A client with type 1 diabetes mellitus is admitted to the intensive care unit with diabetic ketoacidosis (DKA). The client is lethargic, exhibits Kussmaul respirations, and reports severe abdominal pain. Initial laboratory results indicate a blood glucose of 610 mg/dL (33.9 mmol/L) and a serum pH of 7.15. The healthcare provider prescribes a comprehensive DKA treatment protocol. Arrange the following nursing interventions in the correct chronological order of implementation.
- 1Initiate a rapid intravenous infusion of 0.9% sodium chloride.
- 2Verify that the serum potassium level is greater than 3.3 mEq/L (3.3 mmol/L).
- 3Begin a continuous intravenous infusion of regular insulin.
- 4Add 5% dextrose to the intravenous fluid regimen when blood glucose reaches 250 mg/dL (13.9 mmol/L).
- 5Administer the prescribed subcutaneous insulin dose prior to discontinuing the continuous intravenous infusion.
Answer
The correct sequence for managing Diabetic Ketoacidosis is to first initiate fluid resuscitation with 0.9% sodium chloride, verify the potassium level is above 3.3 mEq/L, begin the regular insulin infusion, add 5% dextrose once the glucose level reaches 250 mg/dL, and finally overlap subcutaneous insulin before discontinuing the intravenous insulin infusion.
The priority sequence for diabetic ketoacidosis (DKA) management addresses the most acute life threats first: hypovolemia, electrolyte disturbances, and acidosis. Fluid resuscitation (0.9% sodium chloride) is always the first intervention to restore perfusion. Next, potassium must be verified (> 3.3 mEq/L) before administering insulin to prevent fatal hypokalemia. Following this, regular IV insulin is started to stop ketogenesis and correct the acidosis. Once blood glucose drops to 250 mg/dL, dextrose must be added to IV fluids to prevent hypoglycemia and cerebral edema. Finally, subcutaneous insulin must overlap with the IV infusion to prevent rebound ketoacidosis.
Step-by-Step Solution
Key Concept
Prioritization of Care in Diabetic Ketoacidosis (DKA)