A nurse is caring for a client who has just arrived at the emergency department with diabetic ketoacidosis (DKA). The client is lethargic, displays deep, rapid respirations, and has a blood glucose level of mg/dL ( mmol/L). Arrange the following collaborative and nursing actions in the correct priority sequence.
- 1Establish large-bore intravenous access.
- 2Initiate a rapid infusion of sodium chloride.
- 3Verify the client's serum potassium level.
- 4Initiate a continuous intravenous infusion of regular insulin.
- 5Change the intravenous fluid to include dextrose when blood glucose reaches mg/dL ( mmol/L).
Answer
The correct priority order is to first establish intravenous access, followed immediately by fluid resuscitation with isotonic saline. Next, the nurse must verify the serum potassium level before initiating a continuous intravenous infusion of regular insulin. Finally, the nurse adds dextrose to the intravenous fluids when the blood glucose drops to mg/dL ( mmol/L).
The correct sequence for managing diabetic ketoacidosis (DKA) prioritizes reversing hypovolemia and preventing shock, followed by safely correcting metabolic abnormalities. Establishing intravenous access and administering isotonic fluids is the most critical first step to restore tissue perfusion. Next, it is essential to check potassium levels, because insulin therapy drives potassium into the cells. Administering insulin without knowing the potassium level risks lethal hypokalemia. Once potassium is confirmed safe, an insulin infusion is started to stop ketogenesis. Finally, adding dextrose when blood glucose reaches mg/dL ( mmol/L) prevents life-threatening hypoglycemia and cerebral edema.
Step-by-Step Solution
Key Concept
The primary management of diabetic ketoacidosis focuses on fluid volume replacement first, followed by careful monitoring of potassium levels before initiating insulin therapy.