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Diabetic Ketoacidosis - Jessica and Misbah

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

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Diabetic Ketoacidosis - Jessica and Misbah

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