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Difficulty: HardReduction of Risk Potential

A 28-year-old client is receiving a continuous intravenous (IV) infusion of regular insulin for the treatment of diabetic ketoacidosis (DKA). The most recent laboratory results reveal a serum glucose of 240 mg/dL240\text{ mg/dL} (13.3 mmol/L13.3\text{ mmol/L}), serum potassium of 3.2 mEq/L3.2\text{ mEq/L} (3.2 mmol/L3.2\text{ mmol/L}), and an arterial blood gas (ABG) pH of 7.287.28. Which of the following actions should the nurse take to reduce the client's risk for physiological complications? Select all that apply.

  1. Initiate a prescribed intravenous fluid containing 5% dextrose.Answer
  2. Contact the healthcare provider to add potassium to the maintenance intravenous fluids.Answer
  3. Monitor the client's continuous electrocardiogram (ECG) for the development of prominent U waves.Answer
  4. D
    Pause the continuous regular insulin infusion until the serum potassium level reaches the normal range.
  5. E
    Delegate the evaluation of the client's hourly capillary blood glucose trends to the unlicensed assistive personnel (UAP).
  6. F
    Prepare to administer an intravenous bolus of sodium bicarbonate to correct the arterial blood gas pH.

Answer

The nurse should initiate an intravenous fluid with 5% dextrose, request potassium to be added to the maintenance fluids, and monitor the continuous ECG for prominent U waves.
Appropriate risk reduction in DKA involves anticipating the physiological shifts caused by insulin therapy. Adding 5% dextrose prevents hypoglycemia as blood glucose approaches 250 mg/dL250\text{ mg/dL}. Identifying hypokalemia (3.2 mEq/L3.2\text{ mEq/L}) requires immediate potassium supplementation and vigilant continuous ECG monitoring for classical signs of hypokalemia, such as prominent U waves.

Step-by-Step Solution

1
Analyze the serum glucose level.
The glucose has reached 240 mg/dL240\text{ mg/dL} (13.3 mmol/L13.3\text{ mmol/L}).
When blood glucose drops below 250 mg/dL250\text{ mg/dL} in DKA, dextrose must be added to IV fluids to prevent hypoglycemia during continued insulin administration.
2
Analyze the serum potassium level and continuous insulin infusion.
The potassium is low at 3.2 mEq/L3.2\text{ mEq/L}.
Insulin shifts potassium into the cells. Because the level is already low, potassium replacement is required to prevent fatal arrhythmias like ventricular tachycardia.
3
Analyze the ABG pH and evaluate the need for bicarbonate or pausing insulin.
The pH is 7.287.28, indicating ongoing metabolic acidosis.
Because the client is still acidotic, the insulin drip must not be stopped. Furthermore, a pH of 7.287.28 is not low enough to warrant sodium bicarbonate, which is typically reserved for pH less than 6.96.9.

Key Concept

In diabetic ketoacidosis (DKA), when serum glucose reaches approximately 250 mg/dL, intravenous dextrose is added to prevent hypoglycemia while insulin continues to resolve the acidosis. Concurrent potassium replacement and continuous cardiac monitoring are critical due to insulin-induced intracellular potassium shifts.
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Reduction of Risk Potential

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