Dx Help: DM vs. DKA?
0For 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.
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 senseLast edit by Joe V on Aug 12, '12
1Aug 12, '12 by SHGR, MSN, RNI think you are working under some incorrect assumptions, so go back to the beginning, and review DKA patho... think it through:
What body systems would DKA affect? What would this patient look like, what will your assessment likely show? Think respiratory, fluid and electrolytes, mentation. How critical might he or she be?
Also, knowledge deficit is my absolute most-used nursing dx. Is this a newly diagnosed patient, or one that has had DM for a long time?
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
One of the biggest concerns with DKA is the respiratory system, correct? At that point the body has become acidotic and the respiratory system tries to compensate by exaggerating respirations. Fluid and electrolytes wise, the client in this senario is likely to have a low sodium because of fluid loss so my priority Dx would be Deficient Fluid Volume, correct?
I guess, even this late in the program I have a hard time prioritzing my Dx's. I mean, I know airway is always first, then you have worries such as injury, infection, fluid volume, and the list goes on.
My brain hurts! hah
Am I on the right track?
0Aug 12, '12 by SHGR, MSN, RNYou are absolutely on the right track!! So, yes, safety, correcting the imbalances, and think too about the effects the fluctuating K+ may have and what you are going to do to monitor and help him compensate for that.
Hard work, yes, but sooo worth it!
Is there an "alteration in fluid/electrolyte" dx? I don't know them all offhand. They have changed some since I graduated!
1Haha! YESSS! Go me! :P
No specific Dx speaks on electrolytes, if I am correct
But I do know that with Deficient Fluid Volume being my top priority, my interventions can reflect correcting the fluid/electrolyte imbalance since I would be giving a client with DKA 0.9% NS (: Anddd I know that within 2hrs they need to have had at least 2L infused, so it's likely the infusion rate would be 1L/hr.
My next priority is correcting the blood glucose since he has been off of his insulin for 2 days and probably looks something like this -->
So the Dx would be unstable blood glucose. And in the case of DKA, isn't IV Humulin R admin'd?
Thirdly, due to his altered mental status, I know that I need to addess safety! BUT I cannot decide if this should take priority over everything else or what...
Because, here is my thought: If I do not correct the fluid volume and the glucose, the DKA state is going to exacerbate and he is at risk for falling into a coma, correct?
Can I get a hint? LOL
0I mean OBV!! (-_-)
Before treating glucose priorities, you need to know what you're working with!
But I as saying before that it is obv that he is most definitely going to be unstable because he has been off of insulin for the past 2 days...and that is what caused him to go into DKA.