Reference no: EM133565524

Diabetic Ketoacidosis, Care of the Adult Client Location: Emergency Department History/Information: A 36-year-old man, was admitted to the Emergency Department after his wife found him confused and agitated in their apartment. According to his wife, he was diagnosed with Type I (insulin-dependent) diabetes mellitus 12 months ago. He was taking 48units of insulin daily: 12units of Humulin Regular plus 20units of Humulin NPH before breakfast; 8units of Humulin Regular before dinner; and 8units of Humulin NPH at bedtime. She states he has had "the flu" for 5 days with vomiting and anorexia and stopped taking his insulin 2 days ago when he was unable to eat. The paramedics started a saline lock in the right forearm and administered 250mL of 0.9% NS en route to the hospital. Prepare these

Questions:

1. Describe the pathophysiologic changes in DKA.

a. Why do blood glucose levels increase?

b. What are commonly seen blood glucose levels?

c. What fluid and electrolyte disturbances commonly occur? d. What causes the fluid and electrolyte disturbances?

e. What acid-base disturbances are commonly seen? f. Why do the acid-base disturbances occur?

2. Describe the medical management of a patient in DKA.

a. How is fluid status monitored in the acute stage of DKA?

b. How is hypovolemia corrected? How rapidly is fluid volume replaced? Why?

c. How are blood glucose levels monitored? How often?

d. How are elevated blood glucose levels corrected?

e. How quickly is blood glucose corrected? Why?

3. What electrolytes are monitored in the acute stage of DKA? Why?

a. How are electrolyte imbalances corrected? How rapidly accomplished? Why?

b. How are acid-base disturbances monitored? How often?

c. How are acid-base disturbances corrected? How quickly is this accomplished? Why?

4. Describe the nursing management of a patient in DKA.

a. How is fluid status assessed? How often?

b. What are the complications of fluid replacement and how are they prevented?

c. How are blood glucose levels assessed? How often?

d. What are the complications of lowering blood glucose levels and how are they prevented?

e. How are electrolyte disturbances assessed? How often?

f. What are the complications of electrolyte replacement and how are they prevented?

g. How are acid-base disturbances assessed? How often?

h. What are the complications of acid-base correction and how are they prevented?

5. Complete: System Disorders Template: Diabetic Ketoacidosis.