Materiały źródłowe

• #1 Diabetic Ketoacidosis (DKA) – Warning Signs, Causes & Prevention

  https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones

  Diabetic ketoacidosis (DKA) is life-threatening learn the warning signs to be prepared for any situation. […] DKA is no joke, its a serious condition that can lead to diabetic coma or even death. […] Treatment for DKA usually takes place in the hospital. But you can help prevent it by learning the warning signs and checking your urine and blood regularly. […] Warning! DKA is dangerous and serious. If you have any of the above symptoms, contact your health care provider IMMEDIATELY, or go to the nearest emergency room of your local hospital. […] Do NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levels can mean your diabetes is out of control. Check with your health care provider about how to handle this situation.

• #2 Nursing Care Plan for Diabetic Ketoacidosis (DKA) | Free NURSING.com Courses

  https://nursing.com/lesson/nursing-care-plan-for-diabetic-ketoacidosis-dka-2

  Diabetic ketoacidosis is a serious complication of diabetes mellitus that occurs when uncontrolled blood sugar rises and the body cant produce enough insulin to use the glucose. When this happens, the body begins to break down fat as energy which produces a build-up of acid in the bloodstream called ketones. This is a serious life-threatening condition that occurs most often in Type I diabetics. […] Ketoacidosis can occur when diabetic patients experience emotional or physical stress such as with bacterial infections (UTI, etc), prolonged vomiting, surgery or when they miss doses of insulin. Alcohol and drug abuse in a diabetic patient can also cause the body to produce ketones that poison the blood. […] Maintain blood glucose level within the target range, maintain normal fluid balance.

• #3 4 Diabetic Ketoacidosis and HHNS Nursing Care Plans

  https://nurseslabs.com/diabetic-ketoacidosis-nursing-care-plans/

  Without insulin, the amount of glucose entering the cells is reduced, and the production and release of glucose by the liver are increased, leading to hyperglycemia. In an attempt to rid the body of excess glucose, the kidneys excrete the glucose along with water and electrolytes. This osmotic diuresis, which is characterized by excessive urination, leads to dehydration and marked electrolyte loss. […] Diabetic ketoacidosis is an acute complication of diabetes. Around one-third of DKA cases occur in newly diagnosed diabetes mellitus clients. Most deaths are caused by cerebral edema complications. Awareness forms the basis for health-related practices being implemented. Therefore, it is important to assess and update the knowledge and understanding of clients about diabetes and DKA.

• #4 Diabetic Ketoacidosis | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html

  DKA is a serious complication of diabetes that can be life-threatening. […] DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. […] DKA is most common among people with type 1 diabetes. […] If you’re concerned about DKA or have questions about how to manage your diabetes, talk to your diabetes care team. […] Elevated ketones are a sign of DKA. This is a medical emergency that needs to be treated immediately. […] If you have DKA, you’ll be treated in the emergency room or admitted to the hospital. Your treatment will likely include: Replacing fluids you lost through frequent urination and to help dilute excess sugar in your blood. […] Receiving insulin. Insulin reverses the conditions that cause DKA.

• #5 COORDINATED CARE ACROSS THE CONTINUUM

  https://elsevier.health/en-US/preview/diabetic-ketoacidosis-pediatric-cpg

  Care of the hospitalized child experiencing severe insulin deficiency that results in profound hyperglycemia, fluid and electrolyte imbalance and production of ketones causing acidosis. […] It is critical to initially replace fluids, followed by insulin therapy. […] Electrolyte levels may stabilize after initial fluid replacement; correct imbalance based on laboratory values. […] Identification of the cause is key in treatment. The most common causes include new-onset diabetes, insulin deficiency, insulin pump site-related issues, knowledge deficit, psychosocial factors, insulin omission, infection, illness or stress. […] A psychosocial assessment may be beneficial to identify underlying cause for those who are having difficulty with diabetes management and DKA (diabetic ketoacidosis) prevention.

• #6 4 Diabetic Ketoacidosis and HHNS Nursing Care Plans

  https://nurseslabs.com/diabetic-ketoacidosis-nursing-care-plans/

  Therapeutic interventions and nursing actions for patients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome may include: Managing Hyperglycemia, Promoting Infection Control and Preventing Infection, Enhancing Nutritional Balance, Managing Fluid Volume, Initiating Patient Education and Health Teachings, Administering Medications and Providing Pharmacologic Support, Monitoring Results of Diagnostic and Laboratory Procedures. […] Infection is the most common predisposing factor for the development of a hyperglycemic crisis, which is DKA. Among the predisposing factors for DKA, infection is the most common cause of death. […] Nutritional support combined with drug therapy is an important way to treat clients with DKA. Nutritional support not only maintains a good metabolic status, but also avoids the occurrence of complications such as abnormal blood glucose levels, water metabolism disorders, ketosis or hyperosmolar coma, infections, and nerve damage.

• #7

  https://journals.lww.com/ajnonline/fulltext/2002/09001/diabetic_ketoacidosis__rapid_identification,.4.aspx

  Nursing care of patients with DKA includes a thorough nursing assessment as well as patient and family education. […] Primary assessment involves evaluation of airway, breathing, and circulation (ABC), as well as neurologic status. […] If the patient is not able to breathe on his own insert an oral or nasopharyngeal airway. […] If vomiting occurs, oral suctioning may be required. […] If breathing is ineffective or the patient is vomiting and comatose, protect the airway by inserting an endotracheal tube then confirming its placement with an end-tidal CO2 detector, auscultation of breath sounds, and a portable chest radiograph. […] Assess circulation, obtain vascular access, and start a 0.9% NS infusion. […] If the patient is hypotensive, a fluid bolus must be given. […] Finally, assess the patient’s neurologic status: Is he alert and responsive to verbal or painful stimuli?

• #8 Ketoacidosis (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK568717/?report=reader

  List the nursing management roles in a patient with ketoacidosis. […] Monitor vitals […] Check blood sugars and treat with insulin as ordered […] Start two large-bore IVs […] Administer fluids as recommended […] Check electrolytes as potassium levels will drop with insulin treatment […] Check renal function […] Assess mental status […] Look for signs of infection (a common cause of DKA) […] Educate the patient on the importance of compliance with diabetic medications […] Educate the patient on the importance of follow up […] Check urine output […] Encourage patient to quit smoking and abstain from alcohol […] Encourage a healthy diet […] Ask the patient to wear an ID bracelet signifying that he or she has had a DKA episode […] Check urine and blood cultures […] Listen to the lungs for rales and crackles.

• #9

  https://journals.lww.com/ajnonline/fulltext/2002/09001/diabetic_ketoacidosis__rapid_identification,.4.aspx

  Nursing care of patients with DKA includes a thorough nursing assessment as well as patient and family education. […] Primary assessment involves evaluation of airway, breathing, and circulation (ABC), as well as neurologic status. […] If the patient is not able to breathe on his own insert an oral or nasopharyngeal airway. […] If vomiting occurs, oral suctioning may be required. […] If breathing is ineffective or the patient is vomiting and comatose, protect the airway by inserting an endotracheal tube then confirming its placement with an end-tidal CO2 detector, auscultation of breath sounds, and a portable chest radiograph. […] Assess circulation, obtain vascular access, and start a 0.9% NS infusion. […] If the patient is hypotensive, a fluid bolus must be given. […] Finally, assess the patient’s neurologic status: Is he alert and responsive to verbal or painful stimuli?

