COLLEGE OF NURSING
NUR 3180 SIMULATION
1. Describe the pathophysiologic changes in DKA.
The lack of available insulin results in a disorder in the metabolism of carbs, protein, and fat. Because they are attempting to rid the body of excess glucose, the kidneys excrete the glucose along with water and electrolytes (esp. sodium and potassium). The fatty acids are converted into ketone bodies by the liver. Ketone bodies are acidic; their accumulation in the circulation due to lack of insulin leads to metabolic acidosis.
2. What are the commonly seen blood glucose levels?
300-800 mg/dL but some can get as high as 1,000 mg/dL
3. What fluid and electrolyte disturbances commonly occur and why?
Soidum and potassium due to the amount of water loss
4. What acid-base disturbances commonly occur and why?
Metabolic acidosis due to low serum bicarbonate and low pH from the body’s metabolic process
5. Describe the medical management and nursing management of a patient in DKA:
a. How is fluid status monitored in the acute stage of DKA?
Assessed for presence of edema, I & Os, lab values of sodium and potassium, vital signs performed q hour, breath sounds assessed, cardiac monitoring.
b. How is hypovolemia corrected? How rapidly is fluid volume replaced? Why?
.09% NS is infused at 500 ml/hr for 2-3 hours, then .45% NS administered in order to increase the fluid volume back within normal range
c. How are the complications of fluid replacement prevented?
By monitoring I&Os, vitals, orthostatic blood pressure, heart rate, ECGs,
d. How are blood glucose levels monitored? How often?
Checked before meals and q3/4 hours
e. How are elevated blood glucose levels corrected?
A regular insulin IV drip of 5 u/hr is given until back within normal range of 140-180
f. How quickly is blood glucose corrected? Why?
Within 1-1.5 hours because regular insulin is the only type that can be administered IV