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Understanding Dka For Nurses

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 >>

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 >>

Hyperglycemic Crises: Managing Acute Complications Of Diabetes

Hyperglycemic Crises: Managing Acute Complications Of Diabetes

Authors: Kim Cathcart, MS, RN, RRT | Cheryl Duksta, RN, ADN, M.Ed | Kate Biggs, RN, MSN Hyperglycemia occurs from time to time in all people with diabetes. However, at times, hyperglycemia can lead to acute, life-threatening complications known as Hyperglycemic Crises. This course is designed to educate healthcare professionals about the emergencies associated with hyperglycemic crises, including causes, diagnosis, treatment, and prevention of Hyperosmolar Hyperglycemic State (HHS) and Diabetic Ketoacidosis (DKA). Course objectives include: Paraphrase the pathophysiology of diabetic ketoacidosis (DKA) Interpret diagnostic findings related to DKA Relate the nurse’s role in caring for patients with diabetic complications About the Authors Kim Cathcart, MS, RN, RRT, started working in the field of inhalation therapy in 1976 and by 1979 had completed her first test to become a registered respiratory therapist. She earned a bachelor's degree in general studies and a master's degree in educational administration from the University of Dayton, and later she received her bachelor's degree in nursing from Wright State University. She has taught clinicals and labs in respiratory therapy and has served as a respiratory nurse liaison. Her nursing career includes work in skilled nursing, orthopedics, and med-surg/chemical detox. She has also worked as a diabetic resource nurse and in an infectious disease/HIV clinic. Her publishing credentials include articles on respiratory care, contributions to hospital publications, and a tribute in a nursing magazine. Cheryl Duksta, RN, ADN, M.Ed, is currently a critical care nurse in an intermediate care unit in Austin, Texas. She is an active member of the American Association of Critical-Care Nurses (AACN) Greater Austin chapter. A master' Continue reading >>

Nursing Approach To Diabetic Ketoacidosis In Adults Patients

Nursing Approach To Diabetic Ketoacidosis In Adults Patients

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes that progresses rapidly and requires immediate medical attention. This article discusses the prevalence of DKA and the implications, including repeated episodes of DKA and longer stays in hospital. It covers the diagnosis and management of the condition and also emphasises the importance of preventing its occurrence and recurrence by educating people with type 1 diabetes about self-management and recognition of the first signs of illness as soon as they have their initial diabetes diagnosis. The role of the DSN within the wider clinical team is discussed and suggestions are made for measures that can be put in place to aid education about self-management and prevention of this often avoidable complication. AimTo examine, in a national survey, the outcomes of adult patients presenting with DKA in 2014, mapped against accepted UK national guidance.MethodsData were collected in a standardized form covering clinical and biochemical outcomes, risk and discharge planning. The form was sent to all UK diabetes specialist teams (n=220). Anonymized data were collected on five consecutive patients admitted with DKA between 1 May 2014 and 30 November 2014.ResultsA total of 283 forms were received (n=281 patients) from 72 hospitals, of which 71.4% used the national guidelines. The results showed that 7.8% of cases occurred in existing inpatients, 6.1% of admissions were newly diagnosed diabetes and 33.7% of patients had had at least one episode of ketoacidosis in the preceding year. The median times to starting 0.9% sodium chloride and intravenous insulin were 41.5 and 60 min, respectively. The median time to resolution was 18.7 h and the median length of hospital stay was 2.6 days. Significant advers 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 >>

