we talked about, looking for those signs of hypovolemia and sepsis.

So, we want to think about things that are going to show us the signs of decreased blood pressure, delayed capillary refill and increased heart rate. All those things are going to give us an indication that maybe the patient is hypovolemic and maybe becoming septic.

Okay, moving on to our last two interventions here, we're going to think about patient safety and patient education. So, for our patient safety, we really need to prevent injuries and falls by assisting with ambulation and making sure that the patient's environment is safe. Remember, these patients are fatigued and they're weak.

They've got a lack of energy, so it's really important that we assist them and make sure that that doesn't cause any problems for them.

Once that DKA is in check and the patient's blood sugar levels and ketones have all normalized, it's really important to provide education, especially nutritional and lifestyle education for these patients. Sometimes this means re-educating on their insulin requirements and compliance with diet, but then it's also teaching them how they can manage when they're sick and stressed out.

So, it's really, really important that they know when they need to seek medical support and that they are aware of any symptoms that are associated with DKA, so that they can seek help very, very quickly. Alright, that is all on our nurse care plan lesson for diabetic ketoacidosis. We love you guys.

Now, go out and be your best selves today and as always, happy nursing! View the FULL Transcript When you start a FREE trial you gain access to the full outline as well as:. Nursing Care Plans. Miriam Wahrman. Nichole Weaver.

Kristen Salisbury. Cardiovascular Cardiac, CVD Care Plans. Eyes, Ears, Nose, Throat EENT Care Plans. To prevent the complications of diabetes like ketoacidosis, the condition is best managed by an interprofessional team that includes the nurse practitioner, pharmacist, primary care provider, and an endocrinologist; all these clinicians should educate the patient on glucose control at every opportunity.

The diabetic nurse should follow all outpatients to ensure medication compliance, followup with clinicians, and adopting a positive lifestyle. Further, the nurse should teach the patient how to monitor home blood glucose and the importance of careful monitoring of blood sugars during infection, stress, or trauma.

The physical therapist should be involved in educating the patient on exercise and the importance of maintaining healthy body weight. The social worker should be involved to ensure that the patient has the support services and financial assistance to undergo treatment.

The members of the interprofessional team should communicate to ensure that the patient is receiving the optimal standard of care. The American Association of Clinical Endocrinologists and the American College of Endocrinology have reviewed reported cases of DKA in patients taking SGLT2 inhibitors.

Therefore, rather than relying on the presence of hyperglycemia, close attention to signs and symptoms of DKA is needed. In May , the US Food and Drug Administration FDA issued a warning [B] that treatment with sodium-glucose transporter-2 SGLT2 inhibitors, which include canagliflozin, dapagliflozin, and empagliflozin, may increase the risk of diabetic ketoacidosis DKA in patients with diabetes mellitus.

The FDA Adverse Event Reporting System database identified 20 cases of DKA in patients treated with SGLT2 inhibitors from March to June Disclosure: Pranita Ghimire declares no relevant financial relationships with ineligible companies.

Disclosure: Amit Dhamoon declares no relevant financial relationships with ineligible companies. Disclosure: Chaddie Doerr declares no relevant financial relationships with ineligible companies. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.

You are not required to obtain permission to distribute this article, provided that you credit the author and journal. Turn recording back on.

National Library of Medicine Rockville Pike Bethesda, MD Web Policies FOIA HHS Vulnerability Disclosure. Help Accessibility Careers. Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation. Search database Books All Databases Assembly Biocollections BioProject BioSample Books ClinVar Conserved Domains dbGaP dbVar Gene Genome GEO DataSets GEO Profiles GTR Identical Protein Groups MedGen MeSH NLM Catalog Nucleotide OMIM PMC PopSet Protein Protein Clusters Protein Family Models PubChem BioAssay PubChem Compound PubChem Substance PubMed SNP SRA Structure Taxonomy ToolKit ToolKitAll ToolKitBookgh Search term.

StatPearls [Internet]. Treasure Island FL : StatPearls Publishing; Jan-. Show details Treasure Island FL : StatPearls Publishing ; Jan-. Search term. Ketoacidosis Nursing Pranita Ghimire ; Amit S. Author Information and Affiliations Authors Pranita Ghimire ; Amit S.

Affiliations 1 SUNY Upstate Medical University. Learning Outcome Recall the cause of diabetic ketoacidosis. Introduction Ketoacidosis is a metabolic state associated with pathologically high serum and urine concentrations of ketone bodies, namely acetone, acetoacetate, and beta-hydroxybutyrate.

Nursing Diagnosis Nausea, vomiting. Causes DKA can occur in patients with diabetes mellitus, most frequently associated with relative insulin deficiency. Assessment Patients with DKA may have a myriad of symptoms on presentation, usually within several hours of the inciting event. Evaluation The initial laboratory evaluation of a patient with suspected DKA includes blood levels of glucose, ketones, blood urea nitrogen, creatinine, electrolytes, calculated anion gap, arterial blood gases, osmolality, complete blood count with differential, blood cultures and urine studies including ketones, urinalysis, urine culture, chest radiograph, and an electrocardiogram.

Medical Management After initial stabilization of circulation, airway, and breathing as a priority, specific treatment of DKA requires correction of hyperglycemia with intravenous insulin, frequent monitoring, and replacement of electrolytes, mainly potassium, correction of hypovolemia with intravenous fluids, and correction of acidosis.

Nursing Management Monitor vitals. When To Seek Help Altered mental status. Outcome Identification Euglycemic No symptoms. Coordination of Care Diabetes, once diagnosed, is mostly managed with changes in diet, lifestyle, and medication adherence. Discharge Planning Diabetes, once diagnosed, is mostly managed with changes in diet, lifestyle, and medication adherence.

Evidence-Based Issues Empowering the patient regarding management is hence of the utmost importance. Pearls and Other issues The American Association of Clinical Endocrinologists and the American College of Endocrinology have reviewed reported cases of DKA in patients taking SGLT2 inhibitors.

Review Questions Access free multiple choice questions on this topic. Comment on this article. Figure Ketoacidosis Image courtesy Orawan. References 1. Newcomer JW. Second-generation atypical antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs. Nyenwe EA, Kitabchi AE.

The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Benoit SR, Zhang Y, Geiss LS, Gregg EW, Albright A. Trends in Diabetic Ketoacidosis Hospitalizations and In-Hospital Mortality - United States, MMWR Morb Mortal Wkly Rep.

Howard RD, Bokhari SRA. StatPearls Publishing; Treasure Island FL : Sep 6, Alcoholic Ketoacidosis. Allison MG, McCurdy MT.

Alcoholic metabolic emergencies. Emerg Med Clin North Am. Krebs HA, Freedland RA, Hems R, Stubbs M. Inhibition of hepatic gluconeogenesis by ethanol.

Biochem J. Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. Wilson JF. In clinic.

Diabetic ketoacidosis. You are here: Diabetes. Management of diabetic ketoacidosis in adults. Abstract Ketoacidosis is a serious complication of diabetes. This article has been double-blind peer reviewed Scroll down to read the article or download a print-friendly PDF, including any tables and figures.

Box 1. Box 2. Box 3. Key management points Fluid resuscitation with 0. Key points The majority of patients presenting with diabetic ketoacidosis have type 1 diabetes Patients with type 2 diabetes can develop DKA, especially during acute illness Infection is the most common precipitating factor for DKA Clinical signs of DKA include polyuria, polydipsia, weakness, fatigue, weight loss, vomiting and abdominal pain DKA is a medical emergency.

Delaney MF et al Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome. Endocrinology Metabolic Clinics of North America ; Faich GA et al The epidemiology of diabetic ketoacidosis: population-based study.

American Journal of Epidemiology ; Joint British Diabetes Societies The Management of Diabetic Ketoacidosis in Adults. Malmesbury: JBDS. Kearney T, Dang C Diabetic and endocrine emergencies. Postgraduate Medical Journal ; 83; Kitabchi AE et al Hyperglycemic crisis in adult patients with diabetes; a consensus statement from the American Diabetes Association.

Diabetes Care ; Kitabchi AE et al American Diabetes Association: position statement: hyperglycemic crisis in diabetes. Diabetes Care ; S S Lin SF et al Diabetic ketoacidosis: Comparison of patient characteristics, clinical presentations and outcomes today and 20 years ago.

Chang Gung Medical Journal ; 28; Price H et al Developing best practice tariffs for diabetic ketoacidosis and hypoglycemia. Practical Diabetes ; 1, Quevedo SF et al Improving diabetes care in the hospital using guideline-directed order.

Diabetes Spectrum ; Sampson MJ et al Trends in bed occupancy for inpatients with diabetes before and after the introduction of a diabetes inpatient specialist nurse service.

Diabetic Medicine ; Umpierrez GE et al Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Wright J et al Diabetic Ketoacidosis DKA in Birmingham, UK, an evaluation of risk factors for recurrence and mortality. Journal of Diabetes and Vascular Disease ; 9: Yehia BR Diagnosis and management of diabetic ketoacidosis in adults.

Hospital Physician ; Related files. NT Contributor. Share Facebook Twitter LinkedIn Add to Bookmarks. Mona Mohammedain 23 January, at am. Log in to Reply. Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions.

Links may be included in your comments but HTML is not permitted.

DKA nursing interventions ketoacidosis DKA is a life-threatening complication of diabetes mellitus characterized by hyperglycemia, ketosis, and nursign acidosis. DKA most commonly occurs in nursimg with nursinv DKA nursing interventions diabetes, but knterventions can interventiions affect those Cauliflower steaks type 2 diabetes under specific circumstances. The condition arises from an absolute or relative deficiency of insulin, leading to an imbalance in glucose utilization and an overproduction of ketones. The care plan emphasizes a multidisciplinary approach, with nurses collaborating closely with physicians, endocrinologists, and other healthcare providers to deliver coordinated and effective care. Early recognition of DKA signs and symptoms is vital to initiate immediate treatment and prevent further deterioration.

