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Understanding Dka For Nurses

Diabetic Ketoacidosistreatment & Management

Diabetic Ketoacidosistreatment & Management

Diabetic KetoacidosisTreatment & Management Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours always is advisable. When treating patients with DKA, the following points must be considered and closely monitored: Correction of fluid loss with intravenous fluids Correction of electrolyte disturbances, particularly potassium loss Treatment of concurrent infection, if present It is essential to maintain extreme vigilance for any concomitant process, such as infection, cerebrovascular accident, myocardial infarction, sepsis, or deep venous thrombosis . It is important to pay close attention to the correction of fluid and electrolyte loss during the first hour of treatment. This always should be followed by gradual correction of hyperglycemia and acidosis. Correction of fluid loss makes the clinical picture clearer and may be sufficient to correct acidosis. The presence of even mild signs of dehydration indicates that at least 3 L of fluid has already been lost. Patients usually are not discharged from the hospital unless they have been able to switch back to their daily insulin regimen without a recurrence of ketosis. When the condition is stable, pH exceeds 7.3, and bicarbonate is greater than 18 mEq/L, the patient is allowed to eat a meal preceded by a subcutaneous (SC) dose of regular insulin. Insulin infusion can be discontinued 30 minutes later. If the patient is still nauseated and cannot eat, dextrose infusion should be continued and regular or ultrashort-acting insulin should be administered SC every 4 hours, according to blood glucose level, while trying to maintain blood glucose values at 100-180 mg/dL. The 2011 JBDS guideline recommends the Continue reading >>

Differentiating Diabetes Complications: Whats Your Call?

Differentiating Diabetes Complications: Whats Your Call?

Differentiating diabetes complications: Whats your call? Author: Cynthia Ticker, RN, BSN, CDE, CPT Carlos Suarez, age 74, arrives at the emergency department by ambulance after collapsing at home. Emergency personnel report that he is confused and cant tell them what caused his collapse. His vital signs are temperature 102.4 F, respirations 22 breaths/minute, pulse 110 beats/minute, and blood pressure 90/60 mm Hg. He has dry mucous membranes, poor skin turgor, and bilateral wheezing in both lungs. A fingerstick blood glucose level reads high on the meter, indicating a value above 600 mg/dl. Mr. Suarezs wife states that she called 911 after finding her husband lying in the bedroom unresponsive. She says he has a history of hypertension, for which hes taking chlorothiazide (a thiazide diuretic), and hyperlipidemia, which he controls with atorvastatin. Two days ago, he finished a 5-day course of antibiotics prescribed for bronchitis. She also says her husband has been drinking fluidsand urinatingmore frequently than usual. STAT laboratory tests show a plasma glucose level of 1,050 mg/dl, plasma osmolarity above 320 mOsm/kg, serum sodium level below 120 mEq/L, serum potassium level of 4.0 mEq/l, arterial pH 7.45, and a white blood cell (WBC) count of 30,000/mm3. Plasma ketones are absent. Although Mrs. Suarez says her husband has never been diagnosed with diabetes mellitus, his extremely high blood glucose level certainly suggests he has diabetes. Based on his other assessment findings, youd be correct to assume hes experiencing an acute complication of diabetes. But which one? Serious acute complications of diabetes include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Untreated, both can lead to death. However, their exact causes, clinical pr Continue reading >>

