DKA- patient teaching

Treatment- Hospital

Diabetic diet

Diabetic Ketoacidosis (DKA)

1)Ensure airway, Give supplemental oxygen - Is person aware of self, situation, place and time? 2)Treat dehydration = give fluids and replace electrolytes - Monitor Urine output, vital signs: blood pressure, heart rate, respiratory rate, oxygen saturation. 3)SLOWLY lower blood sugar w/ IV Regular insulin/insulin drip and add vitamin K+ to restore K+ loss from nausea vomiting/dehydration. - Once ketones resolve or blood sugar <200 give Insulin SUBQ = An injection given in the fatty tissue, just under the skin. 4) Hourly blood glucose checks and monitor heart place on cardiac monitor 5) Give sodium bicarbonate if pH <7.0

Medical Emergency

Treatment plan - prevention of reoccurance

FOLLow up Appt.

- Incorporate exercise: Work up to 150 minutes of moderate-intensity exercise a week - Follow written medication plan insulin and other diabetes medications on time and at right dose - Teach patient how to check blood glucose levels - Continue to monitor blood glucose at home 3 times a day before meals and medicate as needed (per doctors order) - Teach patient to I.D. symptoms of high glucose levels: increase urination, increase thirst, fatigue, blurred vision, and flushed/hot skin. Also symptoms of LOW glucose: Cold/clammy skin, numbness, dizziness, shaking, sweating. - seek medical attention if blood glucose levels remain elevated, has a fever, nausea/vomiting, and altered awareness occurs.

+Follow-up appointment with primary physician or endocrinologist within 1 to 2 weeks of discharge

Resources

American Diabetes Association - https://diabetes.org/tools-resources Inland Empire Diabetes Resources https://iediabetes.org/contact/partners/

Clinical manifestations

Excessive ketones in the blood alters the pH balance from normal range: 7.35-7.45 to <7.35. If left untreated can lead to a coma or death.

Early: Frequent urination, very thirsty, consistent high blood glucose >250. Later: Kussmaul breathing: rapid, increased heart rate, deep breathing, fruity-smelling breath, dry skin/mouth, flushed face, headache, muscle stiffness/aches, being very tired, dehydrated, confused/disoriented/difficulty concentrating, nausea/vomiting, abdominal pain,

Prevelant disease information

Most common: Patients with Type 1 DM. May also occur in Type 2 DM where infection, severe illness, injury or stress to pancreas msy trigger DKA. Common in patients newly diagnosed with DM or undiagnosed DM. In those who are not compliant with their treatment plan. Patients who lack education, resources, or understanding of DM. Another reason is inadequate insulin dosage. co-morbidities: DM 1&2, high blood pressure, diabetic neuropathy, obesity, renal disease, pancreatitis Mean age of onset: 38.4 years old age range: 18-44 years old

DKA is an rapid/sudden complication of Diabetes mellitus caused by severe insulin deficiency. Insulin is a naturally occuring hormone of the pancreas that allows sugar that is circulating in the blood to enter cells to be use for energy. Without sufficient insulin circulating in the body sugar cannot be used as the primary source of energy for the body. The body makes up for this shortage of energy by breaking down fat as a secondary source of energy. Ketones are acidic and the by-product of fat breakdown.

Disease characteristics

pH 7.3 or less, HCO3 <22, moderate to large ketones in urine. High blood glucose >250, Kussmaul breathing + fruity breath .