Zusammenfassung der Ressource
Diabetic Ketoacidosis - Jessica and
Misbah
- Interventions
- Adjust fluid volumes
(Nyenwe & Kitabchi,
2016)
- correcting electrolyte imbalance
- restoring hyperosmolaity
- Fluid replacement using IV
solutions (Nyenwe & Kitabchi, 2016)
- Normal Saline
- Ringers Lactate
- Increase tissue perfusion
(Nyenwe & Kitabchi, 2016)
- Restore blood glucose
(Nyenwe & Kitabchi, 2016)
- insulin therapy (Noble-Bell &
Cox, 2014)
- resolving ketosis
(Nyenwe & Kitabchi,
2016)
- Nursing
Assessments
- Monitor fluid balance: intake and
output (Noble-Bell & Cox, 2014)
- Monitor vital signs and level of
consciousness hourly (Use Glascow scale)
(Noble-Bell & Coz, 2014)
- Monitor for signs of related to fluid
overload, dehydration, electrolyte
imbalance (Noble-Bell & Cox, 2014)
- Capillary Blood Glucose and ketones every 1
hour during acute phase (Noble-Bell & Cox,
2014)
- Monitor serum potassium
levels (Noble-Bell & Cox, 2014)
- Blood gases in monitoring for
acidosis/alkalosis (Noble-Bell &
Cox, 2014)
- Etiology
- Diabetes Type I / Diabetes Type
II (Nyenwe & Kitabchi, 2016)
- Insulin
deficency, and increase
glucose in the blood
stream
- Infection
(Westerberg, 2013)
- Pneumonia
- Urinary Tract
infection
- Sepsis
- Certain Medications
(Wetserberg, 2013)
- Antipsychotics
(Wetserberg,
2013)
- corticosteroids,
glucagon,
interferon,
pentamidine,
sympathomimetic
agents, thiazide
diuretics
(Wetserberg,
2013)
- Illicit drugs: cocaine, alcohol
(Wetserberg, 2013)
- Risk
factors
- Vomiting (Nyenwe &
Kitabchi, 2016)
- Fasting (Nyenwe &
Kitabchi, 2016)
- Pregnant (Nyenwe &
Kitabchi, 2016)
- poor adherence to insulin/ or insulin omission (Anzola,
Gomez, & Umpierrez, 2016)
- New diagnosis (Nyenwe &
Kitabchi, 2016)
- Previous DKA
(Wolfsdorf et al.,
2014)
- poor management of hydration
(Wolfsdorf et al., 2014)
- Eating disorders
(Wolfsdorf et al., 2014)
- Lack of access to health care (Wolfsdorf et al.,
2014)
- Clinical Manifestations: Evolves over a short time period & can
pogress quickly. (Nyenwe & Kitabchi, 2016)
- Lab values
- glucose > 250 mg/dl
(Nyenwe & Kitabchi,
2016)
- Metabolic Acidosis (Westerberg, 2013)
- Kussmaul Respirations
- Ph < 7.35 (Nyenwe &
Kitabchi, 2016)
- HCO3 <22mmol/ L (Nyenwe &
Kitabchi, 2016)
- Hyperglycemia
(Westerberg, 2013)
- Polydipsia
- Polyphagia
- Polyuria
- Weightloss
- Fatigue
- Vomiting (Nyenwe &
Kitabchi, 2016)
- Abdominal Pain (Nyenwe &
Kitabchi, 2016)
- Dehydration (Westerberg,
2013)
- Hypotension
- Tachycardia
- Poor skin turgor
- Dry mucous
membranes
- Orthostatic
hypotension
- Decreased level of
Consciousness (Anzola
et al., 2016)
- Ketosis: acetone scent (Sweet smell)
(Nyenwe & Kitabchi, 2016)
- Pathophysiology
- Insulin deficiency
(Westberg, 2013)
- increase in counter regullatory hormones
(Westberg, 2013)
- glucagon
- catechalomines
- cortisol
- growth hormones
- Fats are broken down into ketones (Westberg, 2013)
- Proteins are broken down (Westberg,
2013)
- Glucose and ATP is created (Westberg,
2013)
- Leads to hyperglycemia and osmotic diuresis (Westberg,
2013)
- Dehydration
- Hyperosmolaric state.
- Metabolic acidosis
- Complications
- Hypoglycemia (Nyenwe &
Kitabchi, 2016)
- Due to insulin overtreatment
(Nyenwe & Kitabchi, 2016)
- Acute Renal failure
(Westerberg, 2013)
- Shock
(Westerberg, 2013)
- Cerebral Edema
(Westerberg, 2013)
- Hypokalemia (Nyenwe & Kitabchi,
2016)
- Prevention
- Health teaching
(Anzola et al., 2016)
- adherence to insulin therapy
- controling blood glucose levels
- how to adjust insulin when ill
- maintaining adequate fluid intake
- Addressing barriers (Anzola et
al., 2016)
- in access to health care, primary care
- in communication with the health care provider, or
social supports
- in social supports such as family, friends school
and it's affect on health