Podcast
Questions and Answers
What are the main metabolic effects of insulin?
What are the main metabolic effects of insulin?
Hyperglycemia causes fluid and electrolyte imbalances leading to the classic manifestations of Diabetes Mellitus.
Hyperglycemia causes fluid and electrolyte imbalances leading to the classic manifestations of Diabetes Mellitus.
True
What are the classic manifestations of Diabetes Mellitus?
What are the classic manifestations of Diabetes Mellitus?
Polyuria, Polydipsia, Polyphagia
What is the role of the nurse in relation to Diabetes Mellitus?
What is the role of the nurse in relation to Diabetes Mellitus?
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What are the priorities of care for patients with Diabetes Mellitus?
What are the priorities of care for patients with Diabetes Mellitus?
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What are the hallmarks of Diabetic Ketoacidosis?
What are the hallmarks of Diabetic Ketoacidosis?
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Diabetic ketoacidosis is a life-threatening condition.
Diabetic ketoacidosis is a life-threatening condition.
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What is the absolute priority for treating Diabetic Ketoacidosis? Explain why.
What is the absolute priority for treating Diabetic Ketoacidosis? Explain why.
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What are the key nursing diagnoses and goals for patients experiencing hyperglycemic crisis?
What are the key nursing diagnoses and goals for patients experiencing hyperglycemic crisis?
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What are the key nursing management tips for treating Diabetic Ketoacidosis?
What are the key nursing management tips for treating Diabetic Ketoacidosis?
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Diabetic ketoacidosis and hyperosmolar hyperglycemic state are both hyperglycemic crises that require immediate medical attention.
Diabetic ketoacidosis and hyperosmolar hyperglycemic state are both hyperglycemic crises that require immediate medical attention.
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Describe the main management strategies for DKA, focusing on fluid replacement, managing electrolytes, and insulin therapy.
Describe the main management strategies for DKA, focusing on fluid replacement, managing electrolytes, and insulin therapy.
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Which of the following is an example of a pattern of knowing that can be relevant in the management of DKA?
Which of the following is an example of a pattern of knowing that can be relevant in the management of DKA?
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Study Notes
Endocrine Disorders: Diabetes
- Diabetes Mellitus/Diabetic Ketoacidosis (DKA) is a serious, life-threatening condition.
- Nursing process application is essential for patients with DKA.
Learning Objectives
- Apply the nursing process to clients with diabetes mellitus/diabetic ketoacidosis.
- Examine personal values and beliefs in relation to nursing metalanguage (metaparadigms).
- Apply metalanguage (metaparadigms) to patients with diabetes mellitus and DKA.
- Assess how patterns of knowing influence nurses and nursing practice.
- Apply all patterns of knowing to patients with diabetes mellitus and DKA.
DM - Take Away
- Understand different types of diabetes and their characteristics.
- Analyze similarities and differences in diabetes types.
- Determine treatment priorities and care for different diabetes types.
Review: Insulin
- Insulin is a hormone produced by the pancreas that affects metabolism and cellular functions throughout the body.
- Insulin facilitates active transport of glucose and potassium into cells.
- Insulin's main function is to regulate blood glucose levels and manage lipids.
Review: Hyperglycemia
- Hyperglycemia acts as an osmotic diuretic, leading to fluid and electrolyte imbalances.
- Hyperglycemia causes the classic symptoms of diabetes, including polyuria, excess urine loss due to osmotic diuresis; water and electrolyte loss; polydipsia, excessive thirst; and polyphagia, excessive hunger.
Zena's Story
- (Personal story about Zena is included.)
Goals for Diabetes
- Health promotion is a goal for nurses
- Identifying, monitoring, and educating clients at risk.
- Assessing acute situations.
- Creating care priorities.
Nursing Responsibilities?
- Education for patients and their families on diabetes management.
- Assessing patient and family understanding of provided information.
- Adapting teaching methods to suit different languages, cultures, and communication abilities
Diabetes Complications
- Diabetes can lead to severe complications affecting various organs.
- Potential complications include stroke, heart attack, peripheral artery disease, diabetic retinopathy, diabetic nephropathy, peripheral neuropathy, and diabetic foot.
Diabetic Ketoacidosis (DKA)
- Diabetic ketoacidosis is a serious complication of diabetes.
- Undiagnosed diabetes mellitus is a potential cause of DKA before diagnosis.
- Contributing factors also include inadequate treatment, missed insulin doses, or infection.
- Triggers for Type 1 DKA include illness (vomiting or diarrhea) and dietary/exercise regimen changes.
Etiology of Diabetic Ketoacidosis (DKA)
- Undiagnosed diabetes mellitus often presents with DKA prior to diagnosis.
