Nursing Student Needing some assistance on information about a patient wih DKA

[MariaCarter06]

Pt. comes into the ER unconscious, daughter says that her mother has had the flu and been unable eat or drink very much. She is also unsure if her mother has taken her insulin in the past 24 hours. Her VS: Resp:22 deep and fruity odor Temp:101.8 Pulse:120 weak and irregular BP:80/42

1. What type of IV fluids would be prepared for this patient. I know that they would be mixed with Potassium to replace the loss. 0.9% initially?

2. During the first 24 hours, what complications should the nurse monitor for and why?

A physician prescribes blood glucose monitoring instead of urine testing.. is this because Blood glucose is more accurate because it monitors whats in the blood stream and urine can't detect disinguish between low and normal blood glucose?

Thanks for the assistance. It's greatly appreciated

[osbork7815]

Usual treatment is IV Normal saline, or 0.45 Normal saline to rehydrate from what I understand it usually runs 150 - 200 ml/hr But you have to watch for CHF sx if there is heart issues also.

Usually in the ER Bolus of Regular Insulin then hang a insulin drip but then they have to go to a ICU if they are on insulin drip for DKA. Once you start seeing K+ levels become normal change fluid to normal saline.

Always recheck blood sugar. Once it is 250 - 275 then wean off the insulin drip. Never suddenly stop it, then they are put on a sliding scale coverage.

Now this is what we do and what I learned .

Hope this helps.

Complications to watch for are Lungs for fluid overload, If the patient goes into Hyperosmolar never add potassium to the fluid. Watch for signs and sx of hypoglycemia because the body was so used to high levels that a regular level could cause symptoms.

Katina

[classicdame, MSN, EdD]

Depends so much on the patient, but NS is usually the first fluid ordered because patient is dehydrated. Remember, the idea is to get glucose INSIDE the cells and OUTSIDE the blood. So the MD may order D5 or even D10 to balance the potassium and insulin being infused. The sliding scale is now considered an archaic form of management, although many MD's do still use it. Blood glucose levels are checked frequently, maybe even every hour, so that the insulin can be adjusted as needed. IV insulin of course. Usually NPO till lab shows clear of acetone. SX to watch for include anything related to heart attack, stroke, or any organ failure. That means kidneys and eyes. Watch albumin level or your patient might end up with pressure ulcers. Some people recover from DKA quickly and others do not. It can kill.

[classicdame, MSN, EdD]

Another thing - look at this website to get guidelines for in-pt and out-pt care.

www.guidelines.gov

And don't forget - the nurse will have to do a LOT of education when the patient is able to participate.