diabetic ketoacidosis nursing management
TRANSCRIPT
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YASH RAMAWAT M.N. FINAL
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Diabetes meaning
a disorder of the metabolism causing excessive thirst and the production of large amounts of urine.
Ketoacidosis Pathological metabolic state associated
with high concentrations of ketone bodies
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Meaning of diabetic ketoacidosis….
A serious pathological metabolic state in which excessive amount of keton bodies accumulate in body due to lack of insulin ……….
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How lack of insulin develop acidosis
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Insulin Deficiency
Glucose uptake Proteolysis Lipolysis
Amino Acids
GlycerolFree Fatty Acids
GluconeogenesisGlycogenolysis
HyperglycemiaKetogenesis
AcidosisOsmotic diuresis Dehydration
PATHOPHYSIOLOGY
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Signs and Symptoms of DKA
• Polyuria, polydipsia– Enuresis
• Dehydration– Tachycardia– Orthostasis
• Abdominal pain– Nausea– Vomiting
• Fruity breath– Acetone
• Kussmaul breathing• Mental status
changes– Combative– Drunk– Coma
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Counterregulatory Hormones - DKA
Increases insulin
resistance
Activates glycogenolysis
and gluconeogenesis
Activates lipolysis
Inhibits insulin secretion
Epinephrine X X X X
Glucagon XCortisol X XGrowth
Hormone X X X
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IV FLUID
HYPOVOLUMIC SHOCK
ADMINISTER 0.9% NACL (1 LITER/ HR )
MILD HYPOTENSION
EVALUATE NA + LEVEL
NA HIGH NA NORMAL
0.45% NACL (4-14 ML/ KG / HR )
NA LOW
0.9% NACL (4-14 ML/ KG /
HR )
CARDIOGENIC SHOCK
HEMODYNAMIC MONITERING
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Insuline
Intravenous route Insulin regular 0.15 U/kg b.
Wt. As iv bolus
0.1 u/kg/hr Iv insulin infusion
SC/IM routeInsulin regular 0.4 u/kg, ½ Iv
bolus , ½ im or sc
0.1 u/kg / hr regular insulin sc or im
If glucose does not fall by 50 –
70 mg
Double
insuline
infusion
hourly until
glucose fall
by 50-70
mg/dl
Give hourly
iv insulin bolus(10u) until
glucose fall
by 50-70
mg/dl
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potassium
If serum K+ above 5 do not give k+ check it every 2hr
If serum potassium between 3.3 to 5 mEq/l then 20 mEq in each liter of iv fluid
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Assess need for bicarbonate
pH < 6.9
NaHco3( 100 mmol ) dilute in
400 ml water at 200ml/hr
pH .>7 pH6.9-7.0NaHco3(
50 mmol ) dilute in 400 ml
water at 200ml/hr
Repeat HCO3
administration
q 2h untill pH > 7.0.
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WHEN SERUM glucose reaches 250 mg/ dl
Change to 5% glucos with 0.45% Nacl at 150- 250 ml/hr with adequate insulin(0.05-0.1U/kg/hr insulin 5-10 U SC every 2 hr) to keep the
serum glucose between 150-250 mg/dl until metabolic control is achieved
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Nursing Diagnosis
• FLUID VOLUME DEFICIT RELATED TO: OSMOTIC DIURESIS DUE TO HYPERGLYCEMIA, EXCESSIVE DISCHARGE: DIARRHEA, VOMITING; RESTRICTION INTAKE DUE TO NAUSEA, MENTAL MESS.
• MBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS RELATED TO: INSUFFICIENCY OF INSULIN, DECREASED ORAL INPUT, HIPERMETABOLISME STATUS
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• RISK FOR INFECTION (SEPSIS) RELATED TO: INCREASED LEVELS OF GLUCOSE, DECREASED LEUKOCYTE FUNCTION, CHANGES IN THE CIRCULATION.
• RISK FOR SENSORY-PERCEPTUAL ALTERATIONS RELATED TO: KETIDKSEIMBANGAN GLUCOSE / INSULIN AND / OR ELECTROLYTES.
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• FATIGUE RELATED TO: DECREASED METABOLIC ENERGY PRODUCTION, INSUFFICIENCY OF INSULIN, INCREASING ENERGY DEMAND.
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