- Inadequate diabetes treatment is a significant cause, including missed or skipped insulin.
- Infection or illness, especially vomiting or diarrhea, can exacerbate DKA in type 1 diabetics.
- Changes in diet, insulin dosage, or exercise routines can also trigger DKA.
DKA - How Would you Define it?
- DKA is a life-threatening metabolic complication of diabetes, most commonly in type 1.
- DKA usually results from a physical stressor.
- The body rapidly breaks down fat for energy, producing ketones that lower blood pH, resulting in metabolic acidosis.
Manifestations of DKA
- Characteristics include dehydration (dry and high blood sugar), elevated glucose, rapid and fruity-smelling breath due to ketones, abdominal pain, and metabolic acidosis.
- Thirst, abdominal pain, nausea and vomiting, flushed dry skin, and difficulty breathing are also common.
- Patients may also have sunken eyes and acetone breath.
Diabetic Ketoacidosis: Key Features
- Hyperglycemia
- Metabolic acidosis
- Ketosis
- Dehydration/Volume Depletion
What is the Clinical Presentation of DKA
- Symptoms of dehydration include poor skin turgor, altered mental status (LOC), lethargy, tachycardia, and hypotension.
- Common clinical findings include fruity-smelling breath and Kussmaul breathing.
- Other common symptoms include elevated blood glucose, nausea, vomiting, polyuria, polydipsia, weight loss, and diffuse abdominal pain.
- Lab tests will confirm abnormal findings (elevated blood sugar, low pH, and bicarbonate, and ketones in blood and urine)
Nursing Assessment of DKA
- Assessment includes a review of systems, subjective and objective data collection, and diagnostic testing.
- Key symptoms such as dry mouth, thirst, abdominal pain, nausea and vomiting, restlessness, and confusion, are present.
- Patients may exhibit flushed, dry skin, sunken eyes, and breath odor of acetone.
- Rapid, weak pulse, orthostatic hypotension, and labored breathing (Kussmaul respirations), and fever are also possible.
Nursing Diagnosis and Goals for Diabetic Patients
- Possible nursing diagnoses for diabetes patients include those related to hyperglycemia (e.g., risk for fluid volume deficit, impaired gas exchange, acute pain), or hypoglycemia (e.g., risk for injury, imbalanced nutrition).
- Potential goals for hyperglycemia and hypoglycemia include appropriate blood glucose levels and stable fluid/electrolyte balances.
DKA - Goal of Treatment
- The primary goal in treating DKA is fluid resuscitation.
- Maintaining normal blood pressure is essential.
- Electrolyte (especially potassium) correction, addressing underlying causes, and improving mental status also fall under treatment goals.
Management of DKA
- Fluid replacement is crucial; normal saline is typically used initially.
- Electrolyte imbalances should be corrected, especially potassium, using IV administration.
- IV insulin is administered to control blood glucose levels.
- Dehydration, electrolyte imbalance, and metabolic acidosis must be addressed promptly.
Treatments for DKA
- Fluid replacement (0.9%NS) is a primary treatment for dehydration.
- Glucose management (slow, careful increase) with insulin is also vital for a smooth transition.
- Potassium replacement is a key requirement, even if levels are normal, to reduce hypokalemia risk.
Evaluation of DKA Treatment
- Constant monitoring for respiratory, cardiovascular stability, and kidney function is crucial.
- Evaluation includes monitoring patient vital signs, blood glucose, and electrolytes.
- Frequent assessments help gauge treatment effectiveness and adjust therapy as needed.
Nursing Management Pearls
- Identifying the cause of hyperglycemic crisis, such as infection or poor insulin management.
- Managing the cause of hypokalemia.
- Managing hypoglycemia through oral glucose intake.
- Preventing rapid volume correction, ideally through overlapping insulin infusions and oral administration.
- Ongoing monitoring of patient status and blood test values are essential.
Nursing Management Considerations
- Identifying precipitating factors (infection, inadequate insulin, etc).
- Preventing hypokalemia during insulin administration.
- Preventing hypoglycemia.
- Avoiding rapid volume correction.
- Using bicarbonate cautiously.
- Overlapping intravenous and subcutaneous insulin doses.
- Ongoing monitoring and frequent reassessment.
Analysis of Patterns of Knowing in DKA Cases
- Empiric, aesthetic, personal, and ethical patterns of knowing should be addressed.
- Empiric knowledge includes lab findings, DKA related symptoms.
- Aesthetics involves understanding patient's emotional states.
- Personal pattern includes nurses' own values, perspectives.
- Ethics includes acting per moral and professional standards.
Mom's Talk About DKA:
- (Personal account on DKA signs and symptoms.)
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