Nursing Care Plan for Diabetic Ketoacidosis (DKA)

Pathophysiology

Diabetic ketoacidosis is a serious complication of diabetes mellitus that occurs when uncontrolled blood sugar rises and the body can’t 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

Etiology

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.

Desired Outcome

Maintain blood glucose level within the target range, maintain normal fluid balance

Diabetic Ketoacidosis (DKA) Nursing Care Plan

Nursing Interventions and Rationales

• Monitor blood glucose levels and administer insulin as appropriate

• Monitor fluid and electrolyte  balance to prevent dehydration and complications such as decreased sodium, potassium, calcium and magnesium

• Monitor for and treat signs / symptoms of infection

• Administer medications as appropriate
  • Insulin as necessary
  • Antibiotics
  • IV fluids
  • Electrolyte replacement
  • Antiemetics

• Monitor vitals for signs / symptoms of hypovolemia

• Prevent injury and falls; assist with ambulation

• Nutrition and lifestyle education
  • Avoid alcohol / illicit drug use
  • Choose foods that are high in fiber and low in fats, sugars and simple carbs
  • Eat regular meals and snacks, don’t miss meals
  • Check for urine ketones when you have symptoms
  • Do not exercise when urine shows positive for ketones
  • Maintain compliance with medication and insulin therapy

References

• http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html
• https://emedicine.medscape.com/article/118361-overview#a8
• https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/diagnosis-treatment/drc-20371555