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Pete Cobraiti Diabetic Ketoacidosis

1: What have C.J.'s blood glucose levels been running?



How much fluid has C.J. been able to keep down over the past 3 days?

How often has C.J. been vomiting over the past 3 days?

How often has C.J. voided today? Over the past 3 days?

2: Diabetic Ketoacidosis (DKA)- is a state of uncontrolled diabetes and it is characterized by


hyperglycemia, a high anion gap acidosis, and the presence of ketonemia and ketonuria (ketone bodies
in the blood and urine). Although it can occur in patients with type 2 diabetes (during periods of severe
stress), DKA primarily occurs in patients with type 1. Type 1 diabetes is caused by the (usually
autoimmune) destruction of the pancreatic beta cells, which leads to an absolute insulin deficiency.
Thus, patients with type 1 have an absolute requirement for insulin and will develop DKA if they do not
receive it.

3: C.J is suffering from a high fever, with diarrhea and vomiting. Her skin is flashy, respiration is deep and
rapid. Plus, her breath is fruity and sweet smelling. She states, that she is thirsty, but is unable to hold
down fluids. She vomits every-time she drinks something. And, her blood sugar levels have increased.

4: The mom had reported an increase in blood glucose, which could’ve been from an infection or lack of
insulin. The Rn saw that her skin was warm and dry. Which could’ve been from the worsening condition
of Ketoacidosis and infection•

5: Antibiotics: The patient should receive prophylactic broad-spectrum antibiotics after all culture
samples have been obtained.

Blood glucose checks: These should be performed every hour until glucose stabilizes WNL.
• Serum potassium levels: Insulin drives K into the cell; therefore, the nurse should monitor serum
K levels every 1 to 2 hours to prevent complications such as dysrhythmias, altered level of
consciousness, and seizure activity.

Continuous cardiac monitoring: This should be done to monitor for dysrhythmias associated with
hypokalemia.

Strict intake and output with placement of a urinary catheter: This will assist in ensuring accurate
assessment of fluid volume status.

Potassium should be added to the IV solution to replace potassium ions in the extracellular fluid
that will be pushed back into the cells.

6: d. pH7.26, Pao2 94, Paco2 23, HCO3 18

Because C.J. has DKA, she would be expected to have metabolic acidosis, directly related to keto-
sis, with respiratory alkalosis secondary to Kussmaul's respirations

8: A narrow QRS complex and shortening of the QT interval

9: When the blood glucose level falls to 300 to 350 mg/dL, the infusion rate is reduced and 5% dextrose
is added to maintain a blood glucose level of about 250 mg/dL, or until the patient recovers from
ketosis. Because her potassium level is dropping, you would also expect the physician to add potassium
chloride to the IV infusion.

10: 100 units/250 mL: 4 units/0.4 =10


The pump should be set at 10 mL per hour

11: Large amounts of regular insulin are added to D5W to provide a continuous infusion (hospital
policies on mixture may vary). An infusion pump is critical to the safety of the patient to prevent a large
bolus of regular insulin, which can lead to profound hypoglycemia and/or death.

12: The infusion pump is employed to administer the medication in a controlled manner. While managing
(DKA), it is important to treat the fluid loss by administering the IV fluids. Hyperglycemia should also be
treated with insulin. The infusion pump can also be set at a particular rate at which it would administer the
IV fluids to the patient. It administered the fluid at a constant rate that can be regulated to the condition of
the patient. It prevents the drug from hitting the patient’s body at a large amount.

13: I would provide C.J.’s mom with tissue, ask if there is anything I can do to help her. I would stay with
her to give emotional and mental support. As well as listen to her and talk. I would ask what perception
she has about C.J.’s condition. Also provide her with clarification as needed. The mom should have no
doubt regarding her daughter’s health. I would have her talk wit hthe physician if she has any further
doubts.