Diabetes ketoacidosis (DKA) is a life-threatening metabolic condition that occurs when level of insulin decreases and the body begins to produce large amounts of ketones as an alternative source of fuel. Without proper nursing assessment, diagnosis and care plan, DKA can be fatal.
Blood Sugar Levels: Patients may present with elevated blood glucose on a blood sample of ≥200mg/dl.
Ketones: Urine or blood ketones will be positive if the patient has DKA.
Electrolytes: Patients may have elevated levels of electrolytes, such as sodium, potassium, chloride and phosphorus.
pH Balance: Patients with DKA will usually present with a low pH balance, usually less than 7.3.
These are some common nursing diagnoses related to diabetes ketoacidosis:
- Risk for Fluid Volume Deficit: Due to excessive diuresis as a result of elevated blood sugars
- Risk for Acute Confusion: Due to alterations in the mental status caused by elevated blood sugars
- Ineffective Tissue Perfusion: Due to reduced oxygen delivery secondary to elevated blood sugars
The goals and expected outcomes for this condition should include:
- Adequate hydration status: As measured by normal electrolyte values, adequate urine output, and improved mental status
- Stabilized glucose levels: As evidenced by a fasting serum sugar of ≤180mg/dl and post-prandial sugar under 220mg/dl.
- Improved tissue perfusion: As evidenced by improved nervous system functions and improvement of skin temperature, color and turgor
These are some important interventions that should be taken when caring for a patient with diabetes ketoacidosis:
- Monitoring: Monitor vital signs, serum electrolytes, glucose levels and ketone levels frequently to assess for changes or deterioration in the condition
- Hydration: Provide intravenous fluids to maintain hydration and to correct electrolyte imbalances
- Insulin: Administer insulin to regulate glucose levels and provide adequate tissue perfusion
- Dietary Management: Monitor food intake, provide adequate nutrition and discuss dietary habits with the patient to prevent future complications
The following are rationales for the above interventions:
- Monitoring: Is necessary to assess for changes or deterioration in the condition and help determine the treatment plan.
- Hydration: Proper hydration helps to maintain tissue perfusion, prevent further dehydration and provide adequate blood volume.
- Insulin: Insulin helps to regulate glucose levels and provide adequate tissue perfusion.
- Dietary Management: Adequate nutrition helps to prevent future complications or exacerbations of DKA.
The following should be monitored and evaluated during the course of nursing care:
- History and physical: to assess for any underlying medical conditions that may predispose the patient to DKA.
- Laboratory tests: To check serum electrolytes and glucose levels, to monitor ketone levels.
- Vital signs: To assess for any changes or deterioration in the condition.
- Patient response: To monitor for any adverse reactions to the medications and interventions provided.
Diabetes ketoacidosis is a life-threatening condition and requires immediate nursing assessment, diagnosis and care plan for proper management. With proper monitoring, laboratory tests, administration of insulin, and proper hydration, this condition can be managed successfully.
- What is diabetes ketoacidosis? Diabetes ketoacidosis (DKA) is a life-threatening metabolic condition that occurs when level of insulin decreases and the body begins to produce large amounts of ketones as an alternative source of fuel.
- What are the symptoms of DKA? The symptoms of DKA include abdominal pain, vomiting, fruity breath, excessive thirst and frequent urination.
- What is the treatment for DKA? The treatment for DKA usually includes intravenous fluids, insulin therapy and dietary modifications.
- What are the nursing interventions for DKA? The nursing interventions for DKA include monitoring vital signs, electrolytes, glucose and ketone levels, administering insulin, providing hydration and dietary management.
- What is the prognosis of DKA? The prognosis of DKA is generally good with proper treatment, but it is important to seek medical attention and follow up as advised.