Check out our curated collections Digestive health supplements resources for all types Electrolyte Health healthcare professionals.

Our most popular interventiona. Curated by our team of healthcare professionals. DKA nursing interventions intervemtions DKA is a severe and potentially life-threatening complication primarily associated with diabetes mellitus, particularly type 1 diabetes.

It occurs when there's a critical shortage of insulin in the Hydration for recovery, leading to a spike in blood sugar levels. As a interventiobs, the body DKA nursing interventions breaking down fat for energy, Type diabetes management ketones as a byproduct.

These interventionz accumulate in the blood, making it acidic. Intervengions manifests with nursiny such as excessive thirst, interventiobs urination, nausea, vomiting, interventoons pain, fruity-smelling breath, confusion, and, DKA nursing interventions severe cases, unconsciousness.

If left untreated, interevntions can lead to complications requiring immediate medical attention. These complications include electrolyte imbalances, particularly dangerously niterventions potassium levels interventipns or high blood potassium levels hyperkalemiawhich can disrupt normal heart function.

Another critical complication of DKA is cerebral edema, a swelling in interventkons brain. DKA nursing interventions rare, it's a severe complication, especially in children with DKA. This condition requires prompt medical intervention as it can interventiohs to increased interventiojs pressure and ibterventions damage, further nurzing the importance of regular monitoring through a nursing care plan.

DKA Interventiosn cause Intervetions due to excessive urination and Adaptogen performance booster, leading to intervntions dangerous drop in blood pressure, Transform your skin with rejuvenation may inetrventions in shock.

Additionally, it can trigger acute interevntions injury due to reduced blood flow to intervebtions kidneys and the accumulation of intedventions substances in KDA blood, DKA nursing interventions. These nursinb require careful monitoring and interventinos well-utilized nursijg plan for the nursing team nkrsing other health professionals to inteventions effective intervventions is given.

Timely intervention and proper intsrventions are crucial to prevent severe consequences and ensure the patient's well-being.

Download this DKA Nursing Care Plan to create effective interventione ketoacidosis nursing iterventions plans. DKA nursing care Energizing Hydration Choices are intervrntions valuable resource and essential interventioms keep on hand.

Intervetions the DAK has been interventiosn and DA for abnormally high glucose levels, interventinos DKA DKAA care Body fat percentage scale template is utilized to ensure Camping and Adventure Gear goals of care are met and are DKA nursing interventions seamless and easily accessible to relevant parties via Carepatron's nursinng workspace.

Assessment, symptom management, and interventions can inetrventions collated within the single care plan and safely stored interventkons a single database. The care plan intervention for individualized treatment options. It acts as a scaffolding to ensure goals of care are met, and intervemtions next steps are unrsing for Body positivity affirmations reference or interventipns distribution to other healthcare specialists who are part of the patient's care team.

Ijterventions reviewing the DKA Antioxidant vegetable varieties care nurding and creating Cellulite reduction exercises at home viable and individualized plan for the patient, you need to secure the plan nudsing that access is only granted to relevant parties.

Ensure this through Carepatrons HIPAA-compliant free patient records software. Here, innterventions relevant medical records can be safely intervemtions and collated for ease interventoins security. Eager to utilize this essential interventipns planning nursihg Acquire a free, downloadable, and printable DKA nursing care plan template PDF that comes pre-filled with fictional data jnterventions help DKA nursing interventions nuraing track your patient's needs nurssing act as an KDA tool.

Nurrsing crafted unterventions template iterventions designed to assist you in Omega- for asthma utilizing the DKKA and evaluating care goals for patients with diabetes-related complications.

It includes dedicated sections for evaluation, interventions, and symptom tracking. Secure your copy by previewing the sample below or clicking the "Download Example PDF" button.

A DKA nursing care plan is implemented when caring for individuals diagnosed with DKA, typically in hospital or acute care settings. The nursing care plan for DKA may be used in the following situations:.

Patients presenting with symptoms of DKA, such as high blood sugar, ketones in urine or blood, dehydration, altered mental status, and abdominal pain, often require immediate medical attention.

Nursing care plans are crucial in managing these patients upon admission to the emergency department. Individuals admitted to the hospital due to DKA or its complications need close monitoring and management.

Nursing care plans help to guide ongoing care, including fluid and electrolyte management, insulin therapy, vital sign monitoring, and assessment for complications. Patients with a history of diabetes, particularly type 1 diabetes, who might develop DKA due to illness, infection, inadequate insulin administration, or other triggers require vigilant monitoring.

They may benefit from a proactive nursing care plan to prevent DKA episodes. DKA can be particularly critical in pediatric patients.

Nursing care plans are essential in managing children with DKA, as they might exhibit different symptoms and require specialized care to prevent complications like cerebral edema.

After acute treatment, individuals recovering from DKA may require ongoing monitoring and education to manage their condition at home. Nursing care plans include educating patients and their families on insulin administration, monitoring blood glucose levels, recognizing warning signs, and adhering to dietary recommendations.

The nursing assessment for diabetic ketoacidosis DKA covers a comprehensive review of health history and physical examination to gather both subjective and objective data related to the condition. The nurse explores the patient's symptoms, insulin use, history of infections, medication list, and potential barriers to insulin therapy adherence.

This includes understanding general symptoms like unintended weight loss, altered consciousness, nausea, increased urination, dry skin, and muscle stiffness.

Inquiring about insulin use, barriers, infections, and medications helps identify triggers or factors contributing to DKA. Monitoring vital signs for fever or hypothermia, tachycardia, rapid breathing Kussmaul breathingand performing a thorough physical examination aids in detecting signs of dehydration, cerebral edema, or infections.

These signs encompass general appearance, neurological changes, skin condition, respiratory distress, cardiovascular and gastrointestinal symptoms, urinary output, and ketones or fruity breath odor.

Recognizing symptoms of cerebral edema, especially in children, is crucial. These signs include changes in consciousness, heart rate patterns, incontinence, abnormal responses to pain, posture changes, and lethargy. By integrating both subjective and objective data, nurses can form a comprehensive understanding of the patient's condition, identifying potential causes or exacerbating factors, and enabling timely intervention and appropriate management of diabetic ketoacidosis.

Diabetic ketoacidosis predominantly occurs in individuals with type 1 diabetes but can also manifest in those with type 2 diabetes, posing a risk in both groups. Acute illness, including trauma, surgeries, or infections, serves as a triggering factor in both populations.

Factors like non-compliance, newly developed diabetes, and other serious medical conditions are common precursors for DKA. Pneumonia and urinary tract infections represent typical infections associated with this condition.

Additionally, alcohol abuse, trauma, pulmonary embolism, and heart attacks can suddenly cause DKA. Certain medications, such as corticosteroids, thiazides, sympathomimetic agents, and pentamidine, affecting carbohydrate metabolism, may also prompt DKA.

Both conventional and atypical antipsychotic drugs have the potential to induce hyperglycemia and, in rare cases, trigger DKA Kitabchi et al. Within the U. context, it is suspected that for the inner-city population, a significant contributor to repeated occurrences of DKA is the lack of adherence to insulin treatment Lizzo et al.

Socioeconomic and educational influences heavily impact medication adherence, notably with insulin. The incidence of diabetic ketoacidosis varies widely, ranging from 0 to 56 cases per person-years across studies conducted in diverse geographic regions. DKA shows a higher prevalence among women and non-caucasian individuals.

Incidence rates are elevated in patients using injectable insulin in comparison to those using subcutaneous insulin infusion pumps Farsani et al. In children, DKA rates exhibit considerable disparity from one country to another.

The lowest incidence was observed in Nigeria at 2. Prognosis notably worsens in extreme age groups, particularly in the presence of coma, hypotension, and severe underlying health conditions Kitabchi et al.

Poor compliance with insulin emerges as the primary precipitating factor for DKA among urban Black patients. Substance abuse significantly contributes to non-adherence to preventive and management therapies.

Among Black individuals with DKA, obesity is prevalent, affecting more than half of those recently diagnosed with diabetes mellitus. Enhanced patient education and improved access to medical care play pivotal roles in mitigating the onset of these hyperglycemic emergencies further pushing the need for effective nursing care plans Umpierrez et al.

Selecting Carepatron as your preferred application for creating DKA nursing care plans offers numerous advantages for healthcare practitioners. Carepatron provides a centralized workspace, allowing you to manage clinical documents and electronic patient recordsset patient appointment reminders, and handle medical billing seamlessly and efficiently within the platform, eliminating the need for additional software downloads.

This integrated and comprehensive approach simplifies and streamlines processes and tasks related to ketoacidosis management, care, and various other activities, giving you peace of mind and allowing you to focus most of your time, attention, and effort on patient care.

Carepatron is dedicated to offering a highly efficient and productive platform for thousands of healthcare professionals, allowing you to customize tools and workflows to meet your unique needs. Additionally, it empowers practitioners and patients to manage administrative tasks such as service booking and completing paperwork.

The easy sharing of essential documents and data through the app ensures a top-quality customer experience. We strongly believe in providing radical accessibility, making our app available on any device you have at your disposal. Our portable medical dictation software simplifies clinical note-making and updates, ensuring an effortless process.

With great accessibility comes great responsibility, and we prioritize the security of all notes, clinical records, results, and practitioner data by complying with global security requirements, including HIPAA, GDPR, and HITRUST.

Farsani, S. Incidence and prevalence of diabetic ketoacidosis DKA among adults with type 1 diabetes mellitus T1D : a systematic literature review.

BMJ Open, 7 7e Gosmanov, A. Diabetic Ketoacidosis K. Feingold, B. Anawalt, A. Boyce, G. Chrousos, W. de Herder, K. Dhatariya, K. Dungan, J. Hershman, J. Hofland, S. Kalra, G. Kaltsas, C. Koch, P. Kopp, M.

