Diabetic ketoacidosis (DKA) is a critical and potentially life-threatening complication arising from diabetes, marked by severely elevated glucose levels. Predominantly observed in individuals with type 1 diabetes, DKA can also manifest in those with type 2 diabetes under certain circumstances.
The pathophysiology of DKA involves a significant insulin deficiency, preventing glucose from entering cells for energy production. Consequently, the body resorts to breaking down fats, a process that generates ketones. The excessive accumulation of ketones leads to a dangerous acidification of the blood, necessitating prompt and effective medical intervention.
The Nursing Process in DKA Management
Managing DKA demands immediate treatment and continuous patient monitoring. Rapid deterioration can lead to severe complications, including coma and death. The primary treatment strategy revolves around intravenous (IV) administration of insulin and fluids. Precise titration of these interventions is crucial to avoid iatrogenic complications. A vital role of nursing care extends to patient and family education, focusing on recognizing DKA symptoms and implementing preventive measures against recurrences.
Comprehensive Nursing Assessment for DKA
The cornerstone of effective nursing care is a thorough assessment. This involves systematically gathering physical, psychosocial, emotional, and diagnostic data. In the context of diabetic ketoacidosis, this assessment encompasses both subjective and objective data collection to gain a holistic understanding of the patient’s condition.
Health History Review: Subjective Data Collection
1. Eliciting General Symptoms: Nurses should proactively inquire about the constellation of symptoms indicative of DKA. Key warning signs include:
- General Manifestations: Unexplained weight loss, particularly in newly diagnosed type 1 diabetes patients (often linked to dehydration), generalized weakness, profound fatigue, and excessive drowsiness.
- Central Nervous System (CNS) Indicators: Altered levels of consciousness, persistent headaches, and blurred vision.
- Gastrointestinal (GI) Disturbances: Nausea and vomiting, diffuse abdominal pain, and a noticeable decrease in appetite.
- Genitourinary (GU) Changes: Increased urinary frequency (polyuria).
- Integumentary Findings: Dryness of the skin.
- Musculoskeletal Complaints: Myalgia (muscle pain) and muscle stiffness.
2. Insulin Therapy Assessment: For patients with diabetes, especially type 1, a detailed history of insulin use is paramount. Given that type 1 diabetes is characterized by minimal or no insulin production, inadequate insulin administration or improper timing can precipitate hyperglycemia. Nurses should identify potential barriers to effective insulin therapy, such as:
- History of non-adherence to prescribed insulin regimens.
- Missed insulin doses due to nausea, vomiting, or erratic meal schedules.
- Physical or cognitive limitations hindering self-administration of insulin.
- Previous incidents of mechanical failure with insulin infusion pumps.
3. Infection Investigation: Infections are frequently a trigger for DKA. Nurses should actively investigate for recent or current infections, including:
- Urinary tract infections (UTIs).
- Pneumonia.
- Recent surgical procedures.
- Any other potential sources of infection.
Infections elevate blood glucose levels, and illnesses accompanied by vomiting and anorexia further complicate glucose management, increasing the risk of DKA.
4. Medication Reconciliation: A thorough review of the patient’s medication list is essential. Certain medications can increase the risk of DKA:
- Oral antidiabetic drugs, specifically SGLT2 inhibitors, have been associated with an increased DKA risk.
- Corticosteroids and antipsychotic medications can also contribute to DKA development.
- It is crucial to assess for substance abuse disorders, as these can significantly impact adherence to insulin therapy and overall diabetes management.
Physical Examination: Objective Data Collection
1. Vital Signs Monitoring: Vital sign abnormalities are common in DKA. Nurses should meticulously monitor for:
- Fever or hypothermia, particularly in the context of infection.
- Tachycardia (elevated heart rate).
- Tachypnea (rapid breathing).
- Kussmaul breathing – a distinctive pattern of rapid, deep respirations, indicative of the body attempting to compensate for metabolic acidosis.
2. Comprehensive Physical Examination: Physical findings in DKA often reveal signs of dehydration, cerebral edema, or underlying infection. Key findings include:
- General Appearance: Ill appearance, generalized weakness, unintended weight loss, and fever.
- CNS Examination: Decreased level of consciousness, drowsiness, diminished reflexes (hyporeflexia), headache, and confusion.
- Integumentary Assessment: Dry skin, dry mucous membranes, poor skin turgor (indicating dehydration), and flushed skin.
