A triage nurse receives a client with type 1 diabetes mellitus who presents with deep, rapid breathing, a fruity breath odor, and increasing lethargy. The initial point-of-care blood glucose is mg/dL ( mmol/L). Arrange the following nursing interventions in the priority order they should be implemented.
- 1Establish peripheral intravenous access.
- 2Initiate a rapid infusion of 0.9% sodium chloride.
- 3Review the initial serum potassium laboratory results.
- 4Commence a continuous regular insulin intravenous infusion.
- 5Add 5% dextrose to the intravenous fluids when blood glucose reaches 250 mg/dL (13.9 mmol/L).
Answer
The priority sequence is to first establish IV access, then rapidly infuse normal saline, check potassium levels, initiate the continuous insulin infusion, and finally add dextrose when blood glucose drops to mg/dL.
The correct physiological adaptation sequence for DKA emphasizes circulation first. The nurse must establish IV access to deliver rapid fluid boluses (0.9% sodium chloride). Once vascular volume is stabilizing, the nurse must verify the serum potassium level, as insulin forces potassium into cells and can cause fatal hypokalemia. After confirming safe potassium levels, regular insulin is continuously infused. Finally, when the blood glucose level lowers to mg/dL, dextrose is added to the IV fluids to prevent sudden hypoglycemia while continuing to treat the acidosis.
Step-by-Step Solution
Key Concept
Management of Diabetic Ketoacidosis (DKA) prioritizes fluid resuscitation followed by electrolyte evaluation and insulin administration.