• #10

  https://journals.lww.com/ajnonline/fulltext/2002/09001/diabetic_ketoacidosis__rapid_identification,.4.aspx

  Secondary assessment. Undress the patient, and if there’s hypothermia, control temperature using warmed blankets, overhead heating lamps, and warmed IV fluids. […] Insert a nasogastric tube if the patient is vomiting, and insert an indwelling urinary catheter in order to monitor output and obtain urinalysis. […] If the patient has been intubated, place a nasogastric tube to decompress the stomach. […] Initiate cardiac monitoring to check for arrhythmia, which may result from electrolyte imbalances. […] Take steps to make the patient comfortable, such as by administering antiemetics or analgesia. […] Obtain a thorough history from the patient and family in order to identify what may have precipitated the DKA episode. […] The frequency of follow-up assessments will vary depending on the baseline assessment and stability of the patient. […] Reassessment includes examination of ABC, and assessment of neurologic status and vital signs.

• #11 Nursing Care Plan For Diabetic Ketoacidosis (DKA) – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-diabetic-ketoacidosis-dka/

  Patient and Family Education: Nurses provide extensive education to the patient and their families about diabetes management, insulin administration, symptom recognition, and the importance of regular follow-up care. […] Thorough and continuous nursing assessment is pivotal in recognizing any changes in the patients condition, ensuring timely interventions, and preventing further deterioration. […] The nursing care plan for DKA requires diligent monitoring of vital signs, fluid balance, blood glucose levels, and ketone levels, along with a close evaluation of the patients overall response to treatment. […] Through a comprehensive nursing assessment for DKA, healthcare providers can promptly recognize and intervene to stabilize the patients metabolic state and prevent further complications.

• #12 The veterinary nurse’s guide to diabetic ketoacidosis — Veterinary Internal Medicine Nursing

  https://www.veterinaryinternalmedicinenursing.com/blog/dka

  Diabetic ketoacidosis (DKA) is a serious complication of unregulated or decompensated diabetes mellitus, which is associated with significant morbidity and mortality. […] DKA patients are challenging but incredibly rewarding to nurse and the veterinary nurse plays a key role in the management and nursing care of these difficult patients. […] The goals of DKA treatment are: To restore circulating fluid volume, To reverse metabolic acidosis, To reduce glucose and ketone levels, To correct any abnormalities. […] DKA patients should be monitored closely, especially in the early stages of treatment. […] Vital parameters should be regularly assessed and the patient monitored closely for signs of dehydration, hypovolaemia and electrolyte abnormalities (such as neck ventroflexion and muscle weakness in the hypokalaemic patient).

• #13 The veterinary nurse’s guide to diabetic ketoacidosis — Veterinary Internal Medicine Nursing

  https://www.veterinaryinternalmedicinenursing.com/blog/dka

  Due to the high fluid therapy rates often used, especially in the initial stages of stabilisation, fluid overload is a risk for these patients, and they should be monitored closely for signs such as chemosis, acute weight gain, and respiratory changes. […] Nurses should also consider the sampling requirements of these patients since regular blood glucose assessments (every 1-2 hours) and electrolyte assessments (every 6-8 hours) will be required until the patients condition stabilises. […] Consideration should also be given to the patients nutritional status, as many patients present with anorexia and vomiting. Appropriate symptomatic treatment should be administered, the patients resting energy requirement and voluntary food intake should be measured and recorded, and prolonged anorexia should prompt enteral nutritional support.

• #14 Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA) | Free NURSING.com Courses

  https://nursing.com/lesson/nursing-care-plan-for-diabetic-ketoacidosis-dka

  Monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature. Conduct a general assessment to identify signs of distress, altered mental status, or other symptoms associated with DKA. […] Regularly assess glycemic control by monitoring blood glucose levels. Evaluate the effectiveness of insulin therapy and adjustments in achieving and maintaining target blood glucose levels within the normal range. […] Assess fluid and electrolyte balance by monitoring laboratory values and clinical indicators. Evaluate the effectiveness of fluid replacement and electrolyte correction interventions, aiming for restoration of normal levels. […] Regularly monitor ketone levels in blood or urine to assess the resolution of ketosis. Evaluate the impact of insulin therapy and other interventions on suppressing ketone production. […] Provide comprehensive education to individuals with diabetes and their caregivers on the prevention of DKA. Emphasize the importance of regular insulin therapy, continuous glucose monitoring, early recognition of signs of DKA, and prompt medical intervention during illness or stress.

• #15 4 Diabetic Ketoacidosis and HHNS Nursing Care Plans

  https://nurseslabs.com/diabetic-ketoacidosis-nursing-care-plans/

  The following are the nursing priorities for patients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome: Diagnose and recognize the signs and symptoms of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Administer intravenous fluids and electrolytes to correct dehydration and restore fluid balance. Monitor blood glucose levels regularly and administer insulin as prescribed. Assess and manage acid-base imbalances and electrolyte disturbances. Monitor vital signs, including blood pressure and heart rate. Administer supplemental oxygen if necessary. Educate patients and their caregivers about the importance of regular diabetes management, including medication adherence and monitoring blood glucose levels. Provide guidance on preventing future episodes of DKA or HHNS through proper diabetes self-care and lifestyle modifications. Schedule follow-up appointments to monitor recovery, assess glycemic control, and adjust treatment plans as needed.

• #16 Diabetic Ketoacidosis (DKA): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/diabetic-ketoacidosis-dka-nursing-diagnosis-care-plan/

  The cornerstones of management in diabetic ketoacidosis are fluid resuscitation and maintenance, insulin therapy, electrolyte restoration, and supportive care. […] Patients with DKA may lose 10% to 15% of their body weight in fluid. Immediate fluid resuscitation is essential to reverse hypovolemia, restore tissue perfusion, and eliminate ketones. Regardless of insulin, hydration improves glycemic control. 0.9% normal saline is the IV fluid of choice for initial hydration. […] IV short-acting insulin by continuous infusion is recommended until the glucose level is below 200 mg/dL, plus two of the following: Serum bicarbonate level 15 mEq/L, pH 7.3, Anion gap 12 mEq/L. […] Insufficient insulin levels might deplete various electrolytes in the blood. Administer electrolytes intravenously as prescribed to keep the heart, muscles, and nerve cells functioning normally.

• #17 Diabetic Ketoacidosis (DKA): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/diabetic-ketoacidosis-dka-nursing-diagnosis-care-plan/

  The cornerstones of management in diabetic ketoacidosis are fluid resuscitation and maintenance, insulin therapy, electrolyte restoration, and supportive care. […] Patients with DKA may lose 10% to 15% of their body weight in fluid. Immediate fluid resuscitation is essential to reverse hypovolemia, restore tissue perfusion, and eliminate ketones. Regardless of insulin, hydration improves glycemic control. 0.9% normal saline is the IV fluid of choice for initial hydration. […] IV short-acting insulin by continuous infusion is recommended until the glucose level is below 200 mg/dL, plus two of the following: Serum bicarbonate level 15 mEq/L, pH 7.3, Anion gap 12 mEq/L. […] Insufficient insulin levels might deplete various electrolytes in the blood. Administer electrolytes intravenously as prescribed to keep the heart, muscles, and nerve cells functioning normally.