- Respiratory System: Labored, deep, rapid breathing (Kussmaul breathing), and a characteristic fruity odor to the breath, suggestive of acetone production from ketogenesis. Presence of cough should also be noted.
- Cardiovascular System: Delayed capillary refill time, indicating poor peripheral perfusion.
- Gastrointestinal System: Vomiting and abdominal tenderness upon palpation.
- Genitourinary System: Decreased urine output, particularly in cases of severe volume depletion.
3. Ketone Assessment: Ketone presence is a hallmark of DKA. Nurses should assess for ketones in:
- Urine (ketonuria): Ketones spill into the urine as blood levels rise.
- Breath: The characteristic fruity breath odor is due to acetone, a type of ketone, being exhaled.
4. Cerebral Edema Evaluation: Cerebral edema is a serious complication, especially in children, and can occur with rapid blood glucose changes. Nurses must be vigilant for symptoms, including:
- Fluctuations in consciousness.
- Sustained deceleration of heart rate.
- Incontinence (new onset).
- Abnormal pain responses.
- Decorticate or decerebrate posturing, indicating severe neurological compromise.
- Lethargy progressing to unresponsiveness.
Diagnostic Procedures and Laboratory Findings
1. Blood Tests: Blood analysis is crucial for confirming DKA and assessing its severity. Key diagnostic blood results include:
- Hyperglycemia: Blood glucose levels exceeding 250 mg/dL.
- Acidosis: Arterial pH below 7.3, indicating metabolic acidosis.
- Low Bicarbonate: Serum bicarbonate level below 15 mEq/L, further confirming metabolic acidosis.
- Ketonemia: Presence of ketones in the blood.
- Elevated Anion Gap: Anion gap greater than 10 mEq/L in mild DKA and exceeding 12 mEq/L in moderate to severe DKA. (This helps differentiate DKA from Hyperosmolar Hyperglycemic Syndrome (HHS), where blood sugar is much higher, but acidosis and ketosis are less pronounced).
2. Urinalysis: Urine testing provides rapid confirmation of key DKA indicators.
- Glucosuria: Presence of glucose in the urine.
- Ketonuria: Presence of ketones in the urine.
3. Infection Screening: Given infection’s role in DKA, investigations are often needed.
- Leukocytosis: Elevated white blood cell count is common in DKA, but marked leukocytosis or leukopenia may suggest sepsis.
- Further Tests: Depending on clinical suspicion, additional tests may include chest X-rays (for pneumonia), serum lipase (for pancreatitis), and cultures of urine, sputum, and blood to identify specific pathogens.
4. Electrocardiogram (ECG): ECG is important to evaluate for electrolyte imbalances, particularly potassium.
- Hyperkalemia Indicators: Peaked T waves on ECG.
- Hypokalemia Indicators: Flattened T waves and presence of U waves.
5. Imaging Studies: Imaging may be necessary to identify underlying causes or complications.
- CT Scan: May identify acute pancreatitis (if liver enzymes are elevated) as a DKA trigger.
- Head CT or MRI: Used to diagnose cerebral edema if suspected based on neurological findings.
Nursing Interventions for DKA Management
Effective nursing interventions are pivotal in reversing DKA and preventing complications. These interventions are focused on addressing the core physiological derangements of DKA.
Reversing Diabetic Ketoacidosis: Core Interventions
1. Comprehensive DKA Management: The fundamental principles of DKA management are:
- Fluid resuscitation and maintenance.
- Insulin therapy to correct hyperglycemia and ketogenesis.
- Electrolyte repletion to address imbalances.
- Supportive care to manage symptoms and prevent complications.
2. Hydration Promotion: Significant fluid deficits are characteristic of DKA, often representing 10-15% of body weight loss.
- Fluid Resuscitation: Immediate and aggressive fluid replacement is essential to:
- Reverse hypovolemia.
- Restore tissue perfusion.
- Facilitate ketone elimination.
- IV Fluid of Choice: 0.9% normal saline is the preferred initial IV fluid for rehydration, improving glycemic control even before insulin administration.
3. Insulin Administration: Insulin therapy is crucial to reverse the metabolic abnormalities in DKA.
- IV Insulin Infusion: Continuous IV infusion of short-acting insulin is recommended.
- Transition to Subcutaneous Insulin: IV insulin is continued until specific criteria are met, indicating DKA resolution:
- Blood glucose level below 200 mg/dL.
- Serum bicarbonate level ≥ 15 mEq/L.
- Arterial pH > 7.3.
- Anion gap ≤ 12 mEq/L.
