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Zorluk: OrtaPhysiological Adaptation

A client is brought to the emergency department with a decreased level of consciousness, deep and rapid respirations, and a fruity breath odor. Laboratory results confirm a diagnosis of diabetic ketoacidosis (DKA) with a blood glucose level of 680 mg/dL. Arrange the following collaborative and nursing interventions in the chronological order they should be implemented.

  1. 1Establish intravenous access and infuse 0.9% sodium chloride.
  2. 2Evaluate the client's initial serum potassium level.
  3. 3Initiate a continuous intravenous infusion of regular insulin.
  4. 4Add 5% dextrose to the intravenous maintenance fluids.

Cevap

The correct sequence is: 1) Establish intravenous access and infuse 0.9% sodium chloride, 2) Evaluate the client's initial serum potassium level, 3) Initiate a continuous intravenous infusion of regular insulin, and 4) Add 5% dextrose to the intravenous maintenance fluids.
The priority in DKA is restoring intravascular volume to ensure adequate organ perfusion. After initiating fluids, the potassium level must be checked because insulin therapy will lower serum potassium. Once potassium is confirmed safe, regular insulin is infused to reverse the ketoacidosis. Finally, when blood glucose drops to approximately 250 mg/dL, dextrose is added to prevent hypoglycemia while insulin continues to clear blood ketones.

Adım Adım Çözüm

1
Determine the most immediate life-threatening physiological need for a client with DKA.
Severe dehydration and intravascular volume depletion are identified as the primary threats.
Extreme hyperglycemia causes osmotic diuresis, leading to massive fluid loss that must be corrected immediately to prevent cardiovascular collapse.
2
Select the prerequisite assessment required before treating the hyperglycemia.
Evaluate the serum potassium level.
Insulin therapy drives both glucose and potassium into the intracellular space. If the client is already hypokalemic, giving insulin can precipitate life-threatening cardiac arrhythmias.
3
Identify the primary pharmacological intervention to reverse the ketoacidosis.
Initiate a continuous intravenous infusion of regular insulin.
With fluids running and potassium levels confirmed safe, intravenous regular insulin is administered to stop ketogenesis and safely lower the blood glucose level.
4
Anticipate necessary modifications to therapy as the client's condition improves.
Add 5% dextrose to the intravenous fluids when blood glucose reaches approximately 250 mg/dL.
This action prevents treatment-induced hypoglycemia and cerebral edema, allowing the insulin infusion to continue until the acidosis is fully resolved.

Anahtar Kavram

Diabetic Ketoacidosis (DKA) Management Sequence
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Konular

Physiological Adaptation

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