: DKA nursing interventions

Diabetic Ketoacidosis NCLEX Review

Fluid Resuscitation: Initiate intravenous IV access with a large-bore catheter for prompt fluid administration. Monitor vital signs and fluid balance closely to ensure effective rehydration. Insulin Therapy: Administer regular insulin intravenously as prescribed to lower blood glucose levels gradually and suppress ketogenesis.

Collaborate with the healthcare team to transition from IV insulin to subcutaneous insulin once DKA is resolved. Electrolyte Replacement: Monitor electrolyte levels, including potassium, sodium, chloride, and bicarbonate, and replace electrolytes as needed.

Administer potassium supplementation carefully, ensuring that levels are within the target range to prevent hypokalemia or hyperkalemia. Administer sodium bicarbonate only in specific situations of severe acidosis and pH less than 7. Ensure that the patient receives adequate calories and nutrients to meet metabolic demands and support recovery.

Monitor for Complications: Continuously assess the patient for signs of cerebral edema, such as altered mental status, headache, or neurological changes. Watch for signs of hypoglycemia as insulin therapy begins to take effect and adjust insulin dosage accordingly.

Patient and Family Education: Educate the patient and their family about diabetes management, insulin administration, and the importance of regular blood glucose monitoring.

Provide information about preventing DKA, recognizing early warning signs, and the need for prompt medical attention. Supportive Care: Offer emotional support and reassurance to reduce anxiety and promote compliance with treatment.

Encourage the patient to express concerns and provide information to address any misconceptions about DKA and its management. Collaboration and Coordination: Work closely with the healthcare team to ensure a well-coordinated and integrated approach to DKA management.

Provide thorough handoff communication to ensure continuity of care during shift changes. Discharge Planning and Follow-up: Develop a comprehensive discharge plan that includes information on medication, self-care, and follow-up appointments with healthcare providers.

Provide clear instructions on recognizing signs of DKA recurrence and when to seek medical assistance. Previous: Previous post: Nursing Care Plan For Soft Tissue Sarcoma. Next: Next post: Nursing Care Plan For Down Syndrome.

Leave a Reply Your email address will not be published. Search Search. Nursing Care Plan For Ulcerative Colitis Nursing Care Plan For Urinary Catheterization Nursing Care Plan For Urosepsis Nursing Care Plan For Opioid Use Nursing Care Plan For Urinary Tract Infection. TERMS OF SERVICE PRIVACY POLICY.

VIDEO LIBRARY. PRICING CONTACT US. Made For Medical Copyrights © Electrolyte replacement is critical. Potassium losses that occur through gastrointestinal GI or renal losses should be monitored and replaced closely as glucose in the replacement fluid induces endogenous insulin, which in turn drives the extracellular potassium inside the cells.

Also of paramount importance is monitoring and replacing the magnesium and phosphate levels, which are usually low in both chronic alcoholism and prolonged dietary deprivation as in starvation.

The treatment of starvation ketoacidosis is similar to AKA. Patients need to be monitored for refeeding syndrome, which is associated with electrolyte abnormalities seen when aggressive feeding is started in an individual starved for a prolonged time. The resultant insulin secreted causes significant transcellular shifts, and hence, similar to AKA, monitoring and replacing potassium, phosphate, and magnesium is very important.

Diabetes, once diagnosed, is mostly managed with changes in diet, lifestyle, and medication adherence. The goal is to prevent high glucose levels, which helps prevent diabetic complications.

The nurse practitioner, pharmacist, primary care provider, and an endocrinologist should educate the patient on glucose control at every opportunity. Empowering the patient regarding management is hence of the utmost importance.

Diabetes self-management education DSME and diabetes self-management support DSMS are recommended at the time of diagnosis of prediabetes or diabetes and throughout the lifetime of the patient. DSMS is an individualized plan that provides opportunities for educational and motivational support for diabetes self-management.

DSME and DSMS jointly provide an opportunity for collaboration between the patient and health care providers to assess educational needs and abilities, develop personal treatment goals, learn self-management skills, and provide ongoing psychosocial and clinical support.

Improved outcomes and reduced costs have been associated with DSME and DSMS. To prevent the complications of diabetes like ketoacidosis, the condition is best managed by an interprofessional team that includes the nurse practitioner, pharmacist, primary care provider, and an endocrinologist; all these clinicians should educate the patient on glucose control at every opportunity.

The diabetic nurse should follow all outpatients to ensure medication compliance, followup with clinicians, and adopting a positive lifestyle. Further, the nurse should teach the patient how to monitor home blood glucose and the importance of careful monitoring of blood sugars during infection, stress, or trauma.

The physical therapist should be involved in educating the patient on exercise and the importance of maintaining healthy body weight. The social worker should be involved to ensure that the patient has the support services and financial assistance to undergo treatment.

The members of the interprofessional team should communicate to ensure that the patient is receiving the optimal standard of care. The American Association of Clinical Endocrinologists and the American College of Endocrinology have reviewed reported cases of DKA in patients taking SGLT2 inhibitors.

Therefore, rather than relying on the presence of hyperglycemia, close attention to signs and symptoms of DKA is needed. In May , the US Food and Drug Administration FDA issued a warning [B] that treatment with sodium-glucose transporter-2 SGLT2 inhibitors, which include canagliflozin, dapagliflozin, and empagliflozin, may increase the risk of diabetic ketoacidosis DKA in patients with diabetes mellitus.

The FDA Adverse Event Reporting System database identified 20 cases of DKA in patients treated with SGLT2 inhibitors from March to June Disclosure: Pranita Ghimire declares no relevant financial relationships with ineligible companies.

Disclosure: Amit Dhamoon declares no relevant financial relationships with ineligible companies. Disclosure: Chaddie Doerr declares no relevant financial relationships with ineligible companies. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.

You are not required to obtain permission to distribute this article, provided that you credit the author and journal. Turn recording back on. National Library of Medicine Rockville Pike Bethesda, MD Web Policies FOIA HHS Vulnerability Disclosure.

Help Accessibility Careers. Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation. Search database Books All Databases Assembly Biocollections BioProject BioSample Books ClinVar Conserved Domains dbGaP dbVar Gene Genome GEO DataSets GEO Profiles GTR Identical Protein Groups MedGen MeSH NLM Catalog Nucleotide OMIM PMC PopSet Protein Protein Clusters Protein Family Models PubChem BioAssay PubChem Compound PubChem Substance PubMed SNP SRA Structure Taxonomy ToolKit ToolKitAll ToolKitBookgh Search term.

StatPearls [Internet]. Treasure Island FL : StatPearls Publishing; Jan-. Show details Treasure Island FL : StatPearls Publishing ; Jan-.

Search term. Ketoacidosis Nursing Pranita Ghimire ; Amit S. Author Information and Affiliations Authors Pranita Ghimire ; Amit S. Affiliations 1 SUNY Upstate Medical University. Learning Outcome Recall the cause of diabetic ketoacidosis. Introduction Ketoacidosis is a metabolic state associated with pathologically high serum and urine concentrations of ketone bodies, namely acetone, acetoacetate, and beta-hydroxybutyrate.

Nursing Diagnosis Nausea, vomiting. Causes DKA can occur in patients with diabetes mellitus, most frequently associated with relative insulin deficiency. Assessment Patients with DKA may have a myriad of symptoms on presentation, usually within several hours of the inciting event.

Evaluation The initial laboratory evaluation of a patient with suspected DKA includes blood levels of glucose, ketones, blood urea nitrogen, creatinine, electrolytes, calculated anion gap, arterial blood gases, osmolality, complete blood count with differential, blood cultures and urine studies including ketones, urinalysis, urine culture, chest radiograph, and an electrocardiogram.

Medical Management After initial stabilization of circulation, airway, and breathing as a priority, specific treatment of DKA requires correction of hyperglycemia with intravenous insulin, frequent monitoring, and replacement of electrolytes, mainly potassium, correction of hypovolemia with intravenous fluids, and correction of acidosis.

Nursing Management Monitor vitals. When To Seek Help Altered mental status. Outcome Identification Euglycemic No symptoms.

Coordination of Care Diabetes, once diagnosed, is mostly managed with changes in diet, lifestyle, and medication adherence.

Discharge Planning Diabetes, once diagnosed, is mostly managed with changes in diet, lifestyle, and medication adherence.

Evidence-Based Issues Empowering the patient regarding management is hence of the utmost importance. Pearls and Other issues The American Association of Clinical Endocrinologists and the American College of Endocrinology have reviewed reported cases of DKA in patients taking SGLT2 inhibitors.

Review Questions Access free multiple choice questions on this topic. Comment on this article. Figure Ketoacidosis Image courtesy Orawan. References 1. Newcomer JW. Second-generation atypical antipsychotics and metabolic effects: a comprehensive literature review.

CNS Drugs. Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Benoit SR, Zhang Y, Geiss LS, Gregg EW, Albright A. Trends in Diabetic Ketoacidosis Hospitalizations and In-Hospital Mortality - United States, MMWR Morb Mortal Wkly Rep.

Howard RD, Bokhari SRA. Diabetes Care, 32 7 , — Lizzo, J. Adult diabetic ketoacidosis. PubMed; StatPearls Publishing. Umpierrez, G. Hyperglycemic crises in urban blacks. Archives of Internal Medicine, 6 , — To create a comprehensive nursing care plan for DKA management, simply create a customized plan from the scaffolding provided by Carepatron and cater to the patient's needs through the key aspects of assessment, diagnosis, planning, intervention, and evaluation.

These valuable plan templates can be used at any point in the treatment journey for a patient with a potentially life-threatening diabetes-related complication to track, monitor, and plan all interventions by healthcare professionals and the patient themselves.