Management Of Diabetic Ketoacidosis

Management Of Diabetic Ketoacidosis

Donahey, Elisabeth PharmD, BCPS; Folse, Stacey PharmD, MPH, BCPS Section Editor(s): Weant, Kyle A. PharmD, BCPS; Column Editor Diabetes, a chronic medical condition, continues to increase in prevalence. One of the most severe complications of diabetes, diabetic ketoacidosis (DKA), results from insulin deficiency and is a medical emergency that is frequently encountered in the emergency department. Prompt diagnosis, assessment of key laboratory values, appropriate treatment, and close monitoring are important to the successful treatment of this complex metabolic disorder. Fluid repletion and insulin administration are mainstays of DKA treatment and serve to restore normal hemodynamic status while decreasing the metabolic acidosis. Careful monitoring of glucose concentrations, vital signs, and electrolytes is essential to prevent complications arising from the treatment of DKA. This article provides an overview of the pathophysiology, presentation, diagnosis, treatment, monitoring, and complications of DKA. Emory University Hospital; and Mercer College of Pharmacy and Health Sciences, Atlanta, GA. Corresponding Author: Stacey Folse, PharmD, MPH, BCPS, Emory University Hospital, 1364 Clifton Road, Atlanta, GA 30322 ( [email protected] ). Disclosure: The authors report no conflicts of interest. DIABETES is a chronic condition that affects 25.8 million people (8.3%) in the United States. Of these, 7 million cases are undiagnosed. Diabetes continues to increase in prevalence, with the most recent data indicating that 1.9 million people were newly diagnosed in 2010 ( Centers for Disease Control and Prevention, 2010 ). Two of the most serious and life-threatening complications of diabetes are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state. This Continue reading >>

Roles And Responsibilities

Roles And Responsibilities

Nursing staff have an important role and clear responsibilities when treating patients with diabetes or who are having tests to diagnose diabetes. This role and associated responsibilities will be specified in local workplace guidance and policies and by each member of the nursing team's level of competence. If you are not familiar with the guidance in relation to diabetes care in your work setting, it is important to find out where it is so you can be sure you're providing safe patient care, particularly if you are required to perform tests and observations for your patients. Explore the following activity to learn more about some of the specific competencies relating to caring for a patient with diabetes. Screening, prevention and early detection of type 2 diabetes To prevent and aid early detection of type 2 diabetes you should be able to: describe the risk factors for type 2 diabetes explain the importance of prevention or delay of onset of type 2 diabetes in individuals at risk explain the role that exercise plays in the prevention of, or delay in progression to, type 2 diabetes explain the importance of weight control and the role that diet plays in the prevention of, or delay in progression to, type 2 diabetes. Promoting self-care In order to support the patient to self-care their diabetes you should be able to: support the patient and help them develop their own self-care with guidance from a registered nurse observe and report any concerns that you may have about a patient that would affect their ability to self-care encourage patients to use their personalised care plans. Mental health To care for someone with diabetes and mental illness you should be able to: have an understanding and awareness of how mental health issues, such as depression and anxiety, can Continue reading >>

Management Of Diabetic Ketoacidosis In Adults

Management Of Diabetic Ketoacidosis In Adults

Diabetic ketoacidosis is a potentially life-threatening complication of diabetes, making it a medical emergency. Nurses need to know how to identify and manage it and how to maintain electrolyte balance Continue reading >>

4 Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Nonketotic Syndrome Nursing Care Plans

4 Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Nonketotic Syndrome Nursing Care Plans

Risk for Fluid Volume Deficit: At risk for experiencing vascular, cellular, or intracellular dehydration. Risk Factors Decreased intake of fluids due to diminished thirst sensation or functional inability to drink fluids. Excessive gastric losses due to nausea and vomiting. Hyperglycemia-induced osmotic diuresis. Possibly evidenced by [not applicable]. Desired Outcomes Client will remain normovolemic as evidenced by urinary output greater than 30 ml/hr, normal skin turgor, good capillary refill, normal blood pressure, palpable peripheral pulses, and blood glucose levels between 70-200 mg/dL. Nursing Interventions Rationale Assess precipitating factors such as other illnesses, new-onset diabetes, or poor compliance with 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 and HHNS among older clients. Assess skin turgor, mucous membranes, and thirst. To provide baseline data for further comparison. Skin turgor will decrease and tenting may occur. 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. Monitor vital signs: Monitor BP especially for orthostatic hypotension. Decreased blood volume may be manifested by a drop in systolic blood pressure and orthostatic hypotension. Monitor respirations, e.g., acetone breath, Kussmaul’s respirations. Acetone breath is due to the breakdown of acetoacetic acid. Kussmaul’s respiration (rapid and shallow breathing) represent a compensatory mechanism by the respiratory buffering system to raise arterial pH by exhaling more carbon dioxide. Monitor tempera Continue reading >>