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 >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Course Summary Diabetic ketoacidosis is an acute complication of diabetes mellitus, which requires prompt, aggressive, treatment. Complications of diabetic ketoacidosis throughout the age spectrum and during pregnancy require a close evaluation of symptoms, testing, treatment and outcomes to treatment. Anyone with diabetes, regardless of age or gender, can develop ketoacidosis. Guidelines exist that guide diabetes health teams and clinical care of the diabetic patient. Appropriate and timely treatment can reduce diabetic ketoacidosis complications and patients can recover to full health. Course Format Homestudy Course Syllabus Introduction Epidemiology Glucose, Insulin, And Diabetes: A Brief Review Glucose and Energy Type 1 and Type 2 Diabetes Classification System: Out of Date? Pathophysiology Of DKA - Pathophysiology, Signs and Symptoms of DKA Precipitating Causes Of DKA Clinical Signs And Symptoms Of DKA Diagnosis Of DKA Laboratory Tests Hyperkalemia Hyponatremia Other Electrolytes Amylase and Lipase Hepatic Transaminases Leukocytosis Serum Osmolality Renal Function Studies Troponin Levels Euglycemic DKA Gestational Diabetes And DKA Atypical Antipsychotics And DKA Complications Of DKA - Children, DKA and Cerebral Edema XI. Treatment For Diabetic Ketoacidosis Laboratory Tests Fluid Replacement Electrolyte Imbalances Insulin Therapy Acid-Base Disturbances and Bicarbonate Therapy Continuing Care and Monitoring for Complications Treatment Of Cerebral Edema Clinical Care, Prevention and Education Poor Access to Medical Care Lack of Information Emotional Acceptance and Non-compliance Summary Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>

Diabetes - Early Treatment Essential In Dka

Diabetes - Early Treatment Essential In Dka

Diabetic ketoacidosis is a life threatening complication of diabetes mellitus that requires urgent treatment, writes David Chaney Diabetic ketoacidosis (DKA) is a serious, life-threatening metabolic complication of diabetes mellitus, which, whilst most common in type 1 diabetes mellitus, can on rare occasions present in patients with type 2 diabetes mellitus.1,2 DKA develops in those patients with either an absolute deficiency of insulin or a relative lack of insulin brought about by an excess of counter regulatory hormones. Prevalence of DKA Despite improved treatment strategies, DKA has an estimated death rate of 28 per 100, 000 patients with diabetes in the UK.3 Unfortunately there does not appear to be any reported statistics for deaths due to DKA within Ireland. In view of the nature of this condition most deaths occur in those aged under 45 years with some authors proposing DKA, as the most common cause of death in all diabetics under the age of 20 years.4 Given these statistics, it is imperative that nurses who are presented with this condition act promptly to ensure treatment is instigated immediately to guarantee best possible outcome for the patient. Precipitating factors One of the most important aspects of care of the patient with DKA is isolation of trigger factors associated with the condition. Research has repeatedly demonstrated infection as the most common precipitating factor in DKA,5,6 with factors such as missed insulin dose, new onset of diabetes and drugs and alcohol also identified.7 Whilst it must be acknowledged that it is not always possible to identify a cause for DKA, a full investigation is warranted if further episodes are to be avoided. DKA diagnosis and symptoms Diagnosis of DKA z Blood Glucose >12 mmol/l9 Presence of ketonuria9, or posit 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 >>

Clinical Tip: Closing The Anion Gap

Clinical Tip: Closing The Anion Gap

When I was a student nurse, I prayed that my instructor wouldn’t choose me for her “game show” humiliation during post-conference. She would randomly challenge us with impromptu questions like, “What’s the difference between pre-load and after-load? Tina. Can you answer?”…like she was a game show host but without the fabulous prizes. Of course the questions in some way related to the lecture content of that week but with the gazillion things to learn, it was impossible to be fully prepared. If you knew the answer, you were a superstar, however if you didn’t, she made you feel that you were forever unworthy of the RN title. During the week we discussed acid-base balance, I felt prepared. There’s just something about interpreting blood gases that I “get.” To this day (24 years later), you can show me any blood gas result and I’ll be able to interpret it within a few seconds. I have a great self-learning module on blood gases. If you want a copy, just contact me by clicking here. However, I wasn’t prepared for this question, “Who can explain the anion gap? Renee – go!” Ugh. I didn’t really pay attention to the anion gap and what the heck does it have to do with acid-base balance??? Your body spends energy everyday to maintain acid-base balance. On a macro level, it does this by holding onto or getting rid of carbon dioxide (lungs – acid) or bicarb (kidneys – base). On a micro level, it’s all about cations (positive/base) and anions (negative/acid). The anion gap is simply the difference between the numbers of cations versus anions. WHAT DO THE NUMBERS MEAN? An anion gap can be high, normal, or low (rare). A high anion gap indicates a lot more anions than cations or…acidosis. When bicarb is used up to correct the acid base balance t 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 >>