• #18 Diabetic Ketoacidosis (DKA): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/diabetic-ketoacidosis-dka-nursing-diagnosis-care-plan/

  Potassium levels may appear elevated or normal with DKA, but insulin will cause potassium to shift into the cells, causing severe hypokalemia. If the patient presents with hypokalemia, this must be addressed before administering insulin to prevent life-threatening cardiac arrhythmias. […] Fluid resuscitation is crucial in the management of patients with DKA. IV fluids replace extravascular and intravascular fluids and electrolyte losses. High glucose levels and counterregulatory hormones become diluted. 0.9% normal saline is the IV fluid of choice. […] Administer isotonic solutions initially. Fluid replacement alone will begin to lower blood glucose. Initial isotonic therapy of 0.9% saline is recommended. A transition to a hypotonic solution such as 0.45% saline may be used as long as sodium levels remain normal. […] To prevent a recurrence of DKA or when to seek prompt treatment, educate the patient on symptoms such as polydipsia, polyuria, (early signs) nausea and vomiting, flushed skin, weakness, and fatigue.

• #19 Diabetic Ketoacidosis NCLEX Review

  https://www.registerednursern.com/diabetic-ketoacidosis-nclex-review/

  Administering IV fluids: (depending on MD order) such as 0.9% normal saline (start out with a bolus of this) and progress with 0.45% NS to hydrate the cells (depends on how dehydrated the patient is). […] Administered insulin: REGULAR (only type given IV) and make sure K+ is normal 3.3 […] Watch potassium levels very closely because insulin causes K+ to move back into the cell.

• #20 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  The 2011 JBDS guideline recommends the intravenous infusion of insulin at a weight-based fixed rate until ketosis has subsided. […] In established patients with diabetes, SC long-acting insulin (eg, insulin glargine, Detemir) should be initiated at the dose that was used prior to the manifestation of DKA. […] In newly diagnosed patients with type 1 diabetes, a careful estimate of the long-acting insulin dose should be considered. […] Fluid resuscitation is a critical part of treating patients with DKA. […] Initial correction of fluid loss is either by isotonic sodium chloride solution or by lactated Ringer solution. […] Insulin should be started about an hour after IV fluid replacement is started to allow for checking potassium levels and because insulin may be more dangerous and less effective before some fluid replacement has been obtained.

• #21 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  Pediatric protocols to minimize the risk of cerebral edema by reducing the rate of fluid repletion vary. […] When insulin treatment is started in patients with DKA, several points must be considered. […] Only short-acting insulin is used for correction of hyperglycemia. […] The initial insulin dose is a continuous IV insulin infusion using an infusion pump, if available, at a rate of 0.1 U/kg/h. […] The optimal rate of glucose decline is 100 mg/dL/h. […] Hypoglycemia may develop rapidly with correction of ketoacidosis due to improved insulin sensitivity. […] An endocrinologist also may be consulted to assist with management after the patient has been stabilized adequately. […] Frequent blood glucose monitoring at home makes DKA less likely, as this allows them to promptly search for possible reasons for unexpectedly high blood sugar values before the condition progresses to DKA.

• #22 Diabetic Ketoacidosis (DKA) – Oxford Medical Education

  https://oxfordmedicaleducation.com/endocrinology/dka/

  Ketone levels should fall by 0.5 mM/hour; if this is not the case, increase the infusion rate by 0.1 unit/hour increments until this target rate is achieved. […] Rates adequate to switch off ketogenesis will usually render individuals hypoglycaemic so commence glucose 10% IV at 125 ml/hour once glucose 14 mM. […] Continue any long-acting insulin therapy at the usual dose and timing. […] Potassium replacement: Although potassium levels may be high on arrival, they will fall rapidly once the fixed rate insulin IV infusion commences. […] Monitoring: Blood glucose and ketones should be checked hourly. […] VBG should be repeated at 1 hour, and 2 hourly thereafter. […] Aim for a urine output of 0.5 ml/kg/hour; insert a urethral catheter if necessary. […] Identify and treat the underlying cause. […] Identify and treat any complications. […] Consider critical care referral for those with markers of severity.

• #23 Diabetic ketoacidosis nursing management | PPT

  https://www.slideshare.net/slideshow/diabetic-ketoacidosis-nursing-management/69777894

  Insulin deficiency can lead to diabetic ketoacidosis (DKA), a serious condition where ketone bodies accumulate in the body due to lack of insulin. This causes hyperglycemia, which leads to excessive urination and dehydration. Signs and symptoms of DKA include thirst, frequent urination, abdominal pain, vomiting, fruity breath, and changes in mental status. Treatment of DKA involves intravenous fluids, insulin therapy, monitoring electrolytes like potassium, and administering bicarbonate if needed to raise pH levels. Nursing care focuses on addressing fluid volume deficit, nutritional imbalances, risks of infection and sensory changes, and fatigue. […] Diabetic ketoacidosis nursing management IV FLUID HYPOVOLUMIC SHOCK ADMINISTER 0.9% NACL (1 LITER/ HR ) MILD HYPOTENSION EVALUATE NA + LEVEL NA HIGH NA NORMAL 0.45% NACL (4- 14 ML/ KG / HR ) NA LOW 0.9% NACL (4- 14 ML/ KG / HR ) CARDIOGENIC SHOCK HEMODYNAMIC MONITERING Insuline Intravenous route Insulin regular 0.15 U/kg b. Wt. As iv bolus 0.1 u/kg/hr Iv insulin infusion SC/IM route Insulin regular 0.4 u/kg, Iv bolus , im or sc 0.1 u/kg / hr regular insulin sc or im If glucose does not fall by 50 70 mg Double insuline infusion hourly until glucose fall by 50-70 mg/dl Give hourly iv insulin bolus(10u) until glucose fall by 50-70 mg/dl potassium If serum K+ is 3.3 mEq/l hold insulin and give 40mEq k/hr until k+ 3.3 If serum K+ above 5 do not give k+ check it every 2hr If serum potassium between 3.3 to 5 mEq/l then 20 mEq in each liter of iv fluid Assess need for bicarbonate pH 6.9 NaHco3( 100 mmol ) dilute in 400 ml water at 200ml/hr pH .7 pH6.9-7.0 NaHco3( 50 mmol ) dilute in 400 ml water at 200ml/hr Repeat HCO3 administration q 2h untill pH 7.0.

• #24 How to care for DKA: An Expert Nurse’s Guide to Diabetic Ketoacidosis | Health And Willness

  https://healthandwillness.org/dka-diabetic-ketoacidosis/

  These patients are often visibly dehydrated and tachycardic. Hang 1-2L of NS open to gravity (and of course obtain an order to verify). […] Ask for and administer medications such as Zofran or pain meds if the patient is nauseous or in severe pain. […] Treatment of DKA aims at reversing the acidosis as well as lower the glucose. […] The first step in treating DKA is to replace IV fluids, usually with Normal Saline, which helps stabilize vital signs, replace fluid losses, increase insulin responsiveness, and reduce stress hormone levels. […] As long as potassium >3.3, Insulin can be started. […] If >5.3 mEq/L: IV Potassium is held off until levels drop below 5.3. […] Monitor for tachycardia, ectopy, or any arrhythmias. […] Significant acidosis and hypovolemia can cause hypotension. […] Once the AGAP returns to normal, the gap is considered ‘closed’ and the patient does not require an IV insulin drip anymore.