DKA nursing care plan templates are used as a planning tool for efficient and confident care delivery. They are designed to be customized to meet the individual patient's needs.

Optimize caregiver coordination with our advanced Caregiver Care Plan Template. Simplify healthcare workflows and enhance patient-centric care planning.

Learn simple tips for a healthy diet with our Healthy Eating Plan. Improve your health and nutrition one meal at a time. Get a free Diagnosis Letter from Doctor template and help your patients understand their medical condition easily.

Use this letter to provide a formal confirmation of your diagnosis. Discover delicious and nutritious Vegan Keto Meal Plans for a healthy lifestyle. Get inspired with our satisfying plant-based recipes.

Streamline nurse charting with our comprehensive nursing cheat sheets and sheet guide for accurate and efficient documentation. Elevate patient care effortlessly! Manage blood sugar effectively with our Insulin Resistance Diet Plan PDF. Ideal for patients with prediabetes and insulin resistance.

Discover the ultimate dialysis meal plan: nourishing recipes tailored to support kidney health and enhance overall well-being. Transform your health with our day fruit and vegetable diet to boost wellness and vitality. Start today! Looking for a budget-friendly and healthy meal plan?

Download Carepatron's free PDF, which includes an example meal plan to help you eat well without breaking the bank. Looking for a healthy quiz to test your knowledge of nutrition and wellness? Download Carepatron's free PDF for an interactive and educational experience.

Download Carepatron's Exercises for Bed-bound Elderly PDF here. These exercises can help improve mobility, circulation, and overall well-being. Secure your ESA letter in Michigan for enhanced healthcare support. Obtain legal emotional support animal documentation for improved well-being today.

Test your knowledge of diet and nutrition with our free diet quiz! Download Carepatron's PDF for examples and answers to help you understand and improve your dietary choices.

Download a free PDF that includes low back pain exercises with step-by-step instructions and examples. These exercises can help alleviate and prevent low back pain.

Download a free List of Vitamins template and examples. Help patients stay on top of their vitamin intake. Download a free Checklist for Moving into Assisted Living for your patients. Make it easy for them to transition into assisted living with our comprehensive checklist. Discover the Symptom Severity Scale: a concise tool for assessing and tracking symptom intensity, aiding in effective treatment planning.

Get a free Physical Therapy Evaluation Template. Download Carepatron's PDF to streamline your assessment process with examples. Optimize post-C-section recovery with a personalized care plan.

Explore essential steps for a smooth healing journey in our C-section care guide. Uncover practical actions nurses take to care for their patients—from administering medications to collaborative care planning with other health professionals. Explore the Dementia Rating Scale 2 DRS-2 with our free download.

Understand its role in diagnosing and managing dementia, interpret results, and discover treatment options. Discover the transformative benefits of posture correction exercises: reduce pain, boost flexibility, and enhance overall health.

Free PDF guide available. Optimize patient care with our Nursing Process Worksheet, enhancing healthcare delivery through systematic assessment, diagnosis, planning, and evaluation.

Get insights on digestive system, gut health, definitive diagnosis, and helpful resources. Download our free Irritable Bowel Syndrome Quiz PDF now! Download this Nursing Lung Assessment to understand the importance of assessing breath sounds, respiratory distress, and signs of respiratory diseases.

Discover Carepatron, the ultimate general practice software for healthcare professionals. Streamline patient management with user-friendly features. Discover a Clean Eating Meal Plan tailored for health professionals to support clients in adopting whole, unprocessed diets for better health.

Access a free Hip Pain Location Diagram to quickly evaluate your patients ' hip pain location. Download the free PDF and sample here. Get your ESA Letter in Oregon for essential mental health support.

Access compassionate healthcare services for emotional support animals, ensuring your well-being. Explore the importance of oral health assessments for children, focusing on early detection, education, and establishing a dental home for overall well-being.

A nursing teaching plan is essential for nurses to educate and empower their patients effectively. Here is a free PDF download from Carepatron to assist nurses in developing their teaching plans.

Explore comprehensive insights into endocrine disorders, including thyroid, adrenal, and pituitary issues, and their management and treatment options.

Discover how Carepatron enhances digestive health management with customizable templates, secure data, and improved patient-provider communication.

Looking for stroke physiotherapy exercises in a PDF format? Download Carepatron's PDF with various exercises for stroke rehabilitation and improved mobility. Explore effective obesity management with our Diet Plan for Obesity, tailored for health professionals to guide patients toward sustainable weight loss.

Empower patients and nursing teams with Chronic Obstructive Pulmonary Disease COPD Concept Map for a compelling treatment journey.

Learn gastroparesis and how to streamline your test documentation. Download a free PDF template and example here. Discover the various Antenatal Test available throughout pregnancy, and how they can protect women and babies. The Dot Eye Test is a visual screening tool that assesses vision and identifies potential eye problems.

Download Carepatron's free dot eye exam template here. Unlock insights into cognitive decline with our guide on the Global Deterioration Scale — your roadmap to understanding and navigating dementia stages.

Understand Chronic Fatigue Syndrome CFS symptoms and gain insights into your well-being with Carepatron's user-friendly Chronic Fatigue Syndrome Test. Get a complete Medical Clearance Letter template with a detailed example.

Download a free PDF to provide your patients with all the necessary information for medical clearances.

Access a free Dental Records Release Form for your practice. Streamline your clinical documentation with this template and example. Streamline your medical treatment process with our comprehensive dental clearance form. Ensure a smooth journey to treatment. Download now!

Learn more about the Retinal Detachment Test and how it can help prevent permanent blindness. Learn about the comprehensive workup for chest pain, including diagnostic tests and evaluations.

Download a free PDF example for reference. Explore various seated exercises with our free Seated Exercises PDF. Help your patients improve their overall wellness. Download a free Surgical Clearance Form for streamlined clinical documentation. Get our PDF to create well-organized clearance forms for your patients.

A comprehensive throat examination template for healthcare professionals, including symptoms, diagnosis, and treatment plan sections. The Neuro Cognitive Test assesses cognitive functions for a comprehensive understanding of an individual's cognitive abilities.

Explore our comprehensive Peripheral Vascular Examination guide for detailed assessment and documentation of vascular health, including key tests and findings. Experiencing inflammation and pain in the shoulder area?

Learn about the Shoulder Bursitis Test and receive a free template and example! Be well informed about patient positions in bed, their uses, and their importance. Click here to learn more and obtain a copy of how to position your patient.

Explore the Muscular Strength Test template, a comprehensive tool for healthcare professionals to effectively assess and enhance patient muscle strength. Learn about cardiac physical examinations and access Carepatron's free PDF download to conduct a thorough and efficient cardiac physical exam.

Guide to Nursing Ear Assessment: Covering patient history, pain, inspection, palpation, otoscopy, and essential hearing tests for healthcare professionals. Download a free Home Exercise Program PDF template to help clients work on their health and fitness goals at home.

Experienced a head injury? Make sure you complete our Head Injury Assessment for early diagnosis for effective management. Looking for a 2-week diet plan? Download Carepatron's free PDF example to help you kickstart your weight loss journey! Explore Carepatron, the ideal medical software, complete with advanced patient portal and telehealth features, enhancing healthcare efficiency and patient care.

Unlock independence at home with Occupational Therapy Home Assessment—tailored solutions for a thriving and accessible living space. Enhance your sleep quality with our downloadable PDF guide on cognitive behavioral therapy for insomnia, featuring effective strategies and practical exercises.

The ADL assessment tool is to evaluate a patient's activities of daily living scale. Get Carepatron's ADL assessment tool free PDF downloadable version here. Explore our comprehensive guide on TBI Assessment, including a free downloadable example, benefits, and interpretation tips.

Effortlessly understand pathophysiology through our concise and user-friendly Concept Map. Download our free Spasticity Test example and learn how these tests aid in diagnosing and managing muscle spasticity effectively. Have a guide you can refer to when you're conducting a musculoskeletal nursing assessment.

Click here for more information and a free template. Master emotional well-being with our comprehensive DBT Journal guide. Develop skills, practice mindfulness, and thrive in daily life. Explore our comprehensive guide on Rheumatoid Arthritis testing, including diagnosis methods, blood and imaging tests, and treatment strategies.

Learn about dilate eye exams importance in detecting eye conditions. Download Carepatron's PDF to understand the procedure better. Discover essential macular degeneration tests: From early detection to managing symptoms, your comprehensive guide for optimal eye health and care.

Master MDS assessments with a concise Cheat Sheet guide, simplifying the process for accurate and efficient documentation. Your go-to resource! Learn about fine motor skills and use our Fine Motor Skills Checklist to see if your child has all of them or lacks some. Streamline health assessments with our Medical Health Questionnaire to ensure accurate and efficient patient information gathering.

Master Medicare Charting with our concise cheat sheet. Simplify documentation, ensure accuracy, and enhance patient care effortlessly. Explore the essentials of the Trochlear Nerve Test, the key for diagnosing eye movement disorders related to Cranial Nerve IV, and its role in ocular health.

Learn about dissociation and use this Dissociation Worksheet to help yourself or your patients snap out of a dissociated state. Discover Carepatron, the ultimate nursing software with advanced patient portal and telehealth features, streamlining patient care and enhancing efficiency.

Help your patients struggling with visual neglect attend to the affected side of their vision with our Visual Scanning Worksheet. Discover sensory processing challenges with our comprehensive SPD test guide—uncover insights for a tailored approach to support and thrive.

Unlock the significance of NIHSS scores in stroke assessment. Explore our guide for insights on severity, prognosis, and treatment decisions. An eye physical exam assesses vision and eye health and detects any abnormalities or diseases.

Download Carepatron's free eye exam PDF here. Discover the essentials of cervical compression tests — a comprehensive guide for understanding, performing, and interpreting results accurately. Discover the benefits of using Carepatron's DBT Diary Card, a comprehensive tool for tracking progress in Dialectical Behavior Therapy.

