A nurse is caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). The client is lethargic with Kussmaul respirations, a blood glucose of 640 mg/dL, and an arterial blood pH of 7.18. Arrange the following nursing interventions in the priority order they should be implemented.
- 1Establish intravenous access and initiate fluid resuscitation with 0.9% sodium chloride.
- 2Review the serum potassium level to confirm it is greater than 3.3 mEq/L.
- 3Initiate a continuous intravenous infusion of regular insulin.
- 4Add 5% dextrose to the intravenous fluids when the blood glucose level reaches 250 mg/dL.
Answer
The correct sequence is to first initiate fluid resuscitation, then verify a safe serum potassium level, followed by initiating a continuous insulin infusion, and finally adding dextrose to the fluids when blood glucose decreases to 250 mg/dL.
In the management of DKA, the immediate priority is to restore circulating volume and tissue perfusion with isotonic fluids. Next, because insulin therapy drives potassium into the intracellular space, the nurse must ensure the serum potassium is greater than 3.3 mEq/L to prevent fatal arrhythmias. Once confirmed, continuous regular insulin is initiated to correct the acidosis and lower blood glucose. Finally, to prevent hypoglycemia and cerebral edema, dextrose is added to the IV fluids when the blood glucose level drops to 250 mg/dL.
Step-by-Step Solution
Key Concept
Clinical Prioritization and Protocol Management in Diabetic Ketoacidosis (DKA)
Estimated Time:1m 30s