• #25 COORDINATED CARE ACROSS THE CONTINUUM

  https://elsevier.health/en-US/preview/diabetic-ketoacidosis-pediatric-cpg

  Careful attention to neurologic status is necessary. Cerebral edema is a rare occurrence associated with a high mortality rate or severe permanent long-term complications. […] The severity of the DKA (diabetic ketoacidosis) and acidemia, a young age, new onset diabetes and delay in treatment are key risk factors for cerebral edema. Signs and symptoms of cerebral edema include altered respiratory pattern, abnormal response to pain, change in mental status (e.g., restlessness, irritability, increased drowsiness), decorticate and decerebrate posturing, incontinence and cranial nerve palsy. […] Hyperglycemia resolves faster than ketoacidosis; ongoing insulin management is required even after glucose levels have fallen. […] Provide intravenous fluid replacement to restore peripheral circulation, renal perfusion and electrolyte balance.

• #26 COORDINATED CARE ACROSS THE CONTINUUM

  https://elsevier.health/en-US/preview/diabetic-ketoacidosis-pediatric-cpg

  Administer insulin therapy to reverse ketogenesis and correct hyperglycemia; anticipate ongoing adjustment. […] Anticipate initiation of dextrose-containing fluid therapy as blood glucose levels decrease. […] Monitor and evaluate for changes in neurologic status that may indicate deterioration (e.g., headache, restlessness, increased drowsiness, incontinence, pupillary changes). […] Monitor for cardiorespiratory pattern changes that may indicate worsening status. […] Monitor trends for blood glucose levels, pH, electrolytes, vital signs, serum ketones, intake and output; advocate for treatment adjustment. […] Acknowledge and validate significance of lifestyle impact and expectations (e.g., roles and identity, medication regimen, diet, exercise).

• #27 Diabetic Ketoacidosis

  https://www.rch.org.au/clinicalguide/guideline_index/Diabetic_Ketoacidosis/

  RCH Health Professionals Clinical Practice Guidelines Diabetic Ketoacidosis […] Children and adolescents with DKA should be managed in a unit that has: […] Experienced nursing staff trained in monitoring and management of DKA in children and adolescents […] The most important complications of DKA and its treatment are: […] Cerebral oedema […] Hypoglycaemia […] Hypo/hyperkalaemia […] Hypo/hypernatraemia […] Aspiration (if obtunded) […] If cerebral oedema is suspected, this should be immediately discussed with a consultant […] Nurse head up […] Reduce fluid infusion rate by one-third […] Give mannitol immediately if cerebral oedema suspected do NOT wait for cerebral imaging […] Assess for underlying infections and consider antibiotics after obtaining relevant cultures if appropriate […] Overall, infective precipitants are uncommon […] In children with known T1DM the most common cause of DKA is omission or significant reduction in recent insulin doses.

• #28 Diabetic ketoacidosis nursing management | PPT

  https://www.slideshare.net/slideshow/diabetic-ketoacidosis-nursing-management/69777894

  Nursing Diagnosis FLUID VOLUME DEFICIT RELATED TO: OSMOTIC DIURESIS DUE TO HYPERGLYCEMIA, EXCESSIVE DISCHARGE: DIARRHEA, VOMITING; RESTRICTION INTAKE DUE TO NAUSEA, MENTAL MESS. MBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS RELATED TO: INSUFFICIENCY OF INSULIN, DECREASED ORAL INPUT, HIPERMETABOLISME STATUS RISK FOR INFECTION (SEPSIS) RELATED TO: INCREASED LEVELS OF GLUCOSE, DECREASED LEUKOCYTE FUNCTION, CHANGES IN THE CIRCULATION. RISK FOR SENSORY-PERCEPTUAL ALTERATIONS RELATED TO: KETIDKSEIMBANGAN GLUCOSE / INSULIN AND / OR ELECTROLYTES. FATIGUE RELATED TO: DECREASED METABOLIC ENERGY PRODUCTION, INSUFFICIENCY OF INSULIN, INCREASING ENERGY DEMAND.

• #29 Nursing care plan for diabetes ketoacidosis

  https://nursipedia.com/nursing-care-plan-diabetes-ketoacidosis/

  Diabetes ketoacidosis (DKA) is a life-threatening metabolic condition that occurs when level of insulin decreases and the body begins to produce large amounts of ketones as an alternative source of fuel. Without proper nursing assessment, diagnosis and care plan, DKA can be fatal. […] These are some common nursing diagnoses related to diabetes ketoacidosis: Risk for Fluid Volume Deficit: Due to excessive diuresis as a result of elevated blood sugars […] Risk for Acute Confusion: Due to alterations in the mental status caused by elevated blood sugars […] Ineffective Tissue Perfusion: Due to reduced oxygen delivery secondary to elevated blood sugars. […] The goals and expected outcomes for this condition should include: Adequate hydration status: As measured by normal electrolyte values, adequate urine output, and improved mental status

• #30 Nursing Care Plan For Diabetes Mellitus Diabetic Ketoacidosis | PDF | Hypoglycemia | Dehydration

  https://www.scribd.com/document/481255299/17471548-Nursing-Care-Plan-for-Diabetes-Mellitus-diabetic-Ketoacidosis-rtf

  Initiate IV fluids (normal saline or lactated Ringer’s) at Replaces fluid losses and restores intravascular volume. rate of 500-1000 mL/hr until urine output 30 mL/hr and Goal is to correct dehydration and restore normal vital signs stabilize. hemodynamics. Monitor intake and output hourly. Assess fluid status and response to therapy. Goal is to achieve euvolemia. Monitor vital signs q1hr until stable, then q4hr. Assess response to fluid resuscitation. Goal is to restore normal hemodynamics. Monitor skin turgor, mucous membranes, capillary refill As […] Initiate IV fluids (normal saline or lactated Ringer’s) at Replaces fluid losses and restores intravascular volume. rate of 500-1000 mL/hr until urine output 30 mL/hr and Goal is to correct dehydration and restore normal vital signs stabilize. hemodynamics. Monitor intake and output hourly. Assess fluid status and response to therapy. Goal is to achieve euvolemia. Monitor vital signs q1hr until stable, then q4hr. Assess response to fluid resuscitation. Goal is to restore normal hemodynamics. Monitor skin turgor, mucous membranes, capillary refill As

• #31 Nursing Diagnosis Diabetic Ketoacidosis | PDF | Diabetes | Hyperglycemia

  https://www.scribd.com/document/453480897/nursing-diagnosis-diabetic-ketoacidosis

  The patient presented with dry lips and oral mucosa, indicating deficient fluid volume due to decreased fluid intake. Objective assessments found dry skin and membranes with urinary output over 30 ml/hr, confirming the nursing diagnosis of deficient fluid volume. The patient has diabetes and poor compliance, and initial interventions assessed baseline hydration status and administered isotonic IV fluids to rapidly correct the fluid deficit. Ongoing monitoring of vital signs and lab values will evaluate fluid status and treatment effectiveness. The goal is for the patient to maintain normal fluid volume.

• #32 4 Diabetic Ketoacidosis and HHNS Nursing Care Plans

  https://nurseslabs.com/diabetic-ketoacidosis-nursing-care-plans/

  Therapeutic interventions and nursing actions for patients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome may include: Managing Hyperglycemia, Promoting Infection Control and Preventing Infection, Enhancing Nutritional Balance, Managing Fluid Volume, Initiating Patient Education and Health Teachings, Administering Medications and Providing Pharmacologic Support, Monitoring Results of Diagnostic and Laboratory Procedures. […] Infection is the most common predisposing factor for the development of a hyperglycemic crisis, which is DKA. Among the predisposing factors for DKA, infection is the most common cause of death. […] Nutritional support combined with drug therapy is an important way to treat clients with DKA. Nutritional support not only maintains a good metabolic status, but also avoids the occurrence of complications such as abnormal blood glucose levels, water metabolism disorders, ketosis or hyperosmolar coma, infections, and nerve damage.