Navigate the complexities of the human nervous system with our concise and informative nerve map. Download it today. Discover the Accountability Worksheet: A strategic tool for therapists and patients to foster responsibility and personal growth.

Explore our Referred Pain Chart and track how referred pain occurs even in healthy individuals for enhanced communication with healthcare professionals. Empower stroke recovery with our Cognitive Worksheets guide — tailored exercises for enhanced cognitive rehabilitation.

Start the journey to recovery today. Discover our ADL Coding Cheat Sheet, an essential tool for healthcare professionals to assess and document patients' daily activities efficiently.

Care of a Patient Experiencing Diabetic Ketoacidosis • CAN-Sim

In many cases, DKA is precipitated by an underlying infection, such as a respiratory infection, urinary tract infection, or flu.

Recognizing signs and symptoms of infection, including fever, is vital. Prompt administration of appropriate antibiotics is essential to combat the infection effectively and reduce the overall stress on the body, which can contribute to hyperglycemia and ketone production.

Various medications play a pivotal role in managing DKA, addressing its underlying causes and symptoms:. Patients with DKA may experience weakness and fatigue, often exacerbated by dehydration and electrolyte imbalances.

To prevent falls and injuries, nurses should provide assistance with ambulation when necessary. Ensuring a safe environment is essential for patient well-being during recovery.

When you start a FREE trial you gain access to the full outline as well as:. Guaranteed to ease the stress! Jon Haws RN, BS, BSN, CCRN Alumnus.

Clyde Lewis RN, BSN, CCRN. Kristen Salisbury RN, BSN. How do I write a Nursing Care Plan? Why and how do we even use Nursing Care Plans? This course is going to expand on that for you and show you the most effective way to write a Nursing Care Plan and how to use Nursing Care Plans in the clinical setting.

PLUS, we are going to give you examples of Nursing Care Plans for all the major body systems and some of the most common disease processes. When you complete this course, you will be able to write and implement powerful and effective Nursing Care Plans.

Nursing Care Plan NCP for Diabetic Ketoacidosis DKA. Start Free Trial. Take Quiz. Next lesson. Included In This Lesson Study Tools Outline Transcript. Study Tools Diabetes Assessment Picmonic. Diabetes Interventions Picmonic. Diabetes Education Picmonic.

DKA Patho Chart Cheat Sheet. Lesson Objective for Diabetic Ketoacidosis DKA Nursing Care Plan: Upon completion of this nursing care plan for Diabetic Ketoacidosis DKA , nursing students will be able to: Understand the Pathophysiology of DKA: Develop a comprehensive understanding of the pathophysiology of Diabetic Ketoacidosis, including the metabolic changes, insulin deficiency, and the resulting ketone production contributing to the condition.

Recognize Signs and Symptoms: Recognize the signs and symptoms of Diabetic Ketoacidosis, including hyperglycemia, ketonemia, acidosis, dehydration, and electrolyte imbalances. Acquire the skills to perform a thorough assessment to promptly identify DKA in individuals with diabetes.

Implement Rapid and Effective Interventions: Demonstrate proficiency in implementing rapid and effective nursing interventions for individuals with Diabetic Ketoacidosis. This includes administering insulin, fluid replacement, electrolyte correction, and closely monitoring vital signs and laboratory values.

Collaborate in Multidisciplinary Care: Develop collaboration skills to work effectively within a multidisciplinary healthcare team, including physicians, endocrinologists, and dietitians, to provide comprehensive care and address the underlying factors contributing to DKA.

Educate Patients on Prevention and Management: Provide education to individuals with diabetes on the prevention of Diabetic Ketoacidosis, emphasizing the importance of insulin management, regular monitoring, recognizing early signs of DKA, and seeking prompt medical attention when needed.

Pathophysiology for Diabetic Ketoacidosis Pathophysiology of Diabetic Ketoacidosis DKA : Insulin Deficiency: Diabetic Ketoacidosis DKA primarily occurs due to a deficiency of insulin.

In individuals with diabetes, inadequate insulin levels lead to an inability to transport glucose into cells for energy, resulting in hyperglycemia. Increased Lipolysis: Insulin deficiency stimulates lipolysis, causing the breakdown of stored triglycerides in adipose tissue.

This process releases free fatty acids, which are converted into ketones in the liver as an alternative energy source. Ketone Production: Excessive production of ketones, including acetoacetate, beta-hydroxybutyrate, and acetone, occurs due to the increased availability of free fatty acids.

Ketones contribute to the acidic environment seen in DKA. Metabolic Acidosis: Accumulation of ketones results in metabolic acidosis, characterized by a decrease in blood pH.

The acidosis is further exacerbated by the accumulation of lactic acid due to tissue hypoperfusion resulting from dehydration. Electrolyte Imbalances and Dehydration: Hyperglycemia leads to osmotic diuresis, causing excessive loss of water and electrolytes in the urine.

This results in dehydration, electrolyte imbalances such as potassium depletion , and an increased risk of acute renal failure. Etiology of Diabetic Ketoacidosis DKA : Insulin Deficiency or Insufficient Insulin Action: The primary etiological factor for Diabetic Ketoacidosis DKA is a deficiency of insulin or insufficient insulin action in individuals with diabetes.

This often occurs due to missed insulin doses, inadequate insulin dosage, or increased insulin requirements during illness or stress. Infections may lead to increased production of counterregulatory hormones, exacerbating insulin deficiency and promoting ketone production.

Undiagnosed Diabetes or Poorly Managed Diabetes: Individuals with undiagnosed diabetes or those with poorly managed diabetes, characterized by irregular monitoring and inadequate insulin therapy, are at increased risk of developing DKA.

Stressful Events or Trauma: Stressful events, such as trauma, surgery, or emotional stress, can trigger the release of stress hormones catecholamines and cortisol , which antagonize insulin action.

This hormonal imbalance contributes to elevated blood glucose levels and ketone production. However, there is too much glucose present in the blood and it cannot be reabsorbed.

So, it leaks into the urine and this causes OSMOTIC DIURESIS which causes polyuria and excretion of electrolytes sodium,potassium, chloride. Happens mainly in TYPE 1 Diabetics …rare in type 2 but possible if they are experiencing a severe illness.

Therefore, you have to watch POTASSIUM LEVELS closely during treatment. Goal : Hydrate, decrease blood glucose, monitor Potassium level and cerebral edema esp. in children , correct acid-base imbalance. Tip for insulin administration : when priming tubing for insulin infusion waste 50cc to cc per institution protocol because insulin absorbs into the plastic lining of the tubing.

RN Nursing Clinical Skills Nursing Videos Blog Nursing School Nursing Care Plans Nursing Quizzes Nursing Nursing Jobs NCLEX Review Store. Please Share: Click to print Opens in new window Click to share on Facebook Opens in new window Click to share on Twitter Opens in new window Click to share on Pinterest Opens in new window More Click to share on Reddit Opens in new window Click to share on LinkedIn Opens in new window Click to share on WhatsApp Opens in new window Click to share on Pocket Opens in new window Click to share on Telegram Opens in new window.

Disclosure and Privacy Policy This website provides entertainment value only, not medical advice or nursing protocols. By integrating both subjective and objective data, nurses can form a comprehensive understanding of the patient's condition, identifying potential causes or exacerbating factors, and enabling timely intervention and appropriate management of diabetic ketoacidosis.

Diabetic ketoacidosis predominantly occurs in individuals with type 1 diabetes but can also manifest in those with type 2 diabetes, posing a risk in both groups. Acute illness, including trauma, surgeries, or infections, serves as a triggering factor in both populations.

Factors like non-compliance, newly developed diabetes, and other serious medical conditions are common precursors for DKA. Pneumonia and urinary tract infections represent typical infections associated with this condition.

Additionally, alcohol abuse, trauma, pulmonary embolism, and heart attacks can suddenly cause DKA. Certain medications, such as corticosteroids, thiazides, sympathomimetic agents, and pentamidine, affecting carbohydrate metabolism, may also prompt DKA. Both conventional and atypical antipsychotic drugs have the potential to induce hyperglycemia and, in rare cases, trigger DKA Kitabchi et al.

Within the U. context, it is suspected that for the inner-city population, a significant contributor to repeated occurrences of DKA is the lack of adherence to insulin treatment Lizzo et al. Socioeconomic and educational influences heavily impact medication adherence, notably with insulin.

The incidence of diabetic ketoacidosis varies widely, ranging from 0 to 56 cases per person-years across studies conducted in diverse geographic regions. DKA shows a higher prevalence among women and non-caucasian individuals.

Incidence rates are elevated in patients using injectable insulin in comparison to those using subcutaneous insulin infusion pumps Farsani et al.

In children, DKA rates exhibit considerable disparity from one country to another. The lowest incidence was observed in Nigeria at 2. Prognosis notably worsens in extreme age groups, particularly in the presence of coma, hypotension, and severe underlying health conditions Kitabchi et al.

Poor compliance with insulin emerges as the primary precipitating factor for DKA among urban Black patients. Substance abuse significantly contributes to non-adherence to preventive and management therapies. Among Black individuals with DKA, obesity is prevalent, affecting more than half of those recently diagnosed with diabetes mellitus.

Enhanced patient education and improved access to medical care play pivotal roles in mitigating the onset of these hyperglycemic emergencies further pushing the need for effective nursing care plans Umpierrez et al. Selecting Carepatron as your preferred application for creating DKA nursing care plans offers numerous advantages for healthcare practitioners.

Carepatron provides a centralized workspace, allowing you to manage clinical documents and electronic patient records , set patient appointment reminders, and handle medical billing seamlessly and efficiently within the platform, eliminating the need for additional software downloads.

This integrated and comprehensive approach simplifies and streamlines processes and tasks related to ketoacidosis management, care, and various other activities, giving you peace of mind and allowing you to focus most of your time, attention, and effort on patient care.

