Zusammenfassung der Ressource
Diabetic Ketoacidosis
- Nursing Implications
- Evaluation/ Monitoring
- Continue to monitor vital signs to determine the
presence of fever, hypovolemic shock, tachycardia,
and Kussmaul's breathing (Lewis et al., 2014).
- Monitor the signs of potassium imbalance resulting
from hypoinsulinemia and osmotic diuresis. Use
Cardiac monitoring to detect hyperkalemia and
hypokalemia (Lewis et al., 2014).
- Assessments
- Assess potential Insulin On Board (IOB). When was the last time of
insulin administration? How much insulin was administered at
this time? Do adjustments need to be made due to illness or
stress? (American Diabetes Association (Lilley et al., 2017)
- Assessment of mental status
and level of
consciousness (Lewis et al.,
2014).
- Assess patient
food intake.
- High blood glucose levels (above 14
mmol/L) (Diabetes Canada, 2018).
- Renal status (e.g Polyuria) (Lewis et al., 2014)
- Cardiovascular status related to
hydration and electrolyte levels
(Lewis et al., 2014).
- Respiratory status (eg. Kussmaul's breathing) (Lewis et al., 2014).
- Vital signs (Lewis et al., 2014)
- Signs and symptoms listed under
"Disease Process"
- Patient/Family Teaching
- Managing blood sugar levels when ill. Being
sick may cause blood sugar levels to
fluctuate and become unpredictable (CDA,
2019)
- Checking blood glucose levels more often
than usual (e.g. every two
to four hours) (CDA, 2019).
- Drink plenty of water or
sugar-free fluids (avoid
caffeinated drinks that can lead
to dehydration) (CDA, 2019).
- Continue to take insulin or other
diabetes medication (CDA, 2019).
- As an extra precaution, you should always check with
your health-care team about guidelines for insulin
adjustment or medication changes during an illness (CDA, 2019).
- Check for ketones every 4 to 6 hours. And
check every 4 to 6 hours when your blood
sugar is more than 14 mmol/L (Diabetes Canada,
2018)
- If you have a cold or flu and want to use a cold
remedy or cough syrup, ask your pharmacist to
help you make a good choice. Many cold
remedies and cough syrups contain sugar, so try
to pick sugar-free products (CDA, 2019).
- Monitoring for presence of ketones in urine,
however, blood ketones are preferred for accuracy
(Diabetes Canada, 2018)
- Insulin Information (CDA,
n.d.).
- Discard insulin that has been frozen, exposed
to temperatures greater than 30ºC, or expired.
- Unopened insulin should be stored in
the fridge between 2ºC and 8ºC.
- Opened insulin can be stored at room
temperature for up to 1 month.
- Patient educational support systems
- Patient awareness of when
to contact the emergency
room (CDA, 2019)
- Community support via
telehealth programs (Vellanki &
Umpierrez, 2018)
- Diagnosis (Canadian
Diabetes Association
[CDA], 2019)
- ↑ glucose
- ↑ serum/urine
ketones
- ↓ pH (venous and arterial
and/or ↓ bicarbonate
- Plan/Intervention
(Lewis et al., 2014)
- Recording of intake and output
- Central venous pressure monitoring (if indicated)
- Check blood and urine for ketones
- Obtain blood glucose levels
- Administration of IV fluids to correct dehydration
- IV administration of rapid- or short-acting insulin reduce blood
glucose and serum ketones
- Electrolyte replacement
- Treatment (Lewis et al., 2014)
- Drug Therapy
- Fluid resuscitation with NaCl
solution until blood pressure stabilizes and
urine output normalizes
- Continuous insulin drip
@ 0.1 units/kg/hr
- Potassium IV to correct
deficiency as a result
of hyperglycemia
- Sodium bicarbonate
if severely acidotic
- Non-pharmacological Interventions
- Ensure patent airway
- Gather history of diabetes, when the
person last ate, time/amount of latest
insulin injection
- Factors Associated With DKA
Diagnoses (Malik et al., 2016)
- Public Insurance
- Those with public insurance twice as
likely to be hospitalized for DKA than
those with private insurance
- More unmet prescription
and medical needs than
those with private
- Non-hispanic Black race
- Being older than 12 years old
- Parental monitoring, supervision,
involvement in diabetic care
declines as children age
- Being a female
- Mental health
comorbidity
- Celiac Disease
- Many people with diabetes may
become celiac due to reasons
beyond their control
- Disease Process
- Pathophysiology/Etiology (Lilley,
Collins, Snyder, Swart, 2017))
- Severe insulin deficiency
- Presence of ketones in the serum and urine
- Acidosis
- Dehydration
- Electrolyte imbalance
- Low plasma levels
- Potassium
- Bicarbonate
- Signs (Canadian Diabetes
Association [CDA], 2019)
- Nausea
- Vomiting
- Abdominal pain
- Confusion
- Difficulty paying attention
- Feeling tired
- Difficulty breathing
- Extreme thirst and dry mouth
- Symptoms (Derraik et al., 2018)
- Polyuria
- Hyperglycemia
- Polydipsia
- Weight loss
- Fruity odor on breath
- Dry or flushed skin
- Complications
- If left untreated, leading to
reduced consciousness and
coma (CDA, 2019)
- Can become fatal (CDA, 2019)
- Brain changes, including decreasing IQ
levels and short-term memory loss (Derraik
et al., 2018))
- Liposis and over-production of
ketones (DKA) (Derraik et al.,
2018)
- Risk Factors
- Newly diagnosed Type 1 Diabetics are at increased risk
(Derraik et al., 2018; Lilley, Collins, Snyder, Swart, 2017))
- Emotional or physical stress (ex. illness or infection) (Lilley, Collins,
Snyder, Swart, 2017)
- Uncontrolled diabetes Lilley, Collins,
Snyder, Swart, 2017)