• #33 DKA for nurses | PPT

  https://www.slideshare.net/slideshow/dka-for-nurses/134120194

  Here are four (4) nursing care plans (NCP) for Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome: 1. Risk For Fluid Volume Deficit 2. Risk For Infection 3. Deficient Knowledge 4. Imbalanced Nutrition: Less Than Body Requirements. […] Assess precipitating factors such as other illnesses, new-onset diabetes, or poor compliance with treatment regimen. […] Monitor hourly intake and output. […] Administer fluid as indicated Administer IV potassium and other electrolytes as indicated. […] Assess for signs of infection and inflammation. […] Encourage proper handwashing technique. […] Determine clients dietary program and usual pattern. […] Establish rapport and trust. […] Explain the signs and symptoms of diabetic ketoacidosis. […] Teach client that polyuria, polydipsia, and polyphagia are signs of hyperglycemia which requires increased dosage of insulin. […] Stress the importance of strict follow-up care.

• #34 4 Diabetic Ketoacidosis and HHNS Nursing Care Plans

  https://nurseslabs.com/diabetic-ketoacidosis-nursing-care-plans/

  Goals and expected outcomes may include: The 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. The client will display normal electrolyte levels and stable vital signs. The client will be free of infection as evidenced by normothermia, HR of 100 beats/minute or less, BP within the clients normal range, WBC count of 11,000/mm or less, and negative culture results. The client will identify interventions to prevent and reduce the risk of infection. The client will demonstrate techniques, and lifestyle changes to prevent the development of infection. The client will display a normal energy level. The client will take appropriate amounts of calories/nutrients. The client will demonstrate stabilized weight or gain toward desired range with normal laboratory values. The client will maintain a blood glucose level in the satisfactory range. The client will acknowledge the factors that lead to unstable blood glucose and DKA. The client will verbalize understanding of body and energy needs. The client will verbalize a plan for modifying factors to prevent or minimize complications.

• #35 4 Diabetic Ketoacidosis and HHNS Nursing Care Plans

  https://nurseslabs.com/diabetic-ketoacidosis-nursing-care-plans/

  Therapeutic interventions and nursing actions for patients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome may include: Managing Hyperglycemia, Promoting Infection Control and Preventing Infection, Enhancing Nutritional Balance, Managing Fluid Volume, Initiating Patient Education and Health Teachings, Administering Medications and Providing Pharmacologic Support, Monitoring Results of Diagnostic and Laboratory Procedures. […] Infection is the most common predisposing factor for the development of a hyperglycemic crisis, which is DKA. Among the predisposing factors for DKA, infection is the most common cause of death. […] Nutritional support combined with drug therapy is an important way to treat clients with DKA. Nutritional support not only maintains a good metabolic status, but also avoids the occurrence of complications such as abnormal blood glucose levels, water metabolism disorders, ketosis or hyperosmolar coma, infections, and nerve damage.

• #36 Nursing care plan for diabetes ketoacidosis

  https://nursipedia.com/nursing-care-plan-diabetes-ketoacidosis/

  Diabetes ketoacidosis (DKA) is a life-threatening metabolic condition that occurs when level of insulin decreases and the body begins to produce large amounts of ketones as an alternative source of fuel. Without proper nursing assessment, diagnosis and care plan, DKA can be fatal. […] These are some common nursing diagnoses related to diabetes ketoacidosis: Risk for Fluid Volume Deficit: Due to excessive diuresis as a result of elevated blood sugars […] Risk for Acute Confusion: Due to alterations in the mental status caused by elevated blood sugars […] Ineffective Tissue Perfusion: Due to reduced oxygen delivery secondary to elevated blood sugars. […] The goals and expected outcomes for this condition should include: Adequate hydration status: As measured by normal electrolyte values, adequate urine output, and improved mental status

• #37 4 Diabetic Ketoacidosis and HHNS Nursing Care Plans

  https://nurseslabs.com/diabetic-ketoacidosis-nursing-care-plans/

  Goals and expected outcomes may include: The 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. The client will display normal electrolyte levels and stable vital signs. The client will be free of infection as evidenced by normothermia, HR of 100 beats/minute or less, BP within the clients normal range, WBC count of 11,000/mm or less, and negative culture results. The client will identify interventions to prevent and reduce the risk of infection. The client will demonstrate techniques, and lifestyle changes to prevent the development of infection. The client will display a normal energy level. The client will take appropriate amounts of calories/nutrients. The client will demonstrate stabilized weight or gain toward desired range with normal laboratory values. The client will maintain a blood glucose level in the satisfactory range. The client will acknowledge the factors that lead to unstable blood glucose and DKA. The client will verbalize understanding of body and energy needs. The client will verbalize a plan for modifying factors to prevent or minimize complications.

• #38 DKA for nurses | PPT

  https://www.slideshare.net/slideshow/dka-for-nurses/134120194

  Here are four (4) nursing care plans (NCP) for Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome: 1. Risk For Fluid Volume Deficit 2. Risk For Infection 3. Deficient Knowledge 4. Imbalanced Nutrition: Less Than Body Requirements. […] Assess precipitating factors such as other illnesses, new-onset diabetes, or poor compliance with treatment regimen. […] Monitor hourly intake and output. […] Administer fluid as indicated Administer IV potassium and other electrolytes as indicated. […] Assess for signs of infection and inflammation. […] Encourage proper handwashing technique. […] Determine clients dietary program and usual pattern. […] Establish rapport and trust. […] Explain the signs and symptoms of diabetic ketoacidosis. […] Teach client that polyuria, polydipsia, and polyphagia are signs of hyperglycemia which requires increased dosage of insulin. […] Stress the importance of strict follow-up care.

• #39 Ketoacidosis (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568717/

  Nursing management roles in a patient with ketoacidosis include monitoring vitals, checking blood sugars and treating with insulin as ordered, starting two large-bore IVs, administering fluids as recommended, checking electrolytes as potassium levels will drop with insulin treatment, checking renal function, assessing mental status, looking for signs of infection, educating the patient on the importance of compliance with diabetic medications, educating the patient on the importance of follow up, checking urine output, encouraging the patient to quit smoking and abstain from alcohol, encouraging a healthy diet, asking the patient to wear an ID bracelet signifying that he or she has had a DKA episode, checking urine and blood cultures, and listening to the lungs for rales and crackles. […] The diabetic nurse should follow all outpatients to ensure medication compliance, follow up with clinicians, and adopt a positive lifestyle. Further, the nurse should teach the patient how to monitor home blood glucose and the importance of careful monitoring of blood sugars during infection, stress, or trauma. […] The members of the interprofessional team should communicate to ensure that the patient is receiving the optimal standard of care.

• #40 Diabetic Ketoacidosis Management – Nursing CE Central

  https://nursingcecentral.com/lessons/diabetic-ketoacidosis-management/

  The average timeline may be 1-2 clinical days. The focus of care now shifts to discharge planning, patient education, and ongoing management. […] Compliance with medications, healthy diet, glucose monitoring, sick day management […] Coordination of follow-up care to ensure ongoing medical support, educational services and financial assistance when appropriate (medical provider, endocrinologist, pharmacist, social worker/ case management services, DSMES classes). […] The importance of ongoing, patient specific education to address all aspects of diabetes self-management is a key factor in lowering the occurrence of DKA.