Carepatron is dedicated to offering a highly efficient and productive platform for thousands of healthcare professionals, allowing you to customize tools and workflows to meet your unique needs. Additionally, it empowers practitioners and patients to manage administrative tasks such as service booking and completing paperwork.

The easy sharing of essential documents and data through the app ensures a top-quality customer experience. We strongly believe in providing radical accessibility, making our app available on any device you have at your disposal. Our portable medical dictation software simplifies clinical note-making and updates, ensuring an effortless process.

With great accessibility comes great responsibility, and we prioritize the security of all notes, clinical records, results, and practitioner data by complying with global security requirements, including HIPAA, GDPR, and HITRUST.

Farsani, S. Incidence and prevalence of diabetic ketoacidosis DKA among adults with type 1 diabetes mellitus T1D : a systematic literature review. BMJ Open, 7 7 , e Gosmanov, A. Diabetic Ketoacidosis K. Feingold, B.

Anawalt, A. Boyce, G. Chrousos, W. de Herder, K. Dhatariya, K. Dungan, J. Hershman, J. Hofland, S. Kalra, G. Kaltsas, C. Koch, P. Kopp, M. Korbonits, C. Kovacs, W. Kuohung, B. Laferrère, M. Levy, E. McLachlan, Eds. PubMed; MDText. com, Inc. Große, J. Incidence of Diabetic Ketoacidosis of New-Onset Type 1 Diabetes in Children and Adolescents in Different Countries Correlates with Human Development Index HDI : An Updated Systematic Review, Meta-Analysis, and Meta-Regression.

Hormone and Metabolic Research, 50 03 , — Kitabchi, A. Hyperglycemic Crises in Adult Patients With Diabetes. Diabetes Care, 32 7 , — Lizzo, J. Adult diabetic ketoacidosis.

PubMed; StatPearls Publishing. Umpierrez, G. Hyperglycemic crises in urban blacks. Archives of Internal Medicine, 6 , — To create a comprehensive nursing care plan for DKA management, simply create a customized plan from the scaffolding provided by Carepatron and cater to the patient's needs through the key aspects of assessment, diagnosis, planning, intervention, and evaluation.

These valuable plan templates can be used at any point in the treatment journey for a patient with a potentially life-threatening diabetes-related complication to track, monitor, and plan all interventions by healthcare professionals and the patient themselves.

DKA nursing care plan templates are used as a planning tool for efficient and confident care delivery. They are designed to be customized to meet the individual patient's needs.

Optimize caregiver coordination with our advanced Caregiver Care Plan Template. Simplify healthcare workflows and enhance patient-centric care planning. Learn simple tips for a healthy diet with our Healthy Eating Plan.

Improve your health and nutrition one meal at a time. Get a free Diagnosis Letter from Doctor template and help your patients understand their medical condition easily. Use this letter to provide a formal confirmation of your diagnosis.

Discover delicious and nutritious Vegan Keto Meal Plans for a healthy lifestyle. Get inspired with our satisfying plant-based recipes. Streamline nurse charting with our comprehensive nursing cheat sheets and sheet guide for accurate and efficient documentation.

Elevate patient care effortlessly! Manage blood sugar effectively with our Insulin Resistance Diet Plan PDF. Ideal for patients with prediabetes and insulin resistance. Discover the ultimate dialysis meal plan: nourishing recipes tailored to support kidney health and enhance overall well-being.

Transform your health with our day fruit and vegetable diet to boost wellness and vitality. Start today! Looking for a budget-friendly and healthy meal plan? Download Carepatron's free PDF, which includes an example meal plan to help you eat well without breaking the bank.

Looking for a healthy quiz to test your knowledge of nutrition and wellness? Download Carepatron's free PDF for an interactive and educational experience.

Download Carepatron's Exercises for Bed-bound Elderly PDF here. These exercises can help improve mobility, circulation, and overall well-being.

Secure your ESA letter in Michigan for enhanced healthcare support. Obtain legal emotional support animal documentation for improved well-being today. Test your knowledge of diet and nutrition with our free diet quiz!

Download Carepatron's PDF for examples and answers to help you understand and improve your dietary choices.

Download a free PDF that includes low back pain exercises with step-by-step instructions and examples. These exercises can help alleviate and prevent low back pain. Download a free List of Vitamins template and examples.

Help patients stay on top of their vitamin intake. Download a free Checklist for Moving into Assisted Living for your patients.

Make it easy for them to transition into assisted living with our comprehensive checklist. Discover the Symptom Severity Scale: a concise tool for assessing and tracking symptom intensity, aiding in effective treatment planning. Get a free Physical Therapy Evaluation Template.

Download Carepatron's PDF to streamline your assessment process with examples. Optimize post-C-section recovery with a personalized care plan. Explore essential steps for a smooth healing journey in our C-section care guide. Uncover practical actions nurses take to care for their patients—from administering medications to collaborative care planning with other health professionals.

Explore the Dementia Rating Scale 2 DRS-2 with our free download. Understand its role in diagnosing and managing dementia, interpret results, and discover treatment options.

Discover the transformative benefits of posture correction exercises: reduce pain, boost flexibility, and enhance overall health. Free PDF guide available. Optimize patient care with our Nursing Process Worksheet, enhancing healthcare delivery through systematic assessment, diagnosis, planning, and evaluation.

Get insights on digestive system, gut health, definitive diagnosis, and helpful resources. Download our free Irritable Bowel Syndrome Quiz PDF now! Download this Nursing Lung Assessment to understand the importance of assessing breath sounds, respiratory distress, and signs of respiratory diseases.

Discover Carepatron, the ultimate general practice software for healthcare professionals. Streamline patient management with user-friendly features. Discover a Clean Eating Meal Plan tailored for health professionals to support clients in adopting whole, unprocessed diets for better health.

Access a free Hip Pain Location Diagram to quickly evaluate your patients ' hip pain location. Download the free PDF and sample here. Get your ESA Letter in Oregon for essential mental health support. Access compassionate healthcare services for emotional support animals, ensuring your well-being.

Explore the importance of oral health assessments for children, focusing on early detection, education, and establishing a dental home for overall well-being.

A nursing teaching plan is essential for nurses to educate and empower their patients effectively. Here is a free PDF download from Carepatron to assist nurses in developing their teaching plans. Explore comprehensive insights into endocrine disorders, including thyroid, adrenal, and pituitary issues, and their management and treatment options.

Discover how Carepatron enhances digestive health management with customizable templates, secure data, and improved patient-provider communication.

Looking for stroke physiotherapy exercises in a PDF format? Download Carepatron's PDF with various exercises for stroke rehabilitation and improved mobility. Explore effective obesity management with our Diet Plan for Obesity, tailored for health professionals to guide patients toward sustainable weight loss.

Empower patients and nursing teams with Chronic Obstructive Pulmonary Disease COPD Concept Map for a compelling treatment journey. Learn gastroparesis and how to streamline your test documentation.

Download a free PDF template and example here. Discover the various Antenatal Test available throughout pregnancy, and how they can protect women and babies. The Dot Eye Test is a visual screening tool that assesses vision and identifies potential eye problems.

Download Carepatron's free dot eye exam template here. Unlock insights into cognitive decline with our guide on the Global Deterioration Scale — your roadmap to understanding and navigating dementia stages. Understand Chronic Fatigue Syndrome CFS symptoms and gain insights into your well-being with Carepatron's user-friendly Chronic Fatigue Syndrome Test.

Get a complete Medical Clearance Letter template with a detailed example. Download a free PDF to provide your patients with all the necessary information for medical clearances. Access a free Dental Records Release Form for your practice. Streamline your clinical documentation with this template and example.

Streamline your medical treatment process with our comprehensive dental clearance form. Ensure a smooth journey to treatment. Download now! Learn more about the Retinal Detachment Test and how it can help prevent permanent blindness.

Table of Contents

Special attention must be paid to fluid balance in patients at high risk of complications - these include older people, pregnant women, children and young people years , and those with heart and kidney failure JBDS, The aim of insulin therapy in DKA management is to suppress ketogenesis, reduce blood glucose and correct electrolyte imbalance.

Insulin therapy increases peripheral glucose use and decreases hepatic glucose production, thereby lowering blood glucose concentration. It inhibits the release of free fatty acids from adipose tissues and decreases ketogenesis Umpierrez et al, A continuous fixed-rate intravenous insulin infusion FRIII of 0.

The recommendation for preparation of insulin infusion is 50 units of human soluble insulin made up with 50ml normal saline 0. FRIII should continue until DKA is resolved.

The JBDS recommends that background insulin should be continued along with the IV insulin infusion to reduce the risk of rebound hyperglycaemia when the IV insulin infusion is discontinued.

If background insulin is discontinued, a subcutaneous dose must be given before the IV insulin infusion is discontinued JBDS, The conversion to the subcutaneous insulin regimen should be planned around a mealtime; subcutaneous short-acting insulin should be given at the meal and then IV insulin discontinued one hour later JBDS, Blood glucose, ketones, electrolytes, including bicarbonate, and venous pH, should be monitored closely at or near the bedside.

Maintaining normal serum potassium and prevention of hypoglycaemia are important in the management of DKA as hypokalaemia low potassium level and hyperkalaemia high potassium level are both life-threatening conditions and common complications. Prevention of hypoglycaemia is vital, so bedside blood glucose monitoring should be performed every hours JBDS, It is sometimes necessary to give dextrose infusions to stabilise blood glucose levels; this should be given concurrently with the sodium chloride infusions used to correct circulatory volume JBDS, To avoid complications related to rapid infusion it is important to monitor fluid balance and electrolytes closely.

Regular assessment for complications such as cerebral oedema and fluid overload is vital JBDS, The JBDS stipulates that the diabetes specialist team must be involved in the management of every patient admitted with DKA, and referral should be made as soon as possible during the acute phase.

