Dx Help: DM vs. DKA?

[Nursing_Mamacita]

For starters, hello everyone! This is my first post on here (though I have spent much time stalking the site for answers throughout my 14 months of nursing school so far LOL)

Well I am now in the long stretch (will graduate in March) of my RN program and I have hit a wall, of sorts.

Im doing some work for simulation lab tomorrow and the scenario they plan to run is DKA (yay...not)

I have to formulate 3 nursing Dx along with 3 supporting interventions per Dx.

The problem?

While I COMPLETELY understand the differences in pathophysiology and expression of DM and DKA, I am wondering this: Are the nursing Dx for the two different? My thought is no since there are no SPECIFIC nursing Dx for metabolic imbalances. DKA is essentially metabolic acidosis but, if I am correct, the nursing Dx's would simply have to reflect the subcomplications of the condition, right?

I hope this makes sense

[Nursing_Mamacita]

By the way, here is what I went with:

1.) Deficient Fluid Volume

a. monitor VS: noting orthostatic BP changes, respiratory pattern, RR & quality, peripheral pulse quality

b. measure strict I&O

c. administer 0.9% NS as ordered

2.) Unstable Blood Glucose

a. perform blood glucose testing as ordered

b. administer fast acting insulin if indicated as ordered

c. monitor labs (i.e serum glucose, acetone, k, pH, HCO3-)

3.) Risk for Injury

a. follow facility protocol for safety measures (i.e bed in lowest position, call bell within reach, etc)

b. assess LOC qh; orient as needed

c. appoint sitter as necessary (SO, family member, volunteer)

[GitanoRN, BSN, MSN, RN]

By the way, here is what I went with:

1.) Deficient Fluid Volume

a. monitor VS: noting orthostatic BP changes, respiratory pattern, RR & quality, peripheral pulse quality

b. measure strict I&O

c. administer 0.9% NS as ordered

2.) Unstable Blood Glucose

a. perform blood glucose testing as ordered

b. administer fast acting insulin if indicated as ordered

c. monitor labs (i.e serum glucose, acetone, k, pH, HCO3-)

3.) Risk for Injury

a. follow facility protocol for safety measures (i.e bed in lowest position, call bell within reach, etc)

b. assess LOC qh; orient as needed

c. appoint sitter as necessary (SO, family member, volunteer)

Unquestionably, someone has done their homework, you should be proud therefore, I shall wish you the very best in all of your future endeavors in your nursing career.....Aloha~

[Esme12, ASN, BSN, RN]

I know I am late to the party.....nice job! Remember fluid and electrolytes and where the K is going to go while you replace the fluid and correct the glucose....your potassium will plummet giveing rise to arrythmias.

Good luck!

[PunkBenRN]

Hello hey_suz!

The summary of the simulation client:

36 y/o male

Presents to ED confused and agitated

Dx'd with DM I 12 months prior

48 U of insulin daily

Had "the flu" for 5 days with nausea, vomitting and anorexia

Stopped taking insulin 2 days ago because he was not eating

Not to be a cynical jerk, but whenever I have DKA pt's it is almost always a non-compliant diabetic. Sometimes after a drinking binge, sometimes just refuse to acknowledge that diabetes affects them.

Sorry, long night, ha

[Nursing_Mamacita]

Hey everyone! Quick follow up!

I did really well in my simulation lab! All went smoothly and my instructor was pleased with my interventions! Thank you all for your help. Your responses were not in vain

~Erika

FUTURE RN

:w00t:

[Esme12, ASN, BSN, RN]

Congratulations

[SHGR, MSN, RN, CNS]

Hey Nursing_mamacita, thanks for coming back with an update! Congratulations! You have great critical thinking skills. :)

[Nursing_Mamacita]

Congratulations

Thank youu!

Hey Nursing_mamacita, thanks for coming back with an update! Congratulations! You have great critical thinking skills. :)

Thanks! Now if I could just sharpen my common sense!!