• #41 Diabetic Ketoacidosis (DKA): Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.diabetic-ketoacidosis-dka-care-instructions.tw12221

  Diabetic ketoacidosis (DKA) happens when the body does not have enough insulin and can’t use the sugar it needs for energy. […] DKA can only be treated in a hospital with insulin and fluids. These are often given in a vein (I.V.). […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. […] To reduce your chance of ketoacidosis: Take your insulin and other diabetes medicines on time and in the right dose. […] When you are sick: Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. […] If you know your blood sugar is high, treat it before it gets worse. […] Call 911 anytime you think you may need emergency care. […] Watch closely for changes in your health, and be sure to contact your doctor if: Your blood sugar stays outside the level your doctor set for you.

• #42

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12221

  Diabetic ketoacidosis (DKA) happens when the body does not have enough insulin and can’t use the sugar it needs for energy. […] DKA can only be treated in a hospital with insulin and fluids. These are often given in a vein (I.V.). […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. […] To reduce your chance of ketoacidosis: Take your insulin and other diabetes medicines on time and in the right dose. […] When you are sick: Take your insulin and diabetes medicines. This is important even if you are vomiting and having trouble eating or drinking. […] Check your blood sugar at least every 3 to 4 hours. […] If you know your blood sugar is high, treat it before it gets worse. […] Call 911 anytime you think you may need emergency care. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if your blood sugar stays outside the level your doctor set for you.

• #43 Preventing Diabetic Ketoacidosis (DKA) in Insulin Pump Therapy

  https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=custom.ab_dka_ipt_prev_adult_ac

  Diabetic ketoacidosis (DKA) is a serious complication of diabetes. […] When you use an insulin pump, you are at higher risk for DKA because you are not using long-acting insulin. […] If you are pregnant, DKA can harm both you and your baby and may cause miscarriage or stillbirth. Later in pregnancy, you are less sensitive to insulin and your insulin doses increase. You may need to change your infusion site more often, sometimes every day, to help prevent DKA. […] There are things you can do every day to prevent DKA: Check for ketones using a fingertip blood test or urine test if you have glucose values over 14.0 mmol/L, any symptoms of DKA, even if your glucose level is in target, especially if you are on a SGLT2 inhibitor, signs of dehydration, like a dry mouth, dry tongue, cracked lips, sunken eyes, drowsiness, dizziness, feeling faint, or a fast, pounding heartbeat.

• #44 Diabetic Ketoacidosis (DKA): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/diabetic-ketoacidosis-dka-nursing-diagnosis-care-plan/

  Potassium levels may appear elevated or normal with DKA, but insulin will cause potassium to shift into the cells, causing severe hypokalemia. If the patient presents with hypokalemia, this must be addressed before administering insulin to prevent life-threatening cardiac arrhythmias. […] Fluid resuscitation is crucial in the management of patients with DKA. IV fluids replace extravascular and intravascular fluids and electrolyte losses. High glucose levels and counterregulatory hormones become diluted. 0.9% normal saline is the IV fluid of choice. […] Administer isotonic solutions initially. Fluid replacement alone will begin to lower blood glucose. Initial isotonic therapy of 0.9% saline is recommended. A transition to a hypotonic solution such as 0.45% saline may be used as long as sodium levels remain normal. […] To prevent a recurrence of DKA or when to seek prompt treatment, educate the patient on symptoms such as polydipsia, polyuria, (early signs) nausea and vomiting, flushed skin, weakness, and fatigue.

• #45 Diabetic Ketoacidosis NCLEX Review

  https://www.registerednursern.com/diabetic-ketoacidosis-nclex-review/

  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. […] Teach patient early signs and when to seek treatment: […] Monitor glucose and ketones during illness every 4 hours, especially if dealing with illness/infection […] Notify medical doctor if blood sugars are higher than normal or greater than 300 mg/dL consistently […] Ketones present in the urine […] Excessive thirst, frequent urination, abdominal pain, nausea and vomiting, acetone breath. […] Goal: Hydrate, decrease blood glucose, monitor Potassium level and cerebral edema (esp. in children), correct acid-base imbalance.

• #46 Ketoacidosis (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568717/

  Nursing management roles in a patient with ketoacidosis include monitoring vitals, checking blood sugars and treating with insulin as ordered, starting two large-bore IVs, administering fluids as recommended, checking electrolytes as potassium levels will drop with insulin treatment, checking renal function, assessing mental status, looking for signs of infection, educating the patient on the importance of compliance with diabetic medications, educating the patient on the importance of follow up, checking urine output, encouraging the patient to quit smoking and abstain from alcohol, encouraging a healthy diet, asking the patient to wear an ID bracelet signifying that he or she has had a DKA episode, checking urine and blood cultures, and listening to the lungs for rales and crackles. […] The diabetic nurse should follow all outpatients to ensure medication compliance, follow up with clinicians, and adopt a positive lifestyle. Further, the nurse should teach the patient how to monitor home blood glucose and the importance of careful monitoring of blood sugars during infection, stress, or trauma. […] The members of the interprofessional team should communicate to ensure that the patient is receiving the optimal standard of care.

• #47 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  With prompt treatment, recovery from DKA typically happens within 24 hours. Full treatment of DKA happens when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. […] If you have diabetes, taking the following actions can help prevent DKA: Checking your blood sugar often: Checking your blood sugar with a glucose meter and/or using a CGM is crucial to managing diabetes and preventing complications. […] Its important to treat high blood sugar as soon as possible to prevent DKA.

• #48 Diabetic ketoacidosis

  https://www.nhs.uk/conditions/diabetic-ketoacidosis/

  Testing for ketones will help you know when you need to take action, such as increasing your insulin dose. […] follow the treatment plan agreed with your diabetes care team, including adjusting your insulin dose when you need to. […] check your blood glucose regularly. […] test for ketones when your blood glucose is high and when you’re ill. […] contact your care team if you’re not sure what to do. […] do not stop taking insulin, even if you’re not eating. […] do not skip insulin doses.

• #49 Preventing Diabetic Ketoacidosis (DKA) in Insulin Pump Therapy

  https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=custom.ab_dka_ipt_prev_adult_ac

  If you have blood ketones up to 2.9 mmol/L or urine ketones up to 79 mg/dL and you are not vomiting, you can usually manage your high glucose and ketones using the steps below. […] If high blood glucose and ketones continue or get worse after 2 corrections or if symptoms of DKA start or do not improve, go to the emergency department. […] Go to the emergency department if you have any of these: blood ketones 3 mmol/L of more, urine ketones 80 mg/dL or 3+ or more, vomiting and unable to keep fluids down and testing positive for ketones, any signs of symptoms of DKA or dehydration, high blood glucose and ketones continue or get worse after 2 corrections, pump failure when a replacement pump is more than 2 hours away, you don’t know how to replace insulin manually, and you can’t reach your diabetes team.

• #50 Diabetic Ketoacidosis (DKA) – Warning Signs, Causes & Prevention

  https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones

  Diabetic ketoacidosis (DKA) is life-threatening learn the warning signs to be prepared for any situation. […] DKA is no joke, its a serious condition that can lead to diabetic coma or even death. […] Treatment for DKA usually takes place in the hospital. But you can help prevent it by learning the warning signs and checking your urine and blood regularly. […] Warning! DKA is dangerous and serious. If you have any of the above symptoms, contact your health care provider IMMEDIATELY, or go to the nearest emergency room of your local hospital. […] Do NOT exercise when your urine tests show ketones and your blood glucose is high. High levels of ketones and high blood glucose levels can mean your diabetes is out of control. Check with your health care provider about how to handle this situation.

