An emergency nurse is evaluating a client with type 1 diabetes mellitus who presents with altered mental status, profound lethargy, and a distinct sweet-smelling breath odor. The client is exhibiting heavily labored respirations with an increased depth at a rate of breaths per minute. Cardiac monitoring displays sinus tachycardia at beats per minute, and the non-invasive blood pressure reads mm Hg. Laboratory results indicate a capillary blood glucose of mg/dL, of , of mm Hg, and of mEq/L. Which action should the nurse execute immediately?
- Commence a rapid intravenous bolus of isotonic saline.Cevap
- BStart a continuous intravenous infusion of regular insulin.
- CAdminister a prescribed dose of intravenous sodium bicarbonate.
- DProvide a rebreather mask to help the client correct their respiratory alkalosis.
Cevap
Commence a rapid intravenous bolus of isotonic saline.
In Diabetic Ketoacidosis (DKA), extreme hyperglycemia causes severe osmotic diuresis, leading to profound dehydration and hypovolemic shock (evidenced by the hypotension and tachycardia). The most critical initial intervention is massive fluid resuscitation with isotonic crystalloids (0.9% sodium chloride) to restore intravascular volume and maintain organ perfusion. Only after fluid resuscitation has begun should insulin therapy be initiated.
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Anahtar Kavram
Diabetic Ketoacidosis (DKA) Hemodynamic Prioritization