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Understanding Dka For Nurses

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 >>

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 >>

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 >>

Sickly Sweet: Understanding Diabetic Ketoacidosis

Sickly Sweet: Understanding Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life threatening condition that can occur to people with diabetes. It is observed primarily in people with type 1 diabetes (insulin dependent), but it can occur in type 2 diabetes (non-insulin dependent) under certain circumstances. The reason for why it is not often seen in people with type 2 diabetes is because their body is still able to produce insulin, so the pathophysiology explained in the flowchart below is not as dramatic as compared to people with type 1 diabetes who do not make any insulin at all. There are various symptoms associated with DKA including: Hyperglycaemia Polyphagia (increased appetite and hunger) Polydipsia (increased thirst) Polyuria (increased urination) Glycosuria (glucose in the urine) Ketonuria (ketones in urine) Ketones in blood Sweet, fruity breath Tachypnoea leading to Kussmaul breathing (deep and laboured breathing pattern) The body tries to compensate for the ketone bodies (acid) by eliminating carbon dioxide (also an acid) thereby attempting to make the body more alkalotic to normalise the pH The compensation between the metabolic and respiratory system can be read about in this article Decreased bicarbonate The body tries to use the available bicarbonate (base) to buffer the ketone bodies (acid) in order to improve the metabolic ketoacidosis This actually worsens the situation the lower the bicarbonate becomes with a continual production of ketones Increased drowsiness/decreased level of consciousness As the pH decreases and becomes more acidotic, it has a direct effect on decreasing the level of consciousness in a person Increased urea Electrolyte disturbances Tachycardia and other cardiac arrhythmias Tachycardia is often a compensatory mechanism for the hypotension Cardiac arrhythmias a 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: 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 (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 >>

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 >>

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 >>

Dka (diabetic Ketoacidosis): Real Life In The Emergency Room

Dka (diabetic Ketoacidosis): Real Life In The Emergency Room

This is the first in a series from Susan Dupont RN BSN who is an Emergency Room Nurse and contributor at NRSNG.com . . . Click to View All Articles in the “Real Life in the ER Series” Every patient is a mystery that needs to be solved. Some are easy, some are complex, some aren’t solvable, but the thrill of a good challenge is what keeps me coming back for more. The emergency room is full of unsolved mystery’s. Every once in a while a mystery worth writing about comes along. Altered Mental Status? It was like any normal shift. I had just discharged a patient and walked them out of the ER to turn around and see an EMS stretcher waiting to enter my room. I hadn’t even cleaned the room yet. I grabbed a piece of paper and pen and walked into my favorite type of patient, Altered Mental Status. This patient, a 20-year-old female, had been found wandering around the streets and stumbling around. She didn’t know her name and when she attempted to talk, random words were coming out of her mouth. She would only respond to a sternal rub and her breath was fruity. Vital signs: BP 80/48 mmHg Respirations of 32 Heart rate 125 bpm (sinus tachycardia on her EKG). After getting a reading of >500 blood glucose on the glucometer, we started the search for an IV. This was the challenge of the night. This little girl had absolutely tiny veins that were hidden. Her first IV gave us blood but after starting a bolus of normal saline the line infiltrated, causing a grape sized lump on her forearm. The next IV was in her hand and it worked but was only a 22 gauge. We needed better IV access. After using the infrared goggles and ultrasound we got 2 IV’s, one in each antecubital. Suspicious of Diabetic Ketoacidosis, her lab work confirmed the diagnosis. Her blood work showed: Glucose 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 >>

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