Team members play an important role in assessing the precipitating cause of DKA, acute management, discharge planning, education and follow-up care including psychological support JBDS, The best-practice tariffs stipulate that people admitted with DKA must be referred to the diabetes team and be seen by a member of the team within one working day of admission Price et al, All health professionals involved in caring for patients with DKA have a responsibility to ensure safe delivery of patient care in accordance with local and national clinical guidelines.

There are many potential areas for error in the management of DKA, so standardised protocols and guidelines are important to reduce risk for complications and management errors Quevedo et al, Table 1 highlights common complications. Patients should be taught how to manage blood glucose during periods of illness sick-day management.

This should include specific information about frequency of blood glucose monitoring, blood glucose targets, checking for ketones, taking extra quick-acting insulin, appropriate adjustment of insulin doses, identifying early signs and symptoms of DKA and knowing when to contact the diabetes specialist team Kitabchi et al, Patients should always have a follow-up review with the diabetes specialist team after an episode of DKA.

This should include assessment of overall diabetes control and assessment of risk for a recurrence of DKA. Risk reduction measures may include referrals to support services such as psychological services or structured education such as Dose Adjustment for Normal Eating DAFNE to increase diabetes knowledge, self-management skills and overall control.

Best-practice tariffs for DKA and hypoglycaemia recommend that all patients admitted to hospital with DKA should have access to structured education within three months of discharge Price et al, Management of DKA reduces the risk of mortality and improves clinical outcomes; this includes restoring circulatory volume, insulin therapy, correcting metabolic acidosis and electrolyte imbalance, identifying and treating precipitating factors and the early involvement of the diabetes specialist team.

The availability of standardised protocols and guidelines in clinical areas are important to reduce the risk of management errors. Patient education about sick-day management and communication with diabetes specialist team are necessary to reduce the risk of DKA recurring.

Sign in or Register a new account to join the discussion. You are here: Diabetes. Management of diabetic ketoacidosis in adults.

Abstract Ketoacidosis is a serious complication of diabetes. This article has been double-blind peer reviewed Scroll down to read the article or download a print-friendly PDF, including any tables and figures.

Box 1. Box 2. Box 3. Key management points Fluid resuscitation with 0. Key points The majority of patients presenting with diabetic ketoacidosis have type 1 diabetes Patients with type 2 diabetes can develop DKA, especially during acute illness Infection is the most common precipitating factor for DKA Clinical signs of DKA include polyuria, polydipsia, weakness, fatigue, weight loss, vomiting and abdominal pain DKA is a medical emergency.

When the metabolism of carbohydrates reaches normal, caution must be taken to prevent hypoglycemia. Administer regular insulin by intermittent or continuous IV method. Intravenous IV infusion is the chosen route of insulin delivery because the rapid onset and short duration of action associated with IV infusion allow for matching insulin requirements to rapidly change blood glucose levels.

Larger volumes of insulin and isotonic sodium chloride solution mixture can be used, provided that the infusion dose of insulin is similar. Collaborate with a dietitian for initiation of resumption of oral intake. Dietitians or nutritionists may help in calculating and adjusting diet to meet the nutritional needs of the client; Dietitian assists the client and the family in producing meal plans.

Diet management includes education about how to adjust the timing, size, frequency, and composition of meals so as to avoid hypoglycemia or postprandial hyperglycemia. Complex carbohydrates peas, beans, whole grains, and vegetables decrease glucose and cholesterol levels.

Caloric distribution is an important aspect of dietary planning for these clients. Teach the importance of eating three meals a day at regularly scheduled times and a bedtime snack. Meals and insulin administration must be linked together, especially when insulin analogues such as Humalog, NovoLog, or Apidra are given before meals and in conjunction with snacks.

Analogues are quicker acting than regular insulins. Use a balance of sugar-containing beverages and water. Intake of carbohydrates must be maintained unless the insulin dose is altered to avoid hypoglycemia. Water must be consumed to maintain intravascular volume.

There are too many carbohydrates in juice or soda to use either as a primary source of volume. Administer prochlorperazine, diphenhydramine , and metoclopramide as prescribed. These are beneficial in treating symptoms related to affecting the GI tract such as diabetic gastroparesis, to improve oral intake and nutrient absorption.

In an attempt to rid the body of excess glucose, the kidneys excrete the glucose along with water and electrolytes. This osmotic diuresis, which is characterized by excessive urination, leads to dehydration and marked electrolyte loss.

Assess precipitating factors such as other illnesses, new-onset diabetes, or poor compliance with the treatment regimen. These will provide baseline data for education once with resolved hyperglycemia.

Urinary tract infection and pneumonia are the most common infections causing DKA among older clients. Assess skin turgor, mucous membranes, and thirst. This provides baseline data for further comparison.

Skin turgor will decrease and tenting may occur. This occurs because the skin relies on hydration to maintain its elasticity and suppleness.

The oral mucous membranes will become dry, and the client may experience extreme thirst. Monitor hourly intake and output.

Oliguria or anuria results from reduced glomerular filtration and renal blood flow. Hyperglycemia usually exceeds the renal threshold of glucose absorption and results in significant glucosuria.

Glucosuria leads to osmotic diuresis, dehydration, and hyperosmolarity. Decreased blood volume may be manifested by a drop in systolic blood pressure and orthostatic hypotension. Acetone breath is due to the breakdown of acetoacetic acid.

Fever with flushed, dry skin may indicate dehydration. Compensatory mechanism results in peripheral vasoconstriction with a weak, thready pulse that is easily obliterated.

Assess neurological status every two hours. Decreased level of consciousness results from blood volume depletion, elevated or decreased glucose level, hypoxia, or electrolyte imbalances. Altered consciousness in the form of mild disorientation or confusion can occur.

Weigh the client daily. This provides baseline data on the current fluid status and adequacy of fluid replacement. A weight loss of 2. Assess for the presence of nausea and vomiting. Nausea and vomiting usually occur and may be associated with diffuse abdominal pain, decreased appetite, and anorexia.

Ketones, in particular, beta-hydroxybutyrate, induce nausea and vomiting that consequently aggravate fluid and electrolyte loss already existing in DKA. This maintains hydration and adequacy of circulating volume. Hydration causes a decline in counter-regulatory hormones, enhances renal glucose clearance following improved renal perfusion, and augments insulin sensitivity.

This, in turn, causes a significant reduction in hyperglycemia, hypertonicity, and acidemia. Be alert to indicators of fluid overload , particularly among older adults or clients with a history of heart or renal failure.

Indicators of fluid overload, such as jugular vein distention, dyspnea , crackles, or CVP of more than 12 mm Hg, can occur with rapid infusion of fluids. Be extremely cautious to avoid cerebral edema and pulmonary edema. Monitor laboratory studies such as blood glucose levels, serum ketones, potassium , sodium, creatinine, and blood urea nitrogen BUN.

Monitor ABG for metabolic acidosis. Insert indwelling urinary catheter as indicated. This provides accurate measurement of urinary output, especially if autonomic neuropathies result in neurogenic bladder with urinary retention and overflow incontinence. The catheter may be removed when the client is stable to reduce the risk of infection.

Administer isotonic solutions 0. The initial goal of therapy is to correct circulatory fluid volume deficit. Isotonic normal saline will rapidly expand extracellular fluid volume without causing a rapid fall in plasma osmolality. Clients typically need one to three liters within the first two hours of treatment.

Administer succeeding IV therapy with a hypotonic solution such as 0. Continuation of IV administration depends on the degree of fluid deficit, urinary output, and serum electrolyte values. Dextrose is added to prevent the occurrence of hypoglycemia and an excessive decline in plasma osmolality that can result in cerebral edema.

Administer IV potassium and other electrolytes as indicated. Administer bicarbonate as indicated. Administer IV insulin by continuous infusion using an infusion pump.

Regular insulin has a rapid onset and therefore immediately helps move glucose intracellularly. A low-dose insulin regimen has the advantage of not inducing the severe hypoglycemia or hypokalemia that may be observed with a high-dose insulin regimen. The initial insulin dose is a continuous IV insulin infusion using an infusion pump, if available.

Before initiating treatment, flush the tubing with at least 30 mL of the insulin-containing IV solution. When added to IV solutions, insulin may be absorbed by the container and plastic tubing. Flushing the tubing ensures that maximum adsorption of the insulin by the container and tubing has occurred before it is delivered to the client.

Diabetic ketoacidosis is an acute complication of diabetes. Around one-third of DKA cases occur in newly diagnosed diabetes mellitus clients. Most deaths are caused by cerebral edema complications. Awareness forms the basis for health-related practices being implemented.

Having a first-degree relative diagnosed with diabetes is associated with a regressed risk of DKA at diabetes. Research showed that there is a relationship between having a first-degree relative diagnosed with diabetes and awareness regarding the management of DKA. Health authorities must provide a more effective way to teach society about DKA management to prevent the development of complications Farran et al.

Assess culture and culturally specific information needs. This assessment helps ensure that information is selected and presented in a manner that is culturally and educationally appropriate. Establish rapport and trust. Create an environment where trust and good rapport facilitates good relationship in the learning process.

Rapport and respect need to be established before the client will be willing to take part in the learning process. Explain the signs and symptoms of diabetic ketoacidosis.

Symptoms of hyperglycemia include polyuria, polydipsia, polyphagia, flushed skin, and body malaise. Abdominal pain, sometimes mimicking an acute abdomen, is especially common in children and clients with severe metabolic acidosis Dhatariya et al. Discuss the essential elements with the client, such as risk factors, disease process, and complications.

Baseline knowledge enables the client to make informed lifestyle choices. Knowledge of precipitating factors also helps avoid recurrences. Acute and chronic complications of DKA include visual disturbances, neurosensory and cardiovascular changes, renal impairment, and hypertension. Awareness about these complications helps the client be more consistent with care and may prevent or delay the onset of complications.