4. Electrolyte Correction: Insulin deficiency leads to electrolyte imbalances, requiring careful monitoring and replacement.
- Intravenous Electrolyte Replacement: Electrolytes are administered intravenously as prescribed to maintain vital physiological functions, particularly cardiac, muscle, and nerve cell function.
5. Potassium Repletion: Potassium management is critical due to insulin’s effect on potassium levels.
- Hypokalemia Risk: Although initial potassium levels may appear normal or even elevated in DKA, insulin administration drives potassium into cells, potentially causing severe hypokalemia.
- Pre-Insulin Potassium Correction: If hypokalemia is present, it must be corrected before initiating insulin therapy to prevent life-threatening cardiac arrhythmias.
- Potassium Monitoring: Close monitoring of potassium levels is essential, aiming to maintain a range of 4.0 – 5.0 mEq/L.
6. Laboratory Monitoring: Regular laboratory testing is essential to guide DKA management.
- Point-of-Care Testing (POCT): Hourly glucose monitoring using POCT is crucial for tight glycemic control.
- Frequent Serum Electrolyte and Glucose Reassessment: Serum glucose and electrolyte levels should be reassessed every two hours until stable, then every four hours thereafter.
- Baseline Blood Urea Nitrogen (BUN): Obtain a baseline BUN level to assess renal function.
- Arterial Blood Gas (ABG) Monitoring: Monitor ABG levels as clinically indicated to assess acid-base status.
7. Acid-Base Balance Management: In severe, life-threatening metabolic acidosis, particularly when complicated by sepsis or lactic acidosis, sodium bicarbonate may be considered.
- Sodium Bicarbonate Administration: Use with caution, especially in children, as bicarbonate administration carries a risk of cerebral edema. Reserve for cases of severe acidosis (pH < 6.9) and hemodynamic instability.
Treating and Preventing DKA Complications
1. Concurrent Infection Management: Infections are common DKA precipitants and must be addressed.
- Antibiotic Therapy: Administer antibiotics guided by culture and sensitivity results when infection is confirmed.
- Empiric Antibiotics: Initiate empiric antibiotic therapy if infection is suspected while awaiting culture results.
2. Cerebral Edema Management: Cerebral edema, though rare, is a devastating DKA complication.
- Mannitol Infusion: Mannitol is the initial treatment of choice for cerebral edema to reduce intracranial pressure.
- Neurological Monitoring: Frequent mental status and neurological examinations are critical for early detection and intervention for cerebral edema.
3. Overhydration Prevention: Aggressive fluid resuscitation must be balanced, especially in patients with pre-existing conditions.
- Caution in Renal or Heart Failure: Exercise caution when administering large volumes of IV fluids to patients with a history of renal failure or congestive heart failure due to the risk of fluid overload.
- Diuretics: Diuretics may be necessary to manage pulmonary edema if it develops.
4. Hypoglycemia Prevention: Overly rapid correction of hyperglycemia can lead to hypoglycemia.
- Glucose Monitoring: Careful and frequent glucose monitoring is essential to prevent iatrogenic hypoglycemia.
- Dextrose Administration: Once glucose levels approach 200 mg/dL, consider adding dextrose to IV fluids to prevent hypoglycemia and continued ketogenesis.
Patient Education for DKA Recurrence Prevention
1. Glucose Monitoring Device Competency:
- Glucometer Demonstration: Before discharge, ensure the patient can correctly demonstrate glucose monitoring using their glucometer.
2. DKA Prevention Education: Empower patients to prevent future DKA episodes.
- Sick Day Management: Instruct patients on adjusting insulin regimens during illness.
- Urine Ketone Testing: Educate on self-testing for urine ketones when blood sugar is consistently above 250 mg/dL, especially during illness or stress.
- Increased Monitoring: Advise increased blood glucose monitoring during illness and periods of stress.
3. Blood Glucose Target Range Education:
- Individualized Glucose Goals: Educate patients on their personalized target blood glucose ranges.
- Adherence to Regimen: Emphasize the importance of adhering to their prescribed insulin or antidiabetic medication regimen.
4. Referral to Specialists:
- Diabetologist/Endocrinologist Referral: Refer patients to a diabetologist or endocrinologist for specialized diabetes care and management if they are not already under such care.
5. DKA Signs and Symptoms Education: Early recognition of DKA is crucial for timely intervention.
- Warning Signs: Educate patients and families on DKA warning signs requiring immediate medical attention:
- Unexplained vomiting (more than one episode).
