Untitled Quiz

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.)