• #51 Diabetic Ketoacidosis: Symptoms and Treatment | Abbott Newsroom

  https://www.abbott.com/corpnewsroom/diabetes-care/diabetic-ketoacidosis–symptoms-and-treatment.html

  Proper diabetes management is important. […] Ketoacidosis is a serious side effect of diabetes. Here’s what you need to know. […] This is called diabetic ketoacidosis, or DKA, and it’s an emergency that requires immediate medical attention. […] If you have type 1 diabetes, you’re at higher risk of developing the condition, according to Harvard Health. Missing an insulin injection can also lead to ketoacidosis. […] Signs of ketoacidosis can come on quickly, sometimes within a day, the Mayo Clinic notes, so get medical attention at the first signs. […] Call your doctor immediately if you have been vomiting and can’t hold down food, have elevated blood sugar levels that don’t respond to home diabetes care or your urine or blood ketones are somewhat high or very high. Seeking medical care early can minimize the serious effects of ketoacidosis, which could include diabetic coma or death, according to the American Diabetes Association.

• #52 Diabetic Ketoacidosis

  https://www.rch.org.au/clinicalguide/guideline_index/Diabetic_Ketoacidosis/

  RCH Health Professionals Clinical Practice Guidelines Diabetic Ketoacidosis […] Children and adolescents with DKA should be managed in a unit that has: […] Experienced nursing staff trained in monitoring and management of DKA in children and adolescents […] The most important complications of DKA and its treatment are: […] Cerebral oedema […] Hypoglycaemia […] Hypo/hyperkalaemia […] Hypo/hypernatraemia […] Aspiration (if obtunded) […] If cerebral oedema is suspected, this should be immediately discussed with a consultant […] Nurse head up […] Reduce fluid infusion rate by one-third […] Give mannitol immediately if cerebral oedema suspected do NOT wait for cerebral imaging […] Assess for underlying infections and consider antibiotics after obtaining relevant cultures if appropriate […] Overall, infective precipitants are uncommon […] In children with known T1DM the most common cause of DKA is omission or significant reduction in recent insulin doses.

• #53 COORDINATED CARE ACROSS THE CONTINUUM

  https://elsevier.health/en-US/preview/diabetic-ketoacidosis-pediatric-cpg

  Careful attention to neurologic status is necessary. Cerebral edema is a rare occurrence associated with a high mortality rate or severe permanent long-term complications. […] The severity of the DKA (diabetic ketoacidosis) and acidemia, a young age, new onset diabetes and delay in treatment are key risk factors for cerebral edema. Signs and symptoms of cerebral edema include altered respiratory pattern, abnormal response to pain, change in mental status (e.g., restlessness, irritability, increased drowsiness), decorticate and decerebrate posturing, incontinence and cranial nerve palsy. […] Hyperglycemia resolves faster than ketoacidosis; ongoing insulin management is required even after glucose levels have fallen. […] Provide intravenous fluid replacement to restore peripheral circulation, renal perfusion and electrolyte balance.

• #54 Diabetic Ketoacidosis (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/diabetic-ketoacidosis.html

  Diabetic ketoacidosis is an emergency that needs to be treated right away. […] Diabetic ketoacidosis is an emergency and needs to be treated right away. Treatment includes giving insulin and IV fluids. A person with DKA needs to be watched closely in the hospital until their blood sugars and blood acid level are back in a healthy range, and they’re feeling better. […] Help prevent diabetic ketoacidosis by following your childs care plan so blood sugar levels stay in the healthy range. […] You should check the blood or urine for ketones any time your child is sick, has symptoms of DKA, or their blood sugar is high. […] If your childs blood sugars are high, their blood or urine has ketones, or you have any concerns, contact your childs diabetes health care team.

• #55 Preventing Diabetic Ketoacidosis (DKA) in Insulin Pump Therapy

  https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=custom.ab_dka_ipt_prev_adult_ac

  Diabetic ketoacidosis (DKA) is a serious complication of diabetes. […] When you use an insulin pump, you are at higher risk for DKA because you are not using long-acting insulin. […] If you are pregnant, DKA can harm both you and your baby and may cause miscarriage or stillbirth. Later in pregnancy, you are less sensitive to insulin and your insulin doses increase. You may need to change your infusion site more often, sometimes every day, to help prevent DKA. […] There are things you can do every day to prevent DKA: Check for ketones using a fingertip blood test or urine test if you have glucose values over 14.0 mmol/L, any symptoms of DKA, even if your glucose level is in target, especially if you are on a SGLT2 inhibitor, signs of dehydration, like a dry mouth, dry tongue, cracked lips, sunken eyes, drowsiness, dizziness, feeling faint, or a fast, pounding heartbeat.

• #56 GGC Medicines – Management of Diabetic Ketoacidosis (DKA)

  https://handbook.ggcmedicines.org.uk/guidelines/endocrine-system/management-of-diabetic-ketoacidosis-dka/

  Below is the link to the care pathway for the management of diabetic ketoacidosis in adults. Specific guidelines exist for the management of DKA in children. In patients aged 13-16 years presenting with DKA, the management of DKA should be discussed with relevant paediatric staff. […] The care pathways for the emergency management of DKA should be used for all eligible patients. Complete pathways for 04 hours and 4 hours discharge for each DKA episode. These provide instruction on fluid balance, insulin and potassium replacement. Please note there are DKA order sets on TrakCare (DKA baseline and DKA continuing care). […] Continue background SC insulin (glargine, levemir, degludec, isophane insulin) while on fixed rate intravenous insulin. Stop continuous SC insulin infusion (CSII) via a pump in DKA. Do not restart CSII without specialist diabetic input.

• #57 GGC Medicines – Management of Diabetic Ketoacidosis (DKA)

  https://handbook.ggcmedicines.org.uk/guidelines/endocrine-system/management-of-diabetic-ketoacidosis-dka/

  Potassium replacement: administer at rate 20mmol/hour of KCl. […] Insulin management: insulin should be prescribed, beginning at 6units/hour. Rate will generally be reduced with time depending on clinical circumstances, presence of long-acting insulin and to avoid a fall of 5mmol/L per hour as rapid falls in blood glucose may be associated with cerebral oedema. […] In patients with kidney failure or heart failure, as well as elderly and adolescents, the rate and volume of fluid replacement may need to be modified. […] Refer for specialist diabetes review: whenever possible, all patients should be notified to the diabetes team within 12 hours of admission. When the clinical condition has stabilized, consider the educational and emotional needs of the patient and carers. […] Ensure insulin is prescribed before patient leaves hospital. This must include the specific type of insulin, dose and appropriate device.

• #58 Preventing Diabetic Ketoacidosis (DKA) in Insulin Pump Therapy

  https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=custom.ab_dka_ipt_prev_adult_ac

  Diabetic ketoacidosis (DKA) is a serious complication of diabetes. […] When you use an insulin pump, you are at higher risk for DKA because you are not using long-acting insulin. […] If you are pregnant, DKA can harm both you and your baby and may cause miscarriage or stillbirth. Later in pregnancy, you are less sensitive to insulin and your insulin doses increase. You may need to change your infusion site more often, sometimes every day, to help prevent DKA. […] There are things you can do every day to prevent DKA: Check for ketones using a fingertip blood test or urine test if you have glucose values over 14.0 mmol/L, any symptoms of DKA, even if your glucose level is in target, especially if you are on a SGLT2 inhibitor, signs of dehydration, like a dry mouth, dry tongue, cracked lips, sunken eyes, drowsiness, dizziness, feeling faint, or a fast, pounding heartbeat.

