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Zorluk: ZorReduction of Risk Potential

A 28-year-old client with type 1 diabetes mellitus is receiving a continuous intravenous infusion of regular insulin for diabetic ketoacidosis (DKA). After 4 hours of treatment, the client's capillary blood glucose has decreased from 550 mg/dL (30.5 mmol/L) to 220 mg/dL (12.2 mmol/L). The most recent laboratory results show a serum potassium of 3.2 mEq/L (3.2 mmol/L), serum bicarbonate of 14 mEq/L (14 mmol/L), and an arterial pH of 7.25. Which of the following nursing actions are appropriate to reduce the risk of physiological complications? Select all that apply.

  1. Initiate a prescribed intravenous fluid infusion containing 5% dextrose.Cevap
  2. Prepare to administer a prescribed intravenous potassium chloride replacement.Cevap
  3. Initiate continuous electrocardiogram (ECG) monitoring.Cevap
  4. D
    Administer prescribed intravenous sodium bicarbonate to correct the arterial acidosis.
  5. E
    Discontinue the intravenous insulin infusion to prevent hypoglycemia.
  6. F
    Place the client in a strict supine position with the head of the bed flat.

Cevap

The correct actions are initiating a prescribed intravenous fluid infusion containing 5% dextrose, preparing to administer a prescribed intravenous potassium chloride replacement, and initiating continuous electrocardiogram (ECG) monitoring.
Initiating a fluid containing 5% dextrose prevents hypoglycemia while allowing the continuation of the insulin infusion necessary to correct the underlying metabolic acidosis. Preparing to administer intravenous potassium chloride is essential because insulin therapy causes an intracellular shift of potassium, worsening the client's current hypokalemia (3.2 mEq/L). Initiating continuous ECG monitoring is critical because hypokalemia significantly increases the risk of life-threatening cardiac dysrhythmias.

Adım Adım Çözüm

1
Analyze the client's current clinical data and laboratory results.
Blood glucose is 220 mg/dL, potassium is low at 3.2 mEq/L, and metabolic acidosis is still present (pH 7.25, bicarbonate 14 mEq/L).
Identifying unresolved acidosis and electrolyte imbalances is critical for prioritizing interventions.
2
Determine the appropriate interventions for the current blood glucose level.
Dextrose should be added to the IV fluids.
When blood glucose falls below 250 mg/dL during DKA treatment, dextrose must be added to prevent hypoglycemia while insulin continues to close the anion gap.
3
Evaluate the potassium level and determine the necessary cardiac precautions.
Potassium replacement and continuous ECG monitoring are required.
Insulin shifts potassium into cells, exacerbating hypokalemia. This creates a high risk for life-threatening cardiac dysrhythmias, necessitating continuous monitoring and potassium repletion.

Anahtar Kavram

Effective management of diabetic ketoacidosis (DKA) requires careful monitoring and response to changes in blood glucose, electrolytes (specifically potassium), and acid-base balance to prevent life-threatening complications such as hypoglycemia and fatal dysrhythmias.
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Konular

Reduction of Risk Potential

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