Understanding Diabetic Ketoacidosis

Understanding Diabetic Ketoacidosis

Dr. Roger Seheult gives a clear explanation with drawings of diabetic ketoacidosis, which accounts for 135,000 hospital admissions every year in the United States. What is diabetic ketoacidosis? What do you test the patient’s blood for? Is creatinine value increased or decreased in a patient with DKA? Is the glucose level increased or decreased in a patient with DKA? In less than 15 minutes, get the answers and never be confused about diabetic ketoacidosis again. Continue reading >>

Diabetic Ketoacidosis (dka) Nursing Care Plan

Diabetic Ketoacidosis (dka) Nursing Care Plan

Maintain blood glucose level within the target range, maintain normal fluid balance Diabetic Ketoacidosis (DKA) Nursing Care Plan Metabolic Acidosis with elevated Anion Gap Monitor blood glucose levels and administer insulin as appropriate Consistently high blood glucose levels, over 400 mg/dL, are the primary indicator of ketone production. Monitor glucose and intervene with prescribed insulin as appropriate to reduce glucose levels and prevent further ketone production. Monitor fluid and electrolyte balance to prevent dehydration and complications such as decreased sodium, potassium, calcium and magnesium Excess blood glucose can cause nausea and vomiting resulting in electrolyte imbalances. These electrolyte deficiencies can lead to further complications and cardiac arrhythmias. Monitor for and treat signs / symptoms of infection DKA is often the result of an underlying infection such as a common cold, flu or bacterial infection like pneumonia or urinary tract infections. Assess for fever and other symptoms of infection and administer antibiotics as necessary. Medications may be given to lower the blood glucose level in order to prevent further production of ketones or to manage symptoms of vomiting and underlying infection. Monitor vitals for signs / symptoms of hypovolemia Vomiting and frequent urination can cause a deficiency in fluid volume, thus leading to a decreased circulatory volume. This will be evident by low blood pressure and tachycardia Prevent injury and falls; assist with ambulation Fatigue and weakness are common due to the cells inability to use glucose to produce energy, also following vomiting, and in cases of dehydration. Maintaining a high blood glucose level, missing doses of insulin or being sick can cause ketones to form in the blood. Educat Continue reading >>

Actrapid: Eight Steps For Managing Diabetic Ketoacidosis

Actrapid: Eight Steps For Managing Diabetic Ketoacidosis

ACTRAPID: Eight Steps For Managing Diabetic Ketoacidosis ACTRAPID: Eight Steps For Managing Diabetic Ketoacidosis ACTRAPID: Eight Steps For Managing Diabetic Ketoacidosis Diabetic Ketoacidosis (DKA) is a potentially life threatening condition that occurs when excessive amounts of ketones are released into the bloodstream as a result of the body breaking down lipids, instead of utilising glucose as the energy source. This process is known as gluconeogenesis and occurs when the body does not have sufficient insulin to allow the uptake of glucose from the bloodstream into the cells. It is observed primarily in people with type one diabetes (insulin dependent), but it can occur in type two diabetes (non-insulin dependent) under certain circumstances. To understand the symptoms of DKA and therefore how to manage it effectively, it is important to understand the pathophysiology of hyperglycaemia which is explained in the flowchart below: The further down this flowchart the patient gets, the more serious their symptoms become. For this reason, there are varying degrees of severity with DKA: pH 7.25 7.30, bicarbonate decreased to 1518 mmol/L, the person is alert pH 7.00 7.25, bicarbonate 1015 mmol/L, drowsiness may be present pH below 7.00, bicarbonate below 10 mmol/L, stupor or coma may occur To remember the principles involved in managing a patient with DKA, remember the acronym ACTRAPID. Airway, Breathing, Circulation As Per Any Emergency DKA patients need to have their airway, breathing and circulation assessed immediately. A decreased level of consciousness may lead to an unprotected airway and compromised breathing. The osmotic diuresis can cause a significant loss of fluid, leading to severe dehydration and circulatory collapse. Furthermore, severe electrolyte derangeme Continue reading >>

