Nursing Care Plan for Diabetic Ketoacidosis (DKA)
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
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
Diabetic Ketoacidosis (DKA) Nursing Care Plan
- Excessive thirst
- Abdominal pain
- Weakness / fatigue
- Shortness of breath
- Reports of:
- Blurry vision
- Excessive urination
- Frequent urination
- Fruity-scented breath
- Hyperglycemia, usually >400 mg/dL
- High urine ketone levels
- Kussmaul respirations
- Metabolic Acidosis with elevated Anion Gap
Nursing Interventions and Rationales
- Monitor blood glucose levels and administer insulin as appropriate
Consistently high blood glucose levels, over 400 mg/dL, are the primary indicator of ketone production. Monitor glucose and intervene with prescribed insulin as appropriate to reduce glucose levels and prevent further ketone production.
- Monitor fluid and electrolyte balance to prevent dehydration and complications such as decreased sodium, potassium, calcium and magnesium
Excess blood glucose can cause nausea and vomiting resulting in electrolyte imbalances. These electrolyte deficiencies can lead to further complications and cardiac arrhythmias.
- Monitor for and treat signs / symptoms of infection
DKA is often the result of an underlying infection such as a common cold, flu or bacterial infection like pneumonia or urinary tract infections. Assess for fever and other symptoms of infection and administer antibiotics as necessary.
- Administer medications as appropriate
- Insulin as necessary
- IV fluids
- Electrolyte replacement
Medications may be given to lower the blood glucose level in order to prevent further production of ketones or to manage symptoms of vomiting and underlying infection.
- Monitor vitals for signs / symptoms of hypovolemia
Vomiting and frequent urination can cause a deficiency in fluid volume, thus leading to a decreased circulatory volume. This will be evident by low blood pressure and tachycardia
- Prevent injury and falls; assist with ambulation
Fatigue and weakness are common due to the cells inability to use glucose to produce energy, also following vomiting, and in cases of dehydration.
- 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
Maintaining a high blood glucose level, missing doses of insulin or being sick can cause ketones to form in the blood. Educate patients on healthy diet and lifestyle to prevent DKA. Teach patients and caregivers of the warning signs / symptoms of DKA.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell