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Difficulty: MediumPhysiological Adaptation

A nurse is monitoring a client who was admitted with diabetic ketoacidosis (DKA) and is currently receiving a continuous intravenous infusion of regular insulin and 0.9% sodium chloride. Which of the following assessment findings should the nurse identify as a complication of the current treatments? (Select all that apply.)

  1. Serum potassium level of 2.8 mEq/LAnswer
  2. New onset of a severe headache and lethargyAnswer
  3. Fine crackles auscultated in the bilateral lung basesAnswer
  4. D
    Arterial blood gas pH of 7.25 with deep, rapid respirations
  5. E
    Urine output of 60 mL/hr over the past two hours

Answer

The assessment findings indicating a complication of DKA treatment are a serum potassium level of 2.8 mEq/L, new onset of a severe headache and lethargy, and fine crackles in the bilateral lung bases.
The correct findings represent known iatrogenic complications of DKA therapy. Insulin therapy causes potassium to shift intracellularly, resulting in hypokalemia. Rapid lowering of serum osmolality can cause water to shift into brain cells, causing cerebral edema, which presents as a headache and lethargy. Finally, the aggressive fluid resuscitation necessary for DKA can overwhelm the circulatory system, leading to pulmonary edema, which is auscultated as crackles.

Step-by-Step Solution

1
Analyze the client's current therapies
The client is receiving continuous IV insulin and 0.9% sodium chloride for DKA.
Understanding the specific treatments helps anticipate potential adverse physiological effects.
2
Evaluate the physiological effects of IV insulin therapy
Insulin lowers blood glucose but also drives potassium into cells, risking hypokalemia. Furthermore, too rapid glucose reduction can cause cerebral edema.
Insulin directly impacts both glycemic control and intracellular electrolyte balance.
3
Evaluate the physiological effects of aggressive IV fluid resuscitation
Large volumes of isotonic fluids can cause fluid overload, manifesting as pulmonary edema (crackles in lung bases).
DKA requires rapid volume expansion, which inherently carries a risk of fluid volume excess.
4
Differentiate treatment complications from underlying disease symptoms
Acidosis (pH 7.25) and normal urine output (60 mL/hr) are baseline disease manifestations or signs of therapeutic improvement, respectively, not complications.
A nurse must distinguish between the pathology of the disease process and the adverse effects of its management.

Key Concept

Complications of Diabetic Ketoacidosis (DKA) Treatment
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Topics

Physiological Adaptation

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