Diabetic Ketoacidosis Nclex Review

Diabetic Ketoacidosis Nclex Review

NCLEX review on Diabetic Ketoacidosis for nursing lecture exams and the NCLEX exam. DKA is a life-threatening condition of diabetes mellitus. It is important to know the differences between diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) because the two complications affect the diabetic patient. However, there are subtle difference between the two conditions. Don’t forget to take the DKA Quiz. In these notes you will learn about: Key Player of DKA Causes of DKA Signs and Symptoms of DKA Nursing Interventions of DKA Lecture on Diabetic Ketoacidosis Diabetic Ketoacidosis Define: a complication of diabetes mellitus that is life-threatening, if not treated. It is due to the breakdown of fats which turn into ketones because there is no insulin present in the body to take glucose into the cell. Therefore, you will see hyperglycemia and ketosis and acidosis. Key Players of DKA: Glucose: fuels the cells so it can function. However, with DKA there is no insulin present to take the glucose into the cell…so the glucose is not used and the patient will experience hyperglycemia >300 mg/dL. Insulin: helps take glucose into the cell so the body can use it for fuel. In DKA, the body isn’t receiving enough insulin…so the GLUCOSE can NOT enter into the cell. The glucose floats around in the blood and the body starts to think it is starving because it cannot get to the glucose. Therefore, it looks elsewhere for energy. Liver & Glucagon: the body tries an attempt to use the glucose stores in the liver (because it doesn’t know there is a bunch of glucose floating around in the blood and thinks the body is experiencing hypoglycemia). In turn, the liver releases glucagon to turn glycogen stores into more GLUCOSE….so the patient becomes even more hyp Continue reading >>

Diabetic Ketoacidosis Nclex Review

Diabetic Ketoacidosis Nclex Review

NCLEX review on Diabetic Ketoacidosis for nursing lecture exams and the NCLEX exam. DKA is a life-threatening condition of diabetes mellitus. It is important to know the differences between diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) because the two complications affect the diabetic patient. However, there are subtle difference between the two conditions. Define: a complication of diabetes mellitus that is life-threatening, if not treated. It is due to the breakdown of fats which turn into ketones because there is no insulin present in the body to take glucose into the cell. Therefore, you will see hyperglycemia and ketosis and acidosis. Glucose: fuels the cells so it can function. However, with DKA there is no insulin present to take the glucose into the cellso the glucose is not used and the patient will experience hyperglycemia >300 mg/dL. Insulin: helps take glucose into the cell so the body can use it for fuel. In DKA, the body isnt receiving enough insulinso the GLUCOSE can NOT enter into the cell. The glucose floats around in the blood and the body starts to think it is starving because it cannot get to the glucose. Therefore, it looks elsewhere for energy. Liver & Glucagon: the body tries an attempt to use the glucose stores in the liver (because it doesnt know there is a bunch of glucose floating around in the blood and thinks the body is experiencing hypoglycemia). In turn, the liver releases glucagon to turn glycogen stores into more GLUCOSE.so the patient becomes even more hyperglycemic. Ketones: a byproduct of fat break down. In DKA, the body needs FUEL to function so it starts to break down FATS since it cannot use the glucose in the body. The patient will experience increased ketones in the body which are LIFE-THREATEN Continue reading >>

Diagnosis

Diagnosis

Print If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and various blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis. Blood tests Blood tests used in the diagnosis of diabetic ketoacidosis will measure: Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level. When your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream. Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body. Additional tests Your doctor may order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests might include: Blood electrolyte tests Urinalysis Chest X-ray A recording of the electrical activity of the heart (electrocardiogram) Treatment If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves: Fluid replacement. You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood. Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes throu Continue reading >>

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