- Abdominal pain.
- Excessive diarrhea.
- Difficulty breathing.
- Sustained high glucose levels (over 300 mg/dL).
6. Diabetes Self-Management Education and Support (DSMES) Referral:
- DSMES Program Benefits: Refer patients to DSMES programs, which provide essential education and support for managing diabetes and promoting overall health.
7. Diabetic Educator Collaboration:
- Diabetes Educator Role: Collaborate with diabetes educators to provide patients and caregivers with comprehensive knowledge, skills, motivation, and confidence for effective diabetes management.
8. Nurse Case Manager Referral:
- Resource Assistance: For patients with challenges in independent diabetes management or financial barriers to accessing supplies and medications, refer to a nurse case manager or social worker for community and financial resource navigation.
Nursing Care Plans for DKA: Addressing Key Nursing Diagnoses
Nursing care plans are essential tools for organizing and prioritizing nursing care based on identified nursing diagnoses. In DKA, common nursing diagnoses guide interventions to address both immediate and long-term patient needs.
Nursing Diagnosis: Acute Confusion
Severe DKA and complications like cerebral edema can lead to acute confusion.
Nursing Diagnosis: Acute Confusion
Related Factors:
- Delirium
- Cerebral edema
- Metabolic encephalopathy
Evidenced By:
- Confusion
- Agitation
- Fluctuating cognition
- Headache
- Lethargy
- Increased intracranial pressure (in cerebral edema)
Expected Outcomes:
- Patient will maintain orientation to person, place, and time.
- Patient will not experience seizures, cerebral edema progression, or coma related to DKA.
Nursing Assessments:
1. Cognition Assessment:
Rationale: Close monitoring for changes in cognition and consciousness is crucial for early detection of neurological complications. The Glasgow Coma Scale (GCS) may be used for standardized assessment.
2. Laboratory Monitoring:
Rationale: Electrolyte imbalances, acid-base disturbances, and glucose levels directly impact neurological function. Regular monitoring is essential.
3. Imaging Review (if indicated):
Rationale: CT scans or MRIs can detect cerebral edema or other structural brain abnormalities. Prompt diagnosis is vital for timely intervention.
Nursing Interventions:
1. Insulin Administration:
Rationale: IV insulin is the primary treatment to correct hyperglycemia and ketogenesis, addressing the metabolic causes of confusion.
2. Overhydration Avoidance:
Rationale: While fluid replacement is essential, overhydration can exacerbate cerebral edema. Careful fluid management is crucial.
3. Magnesium Level Consideration:
Rationale: Magnesium deficiency can contribute to neurological symptoms. Checking and correcting magnesium levels may improve cognitive function.
4. Medical Alert Bracelet Recommendation:
Rationale: A medical alert bracelet is crucial for patient safety, especially if confusion recurs outside of a monitored setting, ensuring rapid identification and appropriate treatment in emergencies.
Nursing Diagnosis: Decreased Cardiac Output
DKA-related hyperglycemia, acidosis, and electrolyte imbalances can impair myocardial function, leading to decreased cardiac output.
Nursing Diagnosis: Decreased Cardiac Output
Related Factors:
- Hyperglycemia
- Hypovolemia
- Acidosis
- Hypokalemia
- Hyperkalemia
- Myocardial injury (potential in severe cases)
Evidenced By:
- Tachycardia
- Tachypnea
- Dyspnea
- Reduced oxygen saturation
- Hypotension
- Decreased central venous pressure (CVP)
- Increased pulmonary artery pressure (PAP) (in severe cases)
- Chest pain
- Abnormal heart sounds
- Dysrhythmias
- Fatigue
- Change in level of consciousness
- Anxiety/Restlessness
- Abnormal electrolyte levels
- Abnormal ABGs
- Elevated cardiac biomarkers (in rare cases of myocardial stress)
Expected Outcomes:
- Patient will demonstrate adequate cardiac output, evidenced by:
- Systolic BP within 20 mmHg of baseline.
- Heart rate 60-100 bpm with regular rhythm.
- Respiratory rate 12-20 breaths/min.
- Patient will maintain potassium levels within 4.0-5.0 mEq/L.
Nursing Assessments:
1. Vital Signs Monitoring:
Rationale: DKA frequently causes tachypnea, tachycardia, and hypotension due to hypovolemia and compensatory mechanisms.