Assessing And Managing The Acute Complications Of Diabetes Mellitus

Assessing And Managing The Acute Complications Of Diabetes Mellitus

Assessing and managing the acute complications of diabetes mellitus Lauren Elizabeth Palk Staff nurse, Acute Medical Unit, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, England To improve your knowledge of the causes, pathophysiology and treatment of the acute complications of diabetes mellitus, in particular diabetic ketoacidosis and hyperosmolar hyperglycaemic state To understand what is involved in the assessment and management of diabetic ketoacidosis and hyperosmolar hyperglycaemic state, which will enable you to provide effective patient care To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) To contribute towards your professional development and local registration renewal requirements (non-UK readers) Nurses commonly encounter patients with type 1 or type 2 diabetes mellitus in their practice. Management of these conditions requires an in-depth knowledge of blood glucose monitoring. It is essential that nurses are aware of normal blood glucose levels, so that they can respond to complications caused by elevated and reduced blood glucose levels. This article aims to enhance nurses knowledge of the acute metabolic complications of diabetes, such as diabetic ketoacidosis and hyperosmolar hyperglycaemic state, to assist in their recognition and management in clinical practice. It discusses the causes, pathophysiology and treatment of these complications, which are regarded as potentially life-threatening medical emergencies. Nursing Standard. doi: 10.7748/ns.2018.e11250 Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

INTRODUCTION Diabetic ketoacidosis (DKA) is a very serious complication of diabetes mellitus, a metabolic disorder that is characterized by hyperglycemia, metabolic acidosis, and increased body ketone concentrations. The most common causes of DKA are infection and poor compliance with medication regimens. Other causes include undiagnosed diabetes, alcohol abuse, and a multitude of medical conditions such as cerebrovascular accident (CVA), complicated pregnancy, myocardial infarction, pancreatitis, and stress. Diabetic ketoacidosis is a complicated pathology. Early recognition of DKA, a good understanding of the pathological processes of DKA, and aggressive treatment are the keys to successful treatment. With good care, DKA can be managed and the patient will survive. OBJECTIVES When the student has finished studying this module, he/she will be able to: 1. Identify the correct definition of DKA. 2. Identify a basic function of insulin. 3. Identify the insulin derangements of types I and II diabetes. 4. Identify the basic cause of DKA. 5. Identify two specific causes of DKA. 6. Identify the two pathogenic mechanisms that produce the signs/symptoms of DKA. 7. Identify metabolic consequences of increased hormone concentrations in DKA. 8. Identify the criteria used to diagnose DKA. 9. Identify common signs and symptoms of DKA. 10. Identify laboratory abnormalities seen in DKA. 11. Identify complications of DKA. 12. Identify the three most important therapies for treating DKA. 13. Identify the correct roles of sodium bicarbonate and phosphate in treating DKA. 14. Identify an important rule for using potassium replacement in DKA. 15. Identify an important rule for switching from IV to subcutaneous insulin. EPIDEMIOLOGY Most cases of DKA are seen in patients with type I diabete Continue reading >>

Pathophysiology Of Diabetic Ketoacidosis (2018)

Pathophysiology Of Diabetic Ketoacidosis (2018)

Pathophysiology of Diabetic Ketoacidosis (2018) Diabetic ketoacidosis (also known as DKA) is one of those harder topics to learn in nursing school. In order to understand the pathophysiology of diabetic ketoacidosis, youll need to understand the pathophysiology of diabetes as well. And all of these can be tricky to learn as a nursing student. In this video, well break down dka pathophysiology, so that you can finally understand it for nursing school. *Woohoo!* Diabetic ketoacidosis pathophysiology doesnt need to be difficult to understand. So today, were going to break it down so that you can remember it for nursing school. Hey there, friend, my name is Christina Rafano from nursing school of success.com, and in this video Im going to walk you through the pathophysiology of diabetic ketoacidosis (or DKA for short), and well break it down into 5 simple steps so that you can finally understand it for nursing school. And wait! Hold up. Because Ive got a pretty awesome nursing school hack for you. Did you know that you can save these videos to your Pinterest boards? Just click the SHARE button below this video and click the little Pinterest icon, or head on over to our blog and hit the Pinterest button. That way, youll never lose track of the videos you like, so you can save them for when you need to reference them later. Its basically like having a whole library of your favorite videos, made for you and saved special for you right on Pinterest, so you can watch them as you need them as you go through nursing school. Now, lets get to it! Alrighty, so lets do a brief overview of diabetic ketoacidosis first, and then well dive into the steps. So DKA happens when there is not enough insulin in the body, and so the cells arent getting glucose for energy. So they start converti Continue reading >>

Diabetic Ketoacidosis: Implications For The Medical-surgical Nurse.

