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Zorluk: OrtaPhysiological Adaptation

A nurse in the emergency department is caring for a client who presents with lethargy, deep and rapid respirations, and a blood glucose level of 580 mg/dL580\text{ mg/dL}. The healthcare provider diagnoses diabetic ketoacidosis (DKA). Arrange the following nursing actions in the correct priority order from first to last.

  1. 1Assess the client's airway, breathing, and oxygen saturation level.
  2. 2Establish large-bore intravenous (IV) access and draw blood for a comprehensive metabolic panel.
  3. 3Administer a rapid intravenous bolus of 0.9%0.9\% sodium chloride.
  4. 4Begin a continuous intravenous infusion of regular insulin.
  5. 5Add 5%5\% dextrose to the intravenous fluids when the blood glucose level reaches 250 mg/dL250\text{ mg/dL}.

Cevap

The correct sequence of actions prioritizes the airway and breathing first, followed by establishing venous access, restoring vascular volume with isotonic saline, administering intravenous insulin, and finally adding dextrose when blood glucose reaches 250 mg/dL250\text{ mg/dL}.
The correct sequence strictly follows the ABCs (Airway, Breathing, Circulation) and specific DKA protocols. Airway and breathing are always assessed first. IV access allows for both blood sampling and immediate intervention. Fluid resuscitation is the primary medical intervention to correct severe dehydration and hypovolemia before administering insulin. Regular insulin is then given to halt ketosis. Finally, dextrose is added when blood glucose drops to 250 mg/dL250\text{ mg/dL} to prevent hypoglycemia and cerebral edema.

Adım Adım Çözüm

1
Prioritize Airway and Breathing
Assessing airway and oxygenation is completed first.
Basic life support principles dictate that airway and breathing (ABCs) take precedence over all other interventions.
2
Address Circulation and Diagnostics
IV access is obtained and baseline labs are drawn.
Circulation must be secured next to allow for life-saving interventions, and baseline electrolytes (especially potassium) must be known before initiating insulin therapy.
3
Restore Vascular Volume
An isotonic saline bolus is administered.
Severe dehydration is a hallmark of DKA. Rapid fluid resuscitation restores tissue perfusion and helps clear ketones.
4
Correct Hyperglycemia and Ketosis
IV regular insulin is started.
Insulin stops lipolysis and ketogenesis, directly treating the underlying cause of DKA.
5
Prevent Hypoglycemia
Dextrose is added to IV fluids when glucose drops to 250 mg/dL250\text{ mg/dL}.
Rapid drops in blood glucose can cause fatal cerebral edema, so dextrose provides a buffer while insulin continues to clear ketones.

Anahtar Kavram

The priority management of Diabetic Ketoacidosis (DKA) follows the ABCs, prioritizing fluid resuscitation before insulin therapy, and preventing complications like hypoglycemia.
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Physiological Adaptation

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