2. 12-Lead ECG Monitoring:
Rationale: ECG is essential for detecting dysrhythmias and signs of myocardial ischemia, which can be exacerbated by electrolyte imbalances and acidosis.
3. Electrolyte, ABG, and Cardiac Biomarker Monitoring:
Rationale: Electrolyte imbalances (especially potassium) and acidosis are primary drivers of cardiac dysfunction in DKA. Cardiac biomarkers may be monitored to rule out myocardial stress in certain patients.
Nursing Interventions:
1. Electrolyte Imbalance Correction:
Rationale: Insulin-induced potassium shift can lead to severe hypokalemia. Potassium replacement is crucial to prevent cardiac arrhythmias.
2. Supplemental Oxygen Administration:
Rationale: Patients with pre-existing cardiac conditions are at higher risk for fluid overload during resuscitation. Supplemental oxygen supports oxygenation and manages potential pulmonary edema symptoms.
3. Sodium Bicarbonate Consideration for Acidosis:
Rationale: In severe acidosis (pH < 6.9) or when complicated by sepsis or lactic acidosis, sodium bicarbonate may be considered to improve cardiac function and prevent life-threatening dysrhythmias.
4. Cardiology Consultation Consideration:
Rationale: Persistent dysrhythmias despite standard DKA treatment warrant cardiology consultation to investigate underlying cardiac issues and guide further management.
Nursing Diagnosis: Ineffective Tissue Perfusion
DKA leads to systemic hypoperfusion due to hypovolemia, acidosis, and potentially septic shock.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related Factors:
- Septic shock (as a DKA complication)
- Acidosis
- Renal failure (acute kidney injury)
- Vomiting
- Dehydration
- Hyperglycemia
- Cerebral edema
Evidenced By:
- Fever (>38.0°C) or hypothermia (<36.0°C) (if sepsis is present)
- Tachycardia
- Tachypnea
- Leukocytosis or Leukopenia (if sepsis is present)
- Hypotension
- Prolonged capillary refill time
- Change in level of consciousness
- Oliguria
- Nausea and vomiting
- Dry skin
- Poor skin turgor
Expected Outcomes:
- Patient will maintain optimal tissue perfusion, evidenced by:
- Temperature 36.5-37.4°C (afebrile unless infection dictates otherwise)
- HR 60-90 bpm
- RR 12-20 breaths/min
- BP: SBP >90 mmHg
- Urine output 0.5-1.5 cc/kg/hour
- WBC 4,000-12,000/mm3 (unless infection dictates otherwise)
- Capillary refill time <2 seconds.
- Patient will maintain baseline level of consciousness and orientation.
Nursing Assessments:
1. Vital Signs Monitoring (with Sepsis Focus):
Rationale: Elevated WBC count combined with abnormal vital signs (fever/hypothermia, tachycardia, tachypnea, hypotension) are sepsis indicators. Septic shock represents severe tissue hypoperfusion.
2. Complete Blood Count (CBC) Monitoring:
Rationale: While leukocytosis is common in DKA, marked leukocytosis or leukopenia can be sepsis indicators, a serious DKA complication.
3. Blood Urea Nitrogen (BUN) and Creatinine Assessment:
Rationale: Baseline and serial BUN and creatinine measurements monitor renal function, which is vulnerable in DKA due to hypovolemia and potential sepsis.
Nursing Interventions:
1. Intravenous Fluid Administration:
Rationale: Fluid resuscitation is the cornerstone of DKA management, restoring intravascular volume, improving tissue perfusion, and diluting glucose and counter-regulatory hormones. 0.9% normal saline is the initial fluid of choice.
2. Cerebral Edema Prevention and Management:
Rationale: Cerebral edema is a severe complication, especially in children. Close neurological monitoring and prompt mannitol or hypertonic saline administration are crucial if cerebral edema is suspected.
3. Urine Output Monitoring:
Rationale: Urine output is a key indicator of renal perfusion and overall fluid status, particularly important in DKA patients at risk for acute kidney injury.
4. Medication Administration (Antibiotics for Infection):
Rationale: Infections are frequent DKA triggers. Broad-spectrum antibiotics are indicated if infection is suspected or confirmed, targeting the source of infection and preventing further perfusion compromise.
Nursing Diagnosis: Risk for Deficient Fluid Volume
Fluid losses from polyuria, vomiting, and Kussmaul respirations place DKA patients at high risk for deficient fluid volume.
