Diabetic ketoacidosis is a complication of diabetes. It is a result of relative insulin deficiency and is a rare feature of acromegaly, in which the chemical balance of the body becomes far too acidic, and starts a dangerous condition in which the body starts to break down fats for fuel because it has no insulin to allow it to use glucose.
Diabetic Ketoacidosis is unclear or arbitrary, when the case is severe, you may have difficulty breathing, your brain may swell (cerebral edema), and there is a risk of coma, the loss of life due to diabetic ketoacidosis is distinctly linked to the delay in the institution of the appropriate therapy in a hospital setting.
Outward signs and symptoms of DKA include the following; eyeballs are soft and appear sunken, skin turgor is poor, the person is very pale, cold, clammy, and exhibits deep rapid respirations, an effort the body makes to eliminate excess carbon dioxide.
Nursing Care Plan for Diabetic Ketoacidosis
Nursing Diagnosis : Fluid volume deficit related to excessive secretion of fluid ( osmotic diuresis ) due to hyperglycemia.
Outcomes:
- Vital signs within normal limits
- Peripheral pulse can be palpated
- Skin turgor and capillary refill good
- Balance urine output
- Normal electrolyte levels
- Blood sugar while : normal
1. Observation intake and output of fluids every hour.
2. Observation smooth infusion.
3. Monitor vital signs and level of consciousness every 15 minutes, if stable continue for every hour.
4. Observation of skin turgor, mucous membranes, acral, capillary refill.
5. Monitor results of laboratory tests:
- Hematocrit
- BUN / Creatinine
- Blood osmolarity
- Sodium
- Potassium
7. CVP monitoring (when used)
8. Collaboration with other health team:
- Provision of parenteral fluids
- Provision of insulin therapy
- Installation of a urine catheter
- Installation of CVP if possible
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