• #59 Diabetic Ketoacidosis (DKA) Treatment & Management: Approach Considerations, Correction of Fluid Loss, Insulin Therapy

  https://emedicine.medscape.com/article/118361-treatment

  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 hyperglycemia with insulin […] Correction of electrolyte disturbances, particularly potassium loss […] Correction of acid-base balance […] Treatment of concurrent infection, if present. […] It is important to pay close attention to the correction of fluid and electrolyte loss during the first hour of treatment. […] 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. […] Insulin infusion can be discontinued 30 minutes later.

• #60 Diabetic ketoacidosis – Management Approach | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/management-approach

  Insulin therapy should be withheld until the serum potassium level reaches 3.3 mEq/L. […] Likewise, if plasma potassium falls below 3.3 mEq/L at any point during therapy, insulin should be stopped and potassium replaced intravenously. […] Monitoring of respiratory parameters and hemodynamic status are essential in hemodynamically unstable patients. […] Management and monitoring should continue until resolution of DKA. The criteria for resolution are: plasma glucose is 200 mg/dL (at this point, insulin can be decreased by 50%) […] serum bicarbonate is 18 mEq/L […] venous pH is 7.3 […] anion gap is 10.

• #61 Diabetic Ketoacidosis (DKA): Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/diabetic-ketoacidosis-dka-nursing-diagnosis-care-plan/

  The cornerstones of management in diabetic ketoacidosis are fluid resuscitation and maintenance, insulin therapy, electrolyte restoration, and supportive care. […] Patients with DKA may lose 10% to 15% of their body weight in fluid. Immediate fluid resuscitation is essential to reverse hypovolemia, restore tissue perfusion, and eliminate ketones. Regardless of insulin, hydration improves glycemic control. 0.9% normal saline is the IV fluid of choice for initial hydration. […] IV short-acting insulin by continuous infusion is recommended until the glucose level is below 200 mg/dL, plus two of the following: Serum bicarbonate level 15 mEq/L, pH 7.3, Anion gap 12 mEq/L. […] Insufficient insulin levels might deplete various electrolytes in the blood. Administer electrolytes intravenously as prescribed to keep the heart, muscles, and nerve cells functioning normally.

• #62 Diabetic ketoacidosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/diagnosis-treatment/drc-20371555

  Insulin reverses diabetic ketoacidosis. In addition to fluids and electrolytes, insulin is given, usually through a vein. A return to regular insulin therapy may be possible when the blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and the blood is no longer acidic. […] Diabetic ketoacidosis is life-threatening. If you develop mild symptoms, contact your health care provider immediately.

• #63 Ketoacidosis (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568717/

  Nursing management roles in a patient with ketoacidosis include monitoring vitals, checking blood sugars and treating with insulin as ordered, starting two large-bore IVs, administering fluids as recommended, checking electrolytes as potassium levels will drop with insulin treatment, checking renal function, assessing mental status, looking for signs of infection, educating the patient on the importance of compliance with diabetic medications, educating the patient on the importance of follow up, checking urine output, encouraging the patient to quit smoking and abstain from alcohol, encouraging a healthy diet, asking the patient to wear an ID bracelet signifying that he or she has had a DKA episode, checking urine and blood cultures, and listening to the lungs for rales and crackles. […] The diabetic nurse should follow all outpatients to ensure medication compliance, follow up with clinicians, and adopt a positive lifestyle. Further, the nurse should teach the patient how to monitor home blood glucose and the importance of careful monitoring of blood sugars during infection, stress, or trauma. […] The members of the interprofessional team should communicate to ensure that the patient is receiving the optimal standard of care.

• #64 Diabetic Ketoacidosis Management – Nursing CE Central

  https://nursingcecentral.com/lessons/diabetic-ketoacidosis-management/

  Diabetic ketoacidosis is considered one of the most life-threatening complications of diabetes mellitus. […] An interdisciplinary team approach (including medical providers, social workers, case managers, and community resources) has been proven to reduce recurrences of DKA in vulnerable populations. […] The goals of emergency treatment of diabetic ketoacidosis are multifactorial and listed below. Interventions will include, but not be limited to, insulin intravenous infusions, hourly vital sign monitoring (or more frequent), and hourly glucose checks. […] Due to the frequency of monitoring and medication administration during the acute phase of DKA, patients are usually placed in the Intensive Care Unit. […] Transfer to a step-down unit usually occurs when the patient is fully awake, tolerating oral intake (both solid food and liquids), vital signs are stable, and fluid and electrolyte replacements are complete.

• #65 Diabetic Ketoacidosis | Management in Adults | Nursing Times

  https://www.nursingtimes.net/diabetes/management-of-diabetic-ketoacidosis-in-adults-28-02-2014/

  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 […] DKA is a medical emergency and should be managed promptly. It is important to assess for severity to determine the clinical setting in which the patient is to be managed; criteria are outlined in Box 2. […] The management of patients presenting with DKA includes a full clinical assessment, while regular monitoring of vital signs and consciousness levels using the Glasgow Coma Scale is essential. Key areas in the management of DKA include: restoring circulatory volume; insulin therapy (fixed-rate intravenous insulin infusion); correcting metabolic acidosis and electrolyte imbalances; identifying and treating precipitating factors; early involvement of the diabetes specialist team.

• #66 Diabetic Ketoacidosis | Management in Adults | Nursing Times

  https://www.nursingtimes.net/diabetes/management-of-diabetic-ketoacidosis-in-adults-28-02-2014/

  All health professionals involved in caring for patients with DKA have a responsibility to ensure safe delivery of patient care in accordance with local and national clinical guidelines. […] The JBDS stipulates that the diabetes specialist team must be involved in the management of every patient admitted with DKA, and referral should be made as soon as possible during the acute phase. […] Patient education about sick-day management and communication with the diabetes specialist team are necessary to reduce the risk of DKA recurring.

• #67 Nursing Care Plan For Diabetic Ketoacidosis (DKA) – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-diabetic-ketoacidosis-dka/

  The nursing care delivered is patient-centered, evidence-based, and aimed at optimizing patient outcomes and promoting overall well-being. […] By collaborating with the healthcare team and engaging patients in their care, nurses ensure a comprehensive and individualized approach, fostering the best possible outcomes for individuals dealing with Diabetic Ketoacidosis. […] In conclusion, the nursing care plan for Diabetic Ketoacidosis (DKA) is a comprehensive and timely approach aimed at stabilizing the patients metabolic state, correcting electrolyte imbalances, and preventing potential complications. […] Through evidence-based interventions and compassionate care, nurses play a pivotal role in managing DKA effectively and supporting individuals during their journey to recovery. […] Patient and family education are integral components of the care plan, empowering individuals to actively participate in their diabetes management and recognize early signs of DKA.

• #68 Nursing Care Plan For Diabetic Ketoacidosis (DKA) – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-diabetic-ketoacidosis-dka/

  Through thorough education and continuous monitoring, nurses foster patient understanding and promote self-management, contributing to improved long-term diabetes control. […] By addressing the physical, emotional, and educational needs of patients, nurses significantly contribute to improved patient outcomes and overall well-being.

Zobacz więcej