Nursing Diagnosis: Risk for Deficient Fluid Volume
Related Factors:
- Vomiting
- Kussmaul respirations (increased insensible losses)
- Polyuria (osmotic diuresis from hyperglycemia)
- Glycosuria and osmotic diuresis
Evidenced By:
Risk diagnoses are not evidenced by signs and symptoms as the problem has not yet occurred. Interventions are preventative.
Expected Outcomes:
- Patient will identify factors contributing to fluid loss and related symptoms.
- Patient will maintain normovolemic status, evidenced by:
- Urine output within normal limits.
- Electrolyte levels within normal limits.
- Vital signs within normal limits.
Nursing Assessments:
1. Vital Signs and Respirations Assessment:
Rationale: Dehydration causes tachycardia and hypotension. Kussmaul respirations are a compensatory mechanism for acidosis, increasing insensible fluid loss. Fruity breath odor is a classic DKA sign.
2. Electrolyte Monitoring:
Rationale: Initial potassium levels may be elevated, but total body potassium is depleted, and levels will drop with fluid resuscitation and insulin. Magnesium and sodium may also be deficient. Electrolyte replacement is crucial.
3. Kidney Function and Urine Output Assessment:
Rationale: Osmotic polyuria and volume depletion can lead to acute kidney injury. Chronic kidney disease risk increases mortality. Monitoring urine output and serum creatinine is important to assess renal function.
Nursing Interventions:
1. Isotonic Solution Administration (Initial):
Rationale: Initial isotonic fluid replacement (0.9% saline) expands intravascular volume and begins to lower blood glucose. Transition to hypotonic solutions (0.45% saline) may be appropriate once sodium levels are stable.
2. Dextrose Administration (Once Glucose Stabilizes):
Rationale: Once glucose reaches ~250 mg/dL, adding dextrose to IV fluids prevents hypoglycemia and counteracts continued ketogenesis.
3. Oral Fluid Offer (if appropriate):
Rationale: If the patient is alert, oriented, and able to swallow safely, oral fluid resuscitation can supplement IV fluids, especially in mild DKA.
4. Education on Fluid Loss Symptoms and Prevention:
Rationale: Patient education on polydipsia, polyuria (early signs), nausea/vomiting, flushed skin, weakness, and fatigue empowers them to recognize early DKA symptoms and seek timely treatment, preventing recurrence.
Nursing Diagnosis: Risk for Unstable Blood Glucose
Factors like knowledge deficits, illness, stress, and incorrect insulin dosing can lead to unstable blood glucose and DKA.
Nursing Diagnosis: Risk for Unstable Blood Glucose
Related Factors:
- Lack of diabetic diagnosis (new onset diabetes)
- Poor diabetes management
- Illness causing unstable glucose levels
- Nonadherence to insulin regimen
- Physical injury (stress response)
- Alcohol or drug use (impacting self-care and insulin adherence)
Evidenced By:
Risk diagnoses are not evidenced by signs and symptoms as the problem has not yet occurred. Interventions are preventative.
Expected Outcomes:
- Patient will verbalize factors contributing to unstable blood glucose.
- Patient will verbalize correct insulin administration techniques.
- Patient will maintain blood glucose levels within an acceptable range.
Nursing Assessments:
1. Understanding of Diabetes Diagnosis Assessment:
Rationale: DKA can be the initial presentation of undiagnosed diabetes. Assess the patient’s understanding of diabetes and its relationship to insulin.
2. Laboratory Review (Hgb A1c):
Rationale: Hgb A1c reflects long-term glucose control and can indicate new diagnosis or poor diabetes management contributing to DKA.
3. Insulin Understanding and Adherence Assessment:
Rationale: Patients with type 1 diabetes require insulin for survival. Assess their understanding of their insulin regimen and adherence to it.
Nursing Interventions:
1. Glucometer Technique Observation:
Rationale: Observe the patient demonstrating glucometer use to ensure correct technique and accuracy. Calibrate the device to verify accuracy.
2. Ketone Testing Education and Kit Recommendation:
Rationale: Educate patients on using over-the-counter ketone testing kits to monitor for ketosis when blood glucose is elevated (>240 mg/dL). Early ketone detection allows for proactive management.
3. Education on DKA Causes and Prevention:
Rationale: Educate patients on factors that can destabilize blood glucose and precipitate DKA, such as illness, altered food/fluid intake, alcohol use, and medication interactions.
4. Diabetes Educator Referral:
Rationale: Patients struggling with diabetes management benefit from diabetes educator support. Educators provide specialized knowledge and skills to improve diabetes self-management and medication adherence.
References
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