A client is admitted to the intensive care unit with severe diabetic ketoacidosis (DKA). The initial blood glucose level is 680 mg/dL, and the client exhibits Kussmaul respirations. The nurse prepares to implement the standard DKA treatment protocol. Arrange the following nursing actions in the correct chronological sequence from first to last.
- 1Establish intravenous access and infuse a bolus of 0.9% sodium chloride.
- 2Verify the client's serum potassium level is greater than 3.3 mEq/L.
- 3Initiate a continuous intravenous infusion of regular insulin.
- 4Add 5% dextrose to the maintenance intravenous fluids.
Answer
The correct sequence is: 1) Establish IV access and infuse normal saline, 2) Verify serum potassium, 3) Initiate IV regular insulin, 4) Add 5% dextrose to fluids.
The standard protocol for diabetic ketoacidosis (DKA) prioritizes life-threatening deficits in a specific order: volume, electrolytes, and then glucose/acidosis correction. Fluid resuscitation is the absolute first priority to reverse hypovolemia. Next, potassium must be checked because insulin therapy will push potassium intracellularly, risking fatal hypokalemia. Only after verifying potassium can insulin be safely administered. Finally, dextrose is added when glucose reaches 250 mg/dL to prevent hypoglycemia and cerebral edema.
Step-by-Step Solution
Key Concept
The primary management sequence for Diabetic Ketoacidosis (DKA) prioritizes volume expansion first, followed by electrolyte evaluation, insulin administration, and finally glucose stabilization to prevent cerebral edema.