DKA concept map - 10th ed PDF

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Summary

10th ed...

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Disease: Diabetic Ketoacidosis Etiology -

Caused by profound deficiency of insulin and characterized by hyperglycemia, ketosis, acidosis, and dehydration Precipitating factors: illness and infection, inadequate insulin dosage, undiagnosed type 1 diabetes, poor self management, and neglect Body compensates by breaking down fat stores as a secondary source of fuel Ketones: acidic by-products of fat metabolism that can cause serious problems when there are elevated levels in blood Ketosis leads to metabolic acidosis Ketonuria: ketones in urine; electroyltes become depleted Insulin deficiency: impair protein synthesis, and causes excessive protein degradation Stimulates the production of glucose from amino acids which leads to further hyperglycemia Additional glucose cannot be used and the blood glucose level rises further adding to osmotic diuresis If not treated pt will develop sever depletion of sodium, potassium, chloride, magnesium, phosphate Vomiting will lead to more fluid and electrolyte loss Hypvolemia is followed by shock which will lead to renal failure Untreated pt become comatose

S/S: 48-16 -

Dehydration Poor skin turgor Dry mucous membranes Tachycardia Orthostatic hypotension Lethargy Weakness Skin becomes dry and loose Eyes become soft and sunken Abd pain Anorexia N/V Kussmaul respirations Acetone breath Lab findings of elevated glucose 250mg/dL, arterial blood pH less than 7.30, serum bicarbonate level less than 16 mEq/L Moderate to large ketones in urine or serum

Interprofessional care: 48-17, 48-18 -

If F&E imbalance is not severe and blood glucose levels can be safely monitored at home, DKA may be managed on an outpatient basis Managing symptoms If pt has pneumonia or UTI they are usually admitted into a hospital Establish IV access and begin F&E replacement: 0.45% or 0.9% NaCl When blood glucose levels approach 250mg/dL add 5% to 10% dextrose to the fluid to prevent hypoglycemia and sudden drop in glucose Overzelous rehydration can result in cerebral edema IV insulin to correct hyperglycemia and hyperkalemia Blood glucose reduction to of 36-54 mg/dL/hr will avoid complications Insulin allows water and potassium to enter the cell along with glucose and can lead to a depletion of vascular volume and hypokalemia: moniot F&E and potassium levels

Nursing responsibility: -

Monitor pts with renal or cardiac compromise for fluid overload Prevent rapid drops in serum glucose to avoid cerebral edema...