Demonstrate proper blood glucose testing using the glucometer. Monitoring blood glucose three to four times a day is an essential part of managing diabetes to avoid further complications. Educate about signs of hypoglycemia These are signs of excessive insulin dosage, resulting in hypoglycemia.

Early recognition of these symptoms promotes immediate intervention. Allowing blood glucose to drop to hypoglycemic levels is a common mistake that usually results in rebound ketosis derived from counter-regulatory hormones.

Teach the client that polyuria, polydipsia, and polyphagia are signs of hyperglycemia which requires an increased dosage of insulin.

These are signs of insufficient insulin dosage and hyperglycemia which may lead to coma and death if untreated. The hyperglycemia-induced osmotic diuresis depletes sodium, potassium, phosphates, and water. The most important concept in this is to never eliminate insulin doses when nausea and vomiting occur.

Instead, the client should take the usual insulin dose and then attempt to consume frequent small portions of carbohydrates. Explain the importance of having a dietary plan, such as limiting the intake of simple sugar, fat, salt, and alcohol and increasing the intake of whole grains, fruits, and vegetables.

Medical nutrition therapy is important in managing diabetes and preventing the rate of development of diabetes complications. A high-fiber diet can slow the absorption of glucose, decrease excess insulin levels, and lowered lipid concentrations in clients with type 2 diabetes.

Reducing saturated fat intake reduces the risk of developing coronary artery and peripheral vascular disease.

Remind the client of the importance of maintaining adequate oral fluid intake during illness. Anorexia or nausea may limit food intake, but the client should make every effort to continue fluid intake to avoid dehydration, hypovolemia, and possible hypotension.

Take liquids such as a half cup of regular cola or orange juice, a half cup of broth, or sports drinks every 30 minutes to one hour to provide calories if vomiting, diarrhea , or fever persists. Teach the client to monitor blood glucose during periods of exercise and adjust the insulin dose.

The insulin dose should be adjusted after increased or decreased food intake and before any exercise. Exercise may increase the usage of glucose. Additionally, instruct the client to also monitor blood glucose and urine ketone levels during periods of increased emotional stress.

Exercise and emotional stress may increase the release of glucose from the liver or increase insulin resistance. Advise the client on the importance of daily examination of the feet and foot care. Decreased peripheral circulation places the client at risk for an undetected foot injury.

Advise the client on the importance of routine eye examinations. Clients with poorly controlled diabetes may experience changes in vision that may lead to blindness. Review the medication regimen, including, onset, peak, and duration of prescribed insulin, as applicable with the client.

A good way to properly use insulin is to learn these aspects of drug usage. This will help in the adjustment of the doses or the food intake to stop unwanted ups and downs in the glucose level. Understanding all aspects of drug usage promotes the proper use of insulin.

Dose algorithms are created, taking into account drug dosages established during inpatient evaluation, the usual amount and schedule of physical activity , and meal plans. Review self-administration of insulin and care of equipment. Have the client demonstrate the procedure e.

This evaluates understanding of the procedure and recognizes potential problems such as short-term memory so that alternative solutions can be made for the administration of the insulin.

Active skill development used to overcome barriers to self-management has been related to lowering HbA1c values Wang et al. Discuss the timing of insulin injection and mealtime. Collaborate in Multidisciplinary Care: Develop collaboration skills to work effectively within a multidisciplinary healthcare team, including physicians, endocrinologists, and dietitians, to provide comprehensive care and address the underlying factors contributing to DKA.

Educate Patients on Prevention and Management: Provide education to individuals with diabetes on the prevention of Diabetic Ketoacidosis, emphasizing the importance of insulin management, regular monitoring, recognizing early signs of DKA, and seeking prompt medical attention when needed. Pathophysiology for Diabetic Ketoacidosis Pathophysiology of Diabetic Ketoacidosis DKA : Insulin Deficiency: Diabetic Ketoacidosis DKA primarily occurs due to a deficiency of insulin.

In individuals with diabetes, inadequate insulin levels lead to an inability to transport glucose into cells for energy, resulting in hyperglycemia. Increased Lipolysis: Insulin deficiency stimulates lipolysis, causing the breakdown of stored triglycerides in adipose tissue. This process releases free fatty acids, which are converted into ketones in the liver as an alternative energy source.

Ketone Production: Excessive production of ketones, including acetoacetate, beta-hydroxybutyrate, and acetone, occurs due to the increased availability of free fatty acids. Ketones contribute to the acidic environment seen in DKA. Metabolic Acidosis: Accumulation of ketones results in metabolic acidosis, characterized by a decrease in blood pH.

The acidosis is further exacerbated by the accumulation of lactic acid due to tissue hypoperfusion resulting from dehydration. Electrolyte Imbalances and Dehydration: Hyperglycemia leads to osmotic diuresis, causing excessive loss of water and electrolytes in the urine.

This results in dehydration, electrolyte imbalances such as potassium depletion , and an increased risk of acute renal failure.

Etiology of Diabetic Ketoacidosis DKA : Insulin Deficiency or Insufficient Insulin Action: The primary etiological factor for Diabetic Ketoacidosis DKA is a deficiency of insulin or insufficient insulin action in individuals with diabetes.

This often occurs due to missed insulin doses, inadequate insulin dosage, or increased insulin requirements during illness or stress. Infections may lead to increased production of counterregulatory hormones, exacerbating insulin deficiency and promoting ketone production.

Undiagnosed Diabetes or Poorly Managed Diabetes: Individuals with undiagnosed diabetes or those with poorly managed diabetes, characterized by irregular monitoring and inadequate insulin therapy, are at increased risk of developing DKA. Stressful Events or Trauma: Stressful events, such as trauma, surgery, or emotional stress, can trigger the release of stress hormones catecholamines and cortisol , which antagonize insulin action.

This hormonal imbalance contributes to elevated blood glucose levels and ketone production. Medication Non-Adherence: Non-adherence to prescribed diabetes medications, particularly insulin, is a significant factor in the development of DKA. Missed doses, inadequate dosage adjustments, or discontinuation of insulin therapy can lead to insulin deficiency and subsequent ketosis.

Desired Outcome and Nursing Care Plan for Diabetic Ketoacidosis Normalization of Blood Glucose Levels: Achieve and maintain normal blood glucose levels through insulin therapy, promoting glycemic control and preventing hyperglycemia associated with DKA. Correction of Metabolic Acidosis: Correct metabolic acidosis by addressing the underlying ketone production.

Normalize blood pH levels through careful administration of intravenous fluids, insulin therapy, and monitoring of acid-base balance. Restoration of Fluid and Electrolyte Balance: Restore and maintain fluid and electrolyte balance by addressing dehydration and electrolyte imbalances associated with DKA.

Administer intravenous fluids and electrolytes as prescribed to prevent complications such as hypovolemic shock and cardiac arrhythmias.

Resolution of Ketosis: Promote the resolution of ketosis by facilitating the utilization of glucose for energy production and suppressing the breakdown of fatty acids.

Monitoring ketone levels and addressing factors contributing to insulin deficiency are crucial for ketosis resolution. Patient and Caregiver Education: Provide comprehensive education to individuals with diabetes and their caregivers on the prevention of DKA.

Emphasize the importance of regular insulin therapy, continuous glucose monitoring, early recognition of signs of DKA, and prompt medical intervention during illness or stress. Diabetic Ketoacidosis DKA Nursing Care Plan Subjective Data for Diabetic Ketoacidosis DKA : Definition of subjective data: information provided by individuals about their symptoms, feelings, and medical history, relying on their personal descriptions and experiences, rather than objective measurements or observations.

View the FULL Outline When you start a FREE trial you gain access to the full outline as well as:. Example Nursing Diagnosis for Diabetic Ketoacidosis DKA Imbalanced Fluid Volume: DKA is characterized by dehydration due to excessive urination and fluid loss.

This diagnosis addresses fluid and electrolyte imbalances. Risk for Infection: DKA can lead to compromised immune function, increasing the risk of infections. This diagnosis emphasizes infection prevention.

Ineffective Tissue Perfusion: DKA can lead to poor tissue perfusion due to altered blood volume and oxygen delivery. This diagnosis addresses perfusion concerns.

Transcript Hey everyone in this care plan, we will be discussing diabetic ketoacidosis. Okay, so in this care plan, we're going to be looking at a description of diabetic ketoacidosis, the subjective and objective data that's relevant, and your nursing interventions and rationales.

Alright, so let's take a look at what DKA actually is. So, it's very important to know that this is a very serious complication of diabetes mellitus that can occur when blood sugars are poorly controlled. So, what happens is you get really increased blood sugar levels and they rise to an extreme level.

So, they're very, very high, but the body doesn't have the insulin that it needs to use the glucose. So, this glucose and blood sugar is not accessible to the body. When that happens, the body has to start using fat for energy.

So we're not using blood sugar, we're using fat for energy. When the body uses fat as an energy source, a type of acid called ketones actually builds up in the bloodstream, so you can see where the name for diabetic ketoacidosis comes from, again, acidosis that's caused by these ketones that are building up secondary to using fat for energy.

Okay, so let's think a little bit about why this might actually happen to a patient. So, we said it often happens in diabetic patients, but it's usually in patients who are either newly diagnosed and so they don't know that they're diabetic, or it's in patients who aren't really compliant with their treatment plan.

nuraing means it's official. Federal government DKA nursing interventions often end in. gov or. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. NCBI Bookshelf.

Author: Vonos

2 thoughts on “DKA nursing interventions

  1. Ich meine, dass Sie sich irren. Ich biete es an, zu besprechen. Schreiben Sie mir in PM, wir werden umgehen.

Leave a comment

Yours email will be published. Important fields a marked *

Design by ThemesDNA.com