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Difficulty: MediumPhysiological Adaptation

A nurse is caring for a client admitted with severe diabetic ketoacidosis (DKA). The client is currently receiving a continuous intravenous regular insulin infusion along with normal saline. Which assessment finding requires the most immediate intervention by the nurse?

  1. The sudden appearance of flattened T waves and prominent U waves on the cardiac monitorAnswer
  2. B
    An arterial blood gas showing a pH of 7.317.31, a PaCO2 of 30 mm Hg30 \text{ mm Hg}, and an HCO3 of 15 mEq/L15 \text{ mEq/L}
  3. C
    A heart rate that gradually increases from 9898 to 112 beats/min112 \text{ beats/min} with a blood pressure of 108/72 mm Hg108/72 \text{ mm Hg}
  4. D
    A client report of generalized abdominal pain and persistent nausea

Answer

The sudden appearance of flattened T waves and prominent U waves on the cardiac monitor.
The correct answer identifies flattened T waves and prominent U waves, which are hallmark electrocardiogram changes indicating severe hypokalemia. Continuous intravenous insulin drives both glucose and potassium into the cells, rapidly depleting serum intravascular potassium levels. Severe hypokalemia can quickly lead to lethal cardiac arrhythmias and requires immediate life-saving intervention, such as alerting the provider and preparing to administer intravenous potassium chloride.

Step-by-Step Solution

1
Analyze the physiological effects of continuous intravenous insulin therapy.
Insulin drives both serum glucose and serum potassium into the intracellular space.
Understanding the mechanism of action of the treatment helps anticipate potential iatrogenic complications.
2
Evaluate the clinical significance of the provided assessment findings.
The ABG shows expected compensation. The vital signs and abdominal pain are expected consequences of DKA. The ECG changes (flattened T wave, prominent U wave) indicate severe hypokalemia.
Differentiating between expected disease manifestations and acute, life-threatening complications is required for safe care.
3
Prioritize interventions based on immediate life threats.
Severe hypokalemia can rapidly progress to lethal cardiac arrhythmias (such as ventricular fibrillation), making it the highest priority for intervention.
According to the ABCs (Airway, Breathing, Circulation) and acute survival potential, preventing cardiac arrest supersedes managing expected symptoms.

Key Concept

Fluid and Electrolyte Imbalances in Diabetic Ketoacidosis
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Topics

Physiological Adaptation

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