Diabetic Ketoacidosis: Implications For The Medical-surgical Nurse.

Abstract Diabetic ketoacidosis (DKA) is an acute complication associated with type 1 diabetes mellitus. DKA accounts for a significant portion of annual health care expenditures and is considered a medical emergency. Previously treated in the ICU, DKA is now treated on general medical-surgical nursing units. To manage this crisis successfully, medical-surgical nurses must have a comprehensive knowledge and understanding of the pathophysiologic mechanisms, clinical manifestations, and treatment protocols. A critical pathway is presented to guide clinical care. Continue reading >>

Mind The Gap: A Nurses' Map To Understanding And Managing Dka

Mind The Gap: A Nurses' Map To Understanding And Managing Dka

Sep 26, 2014 ... Clinical Nurse Specialist. Cleveland Clinic Respiratory ... will be able to describe the physiology of DKA ... Diabetes. Usually associated with: Type II Diabetes. DKA results from an .... In Current Medical Diagnosis &. Treatment. Mind the Gap: Navigating the Underground World of DKA Christina Canfield, MSN, RN, ACNS-BC, CCRN Clinical Nurse Specialist Cleveland Clinic Respiratory Institute Objectives • Upon completion of this activity the learner will be able to describe the physiology of DKA • Upon completion of this activity the learner will be able to describe the nurse’s role in treatment strategies for DKA Back That Train Up! • Insulin has a number of effects on glucose metabolism, including: – Inhibition of glycogenolysis and gluconeogenesis • Insulin hits the breaks on extra glucose conversion or production – Increased glucose transport into fat and muscle • Insulin takes glucose on a sweet ride into the fat and muscle – Increased glycolysis in fat and muscle • Insulin fuels the generation of ATP – Stimulation of glycogen synthesis • Insulin parks the glucose train at the station until it’s needed 1 9/26/2014 So what causes DKA? How do you know you’re on the right train? Diabetic Keto Acidosis Type I Diabetes DKA results from an insulin deficiency; in response the body switches to burning fatty acids and producing acidic ketone bodies Hyperosmolar Hyperglycemic State Usually associated Type II Diabetes with: >250 Plasma glucose (mg/dL) >600 7.3 18 + Urine Ketones Small + Serum Ketones < 0.6mmol/L Variable Serum Osmolality >10-12 Anion Gap >320 HHS results from an insulin deficiency that leads to a serum glucose that is usually higher 600 mg/dl, and a resulting high serum osmolality Variable Insulin deficiency PHYSIOLO Continue reading >>

Nursing Management Of A Patient With Diabetic Ketoacidosis Nursing Essay

Nursing Management Of A Patient With Diabetic Ketoacidosis Nursing Essay

Disclaimer: This essay has been submitted by a student. This is not an example of the work written by our professional essay writers. Any opinions, findings, conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of UK Essays. David (18 years, male) is suffering from a condition known as 'diabetic ketoacidosis'. This is a very serious condition that occurs in diabetes where the body is unable to use the blood glucose to meet the energy needs due to the lack of insulin in the body. Therefore the body utilizes fat and the breakdown of fats results in the formation of ketones which slowly build up in the body could be toxic. Usually, Insulin plays a major role in the manner in which glucose is utilized as an energy source (Mayo 2010). With a lack of insulin, glucose does not enter the blood cells and hence fat is utilized as an alternative energy source. Any type of diabetes is at the risk of developing diabetic ketoacidosis (especially type 1, & rare case in type 2), and this condition often requires emergency and critical care. Diabetic ketoacidosis is associated with certain risk factors such as illness, problems with insulin therapy, excessive stress, emotional or physical trauma, recent surgery, tremors, heart attack, listlessness, stroke, drug or alcohol abuse (Margaret, 2006). Type 2 diabetics can develop diabetic ketoacidosis following a bout of serious infection. Individuals who are Hispanic or African-American in origin are at a higher risk of developing diabetic ketoacidosis following type 2 diabetes. David is 18 years old and has developed diabetes ketoacidosis as a complication of type 1 diabetes (more likely) or type 2 diabetes (very rare), and this complication is common